9 years old male patient, with chief complain of pain in both heels, which worsen by physical activity such as walking, running.
Physical examination: generally normal, Squeeze test (+) on right side.
X-ray examination and ultrasound was performed.
On ultrasound plantar fascia is normal. Note: the anechoic region between calcaneous is not fluid (which can indirectly suggest fascilitis in case of adult) but infact the normal apophysis (growth plate).
Achilles tendon is normal and remains continous fibrous echotexture (US 2), again, the rough bone surface with anechoic shown normal apophysis.
Normal distance to apophysis in both sides, no dislocation, no avulsion.
X-rays examination of both 2 heel are normal.
Physician suggest Sever's disease, and patient was advided rest and proper physical activity and shoes fitting.
Conclusion:
Sever's disease, the most common cause of children heel pain, known as calcaneal apophysitis is an inflammation of growth plate in heel of growing children. Diagnosis usually bases on clinical, and X-rays is normal. Ultrasound is suitable diagnostic tool while X-ray examination is only helpful when an ossification center of apophysis exist. Ultrasound helps ruling out muscle strain, detect edema, lytic and avulsion.
