Calcaneal Enthesophytes with Concern for Apophysitis in Middle Age Male




LewisGale Medical Center

Document Type


Publication Date



heel spur, cumulative trauma disorders, pain


Family Medicine | Musculoskeletal Diseases | Sports Medicine


Posterior heel pain can come from a large variety of causes and often can come from a combination of a few different factors. Most commonly the etiology stems from a mechanical problem or overuse2,6.The etiology can also vary widely with different ages and gender. For adolescents the most common cause is Sever’s Disease or calcaneal apophysitis3,5. It usually stems from overuse2 and can be diagnosed on x-ray. It affects males more than females4, and common in ages 9-12. Risk factors for Sever’s disease include year-long sports, poor fitting or worn out shoes or poor mechanics5. In adulthood, etiologies of heel pain most commonly include Achilles tendinopathy, Haglund’ssyndrome and calcaneal spurs (or enthesophytes). Achilles tendinopathy is most often caused by overuse or excessive mechanical loading of the tendon and can most easily be diagnosed with ultrasound6. Haglund’s syndrome happens most commonly in middle age females and does cause a physical bump on the back of the heel7. X-ray is the best way to evaluate it. Calcaneal spurs or enthesophytescan cause posterior heel pain and the incidence increases with age1. X-ray again can make the diagnosis. While a majority of heel pain can be treated with conservative measures of rest, ice and stretching, identifying the correct cause can help with deciding further management if the pain persists.

Publisher or Conference

American Osteopathic Academy of Sports Medicine