The calcaneal tuberosity is the posterior rounded eminence of the calcaneus forming the heel, the weight-bearing surface during standing, and the attachment site for the Achilles tendon superiorly and the plantar fascia and intrinsic foot muscles inferiorly. The medial and lateral processes of the tuberosity provide broad surface area for weight distribution across the heel pad.
Sever disease (calcaneal apophysitis) is the most common cause of heel pain in active children aged 8 to 14, producing posterior heel pain at the calcaneal apophysis from repetitive traction of the Achilles tendon on the still-growing tuberosity. It is a traction apophysitis rather than a true avulsion or fracture, managed with heel lifts, activity modification, and stretching. Insertional Achilles tendinopathy and Haglund deformity in adults affect the superior posterior tuberosity at the Achilles insertion.
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