Calcaneal apophysitis (a.k.a. Sever disease) is the painful inflammation of the calcaneal apophysis. It is the most common cause of heel pain in athletes between 5 and 11 years. It is caused by repetitive microtrauma induced by the pull of the Achilles tendon on its insertion and is commonly seen in activities that involve running. It clinically manifests as pain in the posterior aspect of the heel that worsens with activity, and occurs bilaterally in 60% patients 1. It must be considered in the differential diagnosis for posterior heel pain in the pediatric population and is primarily a clinical diagnosis 2.
MRI will show edematous changes within the calcaneal apophysis, which may extend into the adjacent calcaneal tuberosity. MRI can also be helpful in excluding other causes of heel pain 2.