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.
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| Ossification | The calcaneal apophysis (secondary ossification centre at the posterior tuberosity) appears between ages 7 and 10 and fuses with the calcaneal body between ages 14 and 16, remaining open and tender in Sever disease during this period. |
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.
Hold the back of the heel; the large rounded bone is the calcaneal tuberosity. Follow the Achilles tendon down to its insertion on the middle of the back surface. On the sole, press just in front of and inside the bottom of the heel to find the medial process, where the plantar fascia attaches and where plantar heel pain is felt.
Forceful Achilles contraction, often in osteoporotic bone, avulses the posterior tuberosity and can threaten the overlying skin.
Degeneration of the Achilles tendon at its tuberosity insertion, often with calcification or a Haglund prominence.
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