Neither the sclerosis nor the fragmentation of the apophysis could be used to establish the diagnosis of Calcaneal apophysitis. Therefore, obtaining radiographs as an initial step in their evaluation does not seem to be justified.

I guess that means we can keep doing what we have always been doing, but it is nice to have some evidence to defend the practice.

See Podiatry Arena for more on this study on Severs Disease and other Severs Disease topics.

Localized, bilateral, painless, nonpruritic and symmetric papuloid lesions in the posteromedial part of the foot are the clinical features of benign plantar nodules of the heel in children. They are probably congenital; they are asymptomatic and benign. We present 18 children with posteromedial nodules of the heel, 15 bilateral. Mean age was 45.31+/-53.49 months. The reason for the consultation was the lump itself in 10 of the cases. Thirteen were asymptomatic and five presented transient tenderness to pressure. Radiographs were nonspecific in all cases. Sonography showed an accumulation of tissue similar to subcutaneous cell tissue, compatible with fat. MRI was performed in one case, showing an accumulation of fatty tissue similar to subcutaneous cell tissue. Follow-up time was 5.44+/-3.78 years (range 2-16 years). At the end of follow-up, all the patients are asymptomatic with normal functional outcome and with the lump persisting in all but one. In conclusion, a sonographic study is sufficient to diagnose this type of mass, without the need for biopsy and/or surgical exeresis to distinguish fatty tissue from another type of consistency. Subsequent studies should aim at showing piezogenic, hamartomatous or congenital fat herniation aetiology of these typical lumps, probably normal variant of normality.