Orthopedics Book

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Sever's DiseaseAka: Calcaneoapophysitis, Apophysitis of the Achilles Tendon

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  1. Epidemiology
    1. Occurs most commonly in boys, ages 8 to 14 years
    2. Associated Sports
      1. Basketball
      2. Soccer
      3. Track
  2. Definition
    1. Low grade inflammation at achilles tendon insertion
    2. Associated with irregular ossification
      1. Sclerosis of calcaneal apophysis
  3. Mechanism
    1. Traction injury
  4. Symptoms
    1. Heel Pain (often bilateral)
    2. Wearing shoes is painful
    3. Ambulation is not painful
  5. Signs:
    1. Calcaneus inflammation
      1. Local pain
      2. Tenderness
      3. Swelling
    2. Passive dorsiflexion of heel cord reproduces pain
  6. Differential Diagnosis
    1. Plantar Fasciitis
  7. Radiology: Foot Xray
    1. Sclerosis of apophysis
    2. Sclerosis also seen in normal, asymptomatic feet
  8. Management
    1. NSAIDs
    2. Local heat
    3. Rest
    4. Heel lift (1.25 cm)
      1. Diminishes heel cord stress
    5. Heel Cord Stretching Exercises
    6. Short Leg Walking Cast (resistant cases)
      1. Foot in slight equinus (plantar flexion)
  9. Course
    1. Anticipate return to activity within 6 weeks
  10. Prognosis
    1. Self limited condition with good overall prognosis
  11. References
    1. Madden (1996) Am Fam Physician 54(6):1995

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