Craig;
So it isn't really a fracture?!?! ;-)
I love it when the orthopods only take an x-ray of one foot and then tell
the parents that it is a fracture. I have heard and seen that happen 2-3
times!
This post should be a real boon for Kevin Kirby. He can add a new
definition to his burgeoning podiatric thesarus! ;-)
Just kidding Kevin!
Bruce
----- Original Message -----
From: "Craig Payne" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Wednesday, August 18, 2004 5:58 PM
Subject: Sever's disease - this very interesting.
Sever's Injury: A Stress Fracture of the Immature Calcaneal Metaphysis.
Journal of Pediatric Orthopedics. 24(5):488-492, September/October 2004.
Ogden, John A. MD *; Ganey, Timothy M. PhD ++; Hill, J. David MD +;
Jaakkola, Juha I. MD +
Magnetic resonance imaging (MRI) in children with a presumptive
diagnosis of Sever's apophysitis and with continuing pain after
conservative treatment demonstrated bone bruising within the trabecular
bone of the metaphyseal region adjacent to the calcaneal apophysis.
Limited portions of the apophyseal secondary ossification center showed
similar increased signal changes. MRI studies following treatment with
immobilization showed subsidence or disappearance of the metaphyseal but
not any apophyseal signal changes commensurate with improvement in
symptoms. Accordingly, the disorder commonly referred to as Sever's
"apophysitis" may be a metaphyseal trabecular stress fracture, similar
to the toddler's calcaneal stress fracture that has minimal or no
involvement of the apophyseal ossification center, and thus should not
be referred to as an apophysitis. Rather, it appears to be an overuse
injury causing microinjury within the developing metaphyseal
"equivalent" trabecular bone that has not completely adapted to the
changing biologic (biomechanical) requirements of the growing,
athletically active child.
Kind Regards
CP
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Craig Payne
Department of Podiatry ph: (+61)(3) 9479 5820
School of Human Biosciences fx: (+61)(3) 9479 5784
Faculty of Health
LaTrobe University
Bundoora, Vic 3086, Australia
http://www.health.latrobe.edu.au/Schools/POD/home.html
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