Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?

OBJECTIVE: Non-specific heel pain (calcaneal apophysitis) is a common disorder, particularly in physically active growing children. Foot radiographs are usually obtained as part of the clinical evaluation in routine orthopaedic practice. However, there is still controversy about the specific findings on radiographs, and it is unclear what information is present on radiographs that may alter the diagnosis and management. The purpose of this study was to review a consecutive series of patients with the diagnosis of calcaneal apophysitis to assess the yield of routine radiographs of the foot.
MATERIAL AND METHODS: A prospective study was performed on 61 consecutive patients with a diagnosis of calcaneal apophysitis in a single-surgeon practice. Standard anteroposterior and lateral weight-bearing foot radiographs were obtained for each patient. Seventy-one sets of foot radiographs were reviewed to determine whether radiographs had an impact on diagnosis and management. Patients with antecedent trauma, penetrating injury, foot deformity, achilles tendonitis, bursitis and infections were excluded from the study.
RESULTS: Seventy foot radiographs were considered to be normal. The radiographs changed the diagnosis in only one patient, in whom a simple bone cyst of the calcaneous was seen.
CONCLUSION: Calcaneal apophysitis is a self-limiting disease, and patients can be treated conservatively. 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.