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Relationship Between Sever Disease and Skeletal Maturity.

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Sever disease in children is linked to a specific skeletal maturity stage. Radiographic assessment can help differentiate Sever disease from other conditions in growing children.

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Area of Science:

  • Pediatric Orthopedics
  • Radiology
  • Skeletal Development

Background:

  • Sever disease is a common heel pain condition in active children, often considered an overuse injury of the calcaneal apophysis.
  • Current radiographic criteria for Sever disease are lacking, as X-rays typically appear normal.
  • Understanding the link between Sever disease and skeletal maturity may improve radiographic diagnosis.

Purpose of the Study:

  • To investigate the relationship between Sever disease and skeletal maturity.
  • To determine if radiographic assessment of calcaneal maturity can aid in diagnosing Sever disease.

Main Methods:

  • Retrospective case-control study analyzing ICD-9 code 732.5 for Sever disease diagnoses between 2007-2015.
  • Heel X-rays of Sever disease patients were staged for calcaneal maturity within 40 days of diagnosis.
  • Matched controls (age, race, sex) were used for comparison of calcaneal maturity stages.

Main Results:

  • 39 Sever disease patients with available X-rays were analyzed; calcaneal scores averaged 2.2±0.8.
  • 37 of 39 patients were in calcaneal stages 1, 2, or 3.
  • Sever patients showed a significantly smaller mean difference from stage 2 (0.51±0.68) compared to controls (0.95±0.79, P=0.01).

Conclusions:

  • Sever disease is associated with a narrow range of skeletal maturity (calcaneal stages 1-3).
  • Stage 2 calcaneal maturity was more frequent in Sever disease patients than in controls.
  • Children not presenting with calcaneal stages 1-3 may warrant consideration for alternative diagnoses.