Perhamre et al. attempted to establish a clear definition of the diagnostic criteria for the condition through this study.
Clinical and radiographic results of 30 children with Sever’s injury were examined and compared with a control group of 15 matched, symptom-free children.
Three clinical tests were performed: barefoot standing on one heel, the calcaneal edge palpation test and the squeeze test with lateral compression over the calcaneal tubercle.
The children were then asked to complete questionnaires detailing personal characteristics with the Borg CR10 scale and Engstrom’s activity index.
This was followed by a lateral radiograph, with the focus being on the most painful heel.
The degree of sclerosis and fragmentation were assessed using four levels.
Sensitivity for the clinical tests were: one-leg heel standing, 100%; the squeeze test, 97%; and the palpation test 80%; with all three tests showing 100% specificity.
All participants showed increased density in the apophysis.
The highest degree of sclerosis was recorded almost as frequently in the patient group (7 of 30, 23%) as in the control group (4 of 15, 27%).
Fragmentation was found to be less in the control group (8 out of 15) and more in the patient group (26 out of 30).
Sensitivity for the same was found to be 87% with 47% specificity.
It was hence established that Sever’s injury is a clinical, not a radiologic diagnosis.
Radiologic findings of increased density and fragmentation were also reported in the control group and could be a part of normal growth and development.
Patient history is an important consideration in the diagnosis of Sever’s injury along with the results from the one-leg heel standing and squeeze test.
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