musculoskeletal and connective tissue disorders
Apophysitis of the Calcaneus
Introduction
Apophysitis of the calcaneus is painful disruption between the calcaneal apophysis and the body of the heel that occurs before calcaneal ossification is complete. Diagnosis is clinical. The mainstay of therapy is stretching the Achilles tendon both passively and actively. Adjunctive measures include use of heel cups/pads and splinting or casting. (See also Overview of Foot and Ankle Disorders .) The calcaneus develops from two centers of ossification: one begins at birth, the other usually after age 8. Ossification is usually complete by age 15. The cartilaginous disruption in calcaneal apophysitis may result from an excessive pull on the apophysis by contracted or shortened calf muscles. Bone growth spurts without adaptive calf muscle lengthening may play a role. Pain develops in patients (usually aged 9 to 14) with a history of athletic activity, especially those who wear footwear without elevation of the heel (such as track flats or soccer cleats); it affects the sides or margins of the heel and is aggravated by standing on tip toes or running. Warmth and swelling are occasionally present. The diagnosis of apophysitis of the calcaneus is clinical. Radiographs are not usually helpful. MRI may show marrow edema at the apophysis as well as a retrocalcaneal bursa. 