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Seever’s Diease / Calcaneal Apophysitis

- Discussion:
    - classically described as causing heel pain in older children, just prior to fusion of the calcaneal apophysis (between ages 12-15 yrs);
    - diff dx: seronegative arthritis
    - often associated with tight heel cord;
    - it has been argued in the past that the radiographic fragmentation of the apophysis correlated w/ the patient's symptoms;
    - as is shown below, however, fragmentation of the apophysis is a normal finding

- Normal Radiographs:

Prevention and management of calcaneal apophysitis in children: an overuse syndrome.    
Sever's injury: a stress fracture of the immature calcaneal metaphysis.  

Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (sever disease)?

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