What's Your Diagnosis? Pediatric Apophysitis

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Emergency Department Management of Primary Headache Disorders in Pediatric Patients right.

Case Presentation: Pediatric Apophysitis Management in the Emergency Department

A 5-year-old boy with no past medical history presents for heel pain for 1 week…

The patient has been playing basketball for the past month as part of practices for the upcoming season. To address the pain, the boy’s mother has been giving him ibuprofen “every so often,” but she has not tried other medications or interventions. The patient reports that it hurts particularly in the right heel when he jumps and lands on his feet.
The boy has had no fevers, rashes, night sweats, or weight loss. The review of systems is negative. On examination, he has an antalgic gait but is able to bear weight. He has full range of motion of the right foot and ankle, and he is neurovascularly intact. He has a positive calcaneal squeeze test. His physical examination is otherwise negative.
What diagnoses are on your differential?

Case Conclusion

Given the location of the pain, positive calcaneal squeeze test, and otherwise normal physical examination, you diagnosed the boy with Sever disease. The patient was discharged to home with recommendations for use of heel cups, rest and ibuprofen for pain management, and follow-up with his primary care physician.