Imaging recommendation · Musculoskeletal

Pediatric heel pain with running / jumping (calcaneal apophysitis)

Q: What's the alternative imaging for pediatric heel pain with running / jumping (calcaneal apophysitis) when atypical / refractory?

MRI — MRI Foot (no contrast).

Recommended: Clinical diagnosis; X-ray Foot to exclude other causes is the preferred imaging study for pediatric heel pain with running / jumping (calcaneal apophysitis). Repetitive traction at Achilles insertion onto calcaneal apophysis.

Recommended study

Clinical diagnosis; X-ray Foot to exclude other causes

XR No contrast Preferred Musculoskeletal Outpatient Reviewed 2026-05

Repetitive traction at Achilles insertion onto calcaneal apophysis. Common ages 8-14.

If the default doesn't apply

Atypical / refractory

MRI MRI Foot No contrast

Watch-outs

Bilateral heel pain in girls

Consider tarsal coalition; image both feet if recurrent.

Pearls

Fragmented / sclerotic appearance of calcaneal apophysis is normal in this age — clinical correlation essential.
Tight Achilles is common contributing factor.
Treatment: heel cup, stretching, activity modification; rarely casting.