EC Paediatrics

Sever’s disease (calcaneal apophysitis) is the leading cause of heel pain in skeletally immature children and is generally diagnosed clinically. Imaging is mainly performed to exclude alternative diagnoses when symptoms are atypical or unusually severe. A 7-year-old boy presented with progressively worsening bilateral heel pain for three months associated with bilateral calcaneal swelling. One month before admission, the pain became severe enough to prevent weight-bearing, particularly on the left side. Initial radiographs were interpreted as normal. Because of persistent symptoms and significant functional impairment, computed tomography (CT) of both feet was performed. CT demonstrated bilateral irregular fragmentation and sclerosis of the calcaneal apophyses, more pronounced on the left, without fracture, cortical destruction, periosteal reaction, or aggressive bone lesion. These findings, combined with the clinical presentation, established the diagnosis of bilateral Sever’s disease. Conservative treatment resulted in progressive symptom resolution. Although Sever’s disease remains a clinical diagnosis, CT may be valuable in selected patients with persistent symptoms and inconclusive radiographs by excluding more serious conditions while demonstrating characteristic apophyseal abnormalities.

Keywords: Sever’s Disease; Calcaneal Apophysitis; Heel Pain; Computed Tomography; Pediatric Radiology

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