Ultrasonography as a Diagnostic Modality in Sever's Disease (Calcaneal Apophysitis)

Zusammenfassung

Morbus Sever (Apophysitis calcanei) ist eine häufige Ursache für Fersenschmerz bei jungen Athleten. Die Diagnose wird meist klinisch gestellt, Röntgenaufnahmen können die Ossifikation am Knochenkern darstellen und andere knöcherne Ursachen ausschließen. Die Studie sollte die Brauchbarkeit einer Ultraschalluntersuchung (US) zur Diagnostik der Erkrankung evaluieren. Es wurden 48 (37 symptomatische, 11 asymptomatische) Fersen bei 24 Kindern mit Fersenschmerz untersucht, bei denen die Verdachtsdiagnose einer Apophysitis calcanei bestand. Verwendet wurden 8-13-MHz-Linear-Transducer. Alle Fersen zeigten eine gewisse Fragmentation des sekundären Ossifikationszentrums. Eine sägezahnähnliche grobe Fragmentation wiesen 24 der 37 symptomatischen, keine der 11 asymptomatischen Fersen auf. 5 symptomatische Fersen und eine asymptomatische wiesen zusätzlich Flüssigkeit in der retrocalcanearen Bursa auf. Die Autoren werten eine sägezahnähnliche grobe Fragmentation des sekundären Ossifikationszentrums im US als spezifisches Zeichen eines Morbus Sever.

Abstract

Sever's disease or calcaneal apophysitis is a common source of heel pain in young athletes. A possible diagnosis of Sever's disease is generally done clinically. Radiographs are usually taken to assess the ossification of the secondary nucleus, and to rule out other pathologies. In this study we tried to assess the role of ultrasonography in the diagnosis of Sever's disease. We performed ultrasound examination on 24 children (48 heels) with heel pain clinically consistent with Sever's disease. 37 symptomatic heels and 11 non-symptomatic heels were examined. All of these heels showed some fragmentation of the secondary ossification center. 24/37 symptomatic heels showed rough fragmentation, which resembled saw-teeth. None of the 11 non-symptomatic heels showed such rough of fragmentation. Five symptomatic heels and one non-symptomatic heel also showed fluid in the retrocalcaneal bursa. None of the examined heels showed abnormal findings in the Achilles tendon or in the plantar fascia. In conclusion, sonography has been shown to be helpful in the evaluation of Sever's disease. We suggest that the sonographic appearance of rough fragmentation with “saw-teeth” appearance can be used as specific sign for Sever's disease.

Publication History

Publication Date:
02 April 2007 (online)

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