Medial calcaneal neuropathic pain clinically diagnosed in a child initially considered to have Sever’s disease: a case report

Abstract

Abstract Background Sever’s disease is a common cause of pediatric heel pain and usually improves with conservative treatment. However, persistent pain with allodynia and difficulty in heel contact may indicate a neuropathic mechanism. Case presentation A 9-year-old boy developed persistent right heel pain after treatment for a suspected left calcaneal avulsion fracture. Despite a diagnosis of Sever’s disease and conservative therapy, pain, allodynia, and difficulty in heel contact persisted. The pain was localized to the medial and plantar heel, with a Tinel-like sign along the presumed course of the medial calcaneal nerve. Topical lidocaine–prilocaine cream and ultrasound-guided perineural injection of a local anesthetic temporarily relieved the allodynia and enabled heel contact. Ultimately, the symptoms resolved with multimodal treatment. Conclusions Medial calcaneal neuropathic pain should be considered in children with persistent heel pain accompanied by sensory abnormalities, localized pain consistent with nerve distribution, and a Tinel-like sign.