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Sever's injury: a clinical diagnosis
Stefan Perhamre1, Dagmara Lazowska, Sofia Papageorgiou
1Centre of Sports Medicine, Värmland County Council, Karlstad, Sweden.
Journal of the American Podiatric Medical Association
|September 28, 2013
Summary
Sever's injury (apophysitis calcanei) diagnosis is clinical, not radiologic. Clinical tests like one-leg heel standing and squeeze test are more reliable than X-rays for identifying this common childhood heel pain condition.
Area of Science:
- Pediatric Orthopedics
- Sports Medicine
- Radiology
Background:
- Sever's injury (apophysitis calcanei) diagnosis has historically relied on radiographic findings.
- Sclerosis and fragmentation of the calcaneal apophysis were considered indicators of inflammation.
- Previous diagnostic criteria and study populations were often poorly defined.
Purpose of the Study:
- To define diagnostic criteria for Sever's injury.
- To analyze clinical and radiographic characteristics in affected children.
- To compare findings with a control group of symptom-free children.
Main Methods:
- Assessed 30 children diagnosed with Sever's injury.
- Included 15 pain-free, matched children as controls.
- Evaluated clinical tests: one-leg heel standing, squeeze test, and palpation.
Main Results:
- One-leg heel standing (100% sensitivity) and squeeze test (97% sensitivity) were highly effective.
- All tested clinical methods demonstrated 100% specificity.
- Apophysis density was common in both patients and controls; fragmentation was frequent in both groups.
Conclusions:
- Sever's injury diagnosis is primarily clinical, not radiologic.
- Radiographic findings like density and fragmentation may represent normal growth in active children.
- Diagnosis should rely on patient history and specific clinical tests.
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