From the Guidelines
No, a 14-year-old with closed physis on X-ray cannot have Sever's disease (calcaneal apophysitis). Sever's disease specifically affects the calcaneal apophysis (heel bone growth plate) when it is still open and actively growing [ 1 ]. This condition typically occurs in children aged 8-14 years during periods of rapid growth, and it resolves once the growth plate closes and fuses with the rest of the calcaneus. The presence of closed physis on X-ray indicates that the growth plate has already fused, making Sever's disease impossible at this point. Some key points to consider in this diagnosis include:
- Calcaneal apophysitis is probably the most common cause of heel pain in adolescents [ 1 ]
- Palliative treatment is almost always successful for calcaneal apophysitis [ 1 ] If a 14-year-old with closed growth plates is experiencing heel pain, other diagnoses should be considered, such as:
- Plantar fasciitis
- Achilles tendinopathy
- Stress fracture
- Other soft tissue injuries Proper diagnosis would require clinical evaluation, imaging, and possibly other diagnostic tests to determine the actual cause of heel pain in this adolescent.
From the Research
Sever's Disease in Adolescents with Closed Physis
- Sever's disease, or calcaneal apophysitis, is a common cause of heel pain in pediatric patients between the ages of 8 and 15 years 2.
- The condition typically occurs during puberty with an open growth plate in the immature calcaneus, but the provided studies do not explicitly state that it cannot occur with closed physis 2, 3, 4.
- The mean age of presentation in Sever's disease is ten, with a range of 7-15 years, which includes the age of 14 3.
- Diagnostic imaging findings include increased sclerosis and fragmentation of the calcaneal apophysis on plain radiograph x-rays, but Sever's disease cannot be diagnosed radiographically alone 2, 4.
- Clinical diagnosis can be confirmed by performing a "squeeze test" of the heel on physical examination 2, 4.
Treatment and Prognosis
- Conservative treatment, including rest, ice application, heel lifts, stretching and strengthening exercises, and nonsteroidal anti-inflammatory drugs, is usually effective in alleviating symptoms associated with Sever's disease 2, 4, 5.
- The condition is self-limiting and resolves at skeletal maturity or earlier, with no long-term effects associated with Sever's disease 2, 3.
Rare Complications
- Although rare, Sever's disease can be complicated with osteomyelitis, emphasizing the importance of careful assessment and diagnostic procedures, including MRI, in atypical cases 6.