Journal Club Episode 5:  Pediatric Apophysitis – Non-surgical Interventions

Presenter: Dr. Adam Manis– UofT Primary Care Sports Medicine Fellow
Date: January 13, 2014

Part 1 MP3

Part 2 MP3

Articles for Review:

James AM1, Williams CM, Haines TP. “Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review”. J Foot Ankle Res. 2013 May 3;6(1):16. doi: 10.1186/1757-1146-6-16.


de Lucena GL1, dos Santos Gomes C, Guerra RO.  Prevalence and associated factors of Osgood-Schlatter syndrome in a population-based sample of Brazilian adolescents. Am J Sports Med. 2011 Feb;39(2):415-20. doi: 10.1177/0363546510383835. Epub 2010 Nov 12.



Pediatric Apophysitis:

Table 1 – Lower Limb Pediatric Apophysites

Apophysis LocationMuscular/Tendon AttachmentName of Apophysitis
Iliac Crest 1, 3Transverse Oblique InsertionIliac Crest Apophysitis
Anterior Inferior Iliac Spine 1Rectus Femoris Origin 
Anterior Superior Iliac Spine 1,4Sartorius Origin 
Ischeal Tuberosity 1,5,6,7Hamstring Origin 
Lesser Trochanter – Femur 1Psoas Insertion 
Greater Trochanter 1,8Gluteus Medius Insertion 
Proximal Patella 9Quadriceps Tendon 
Distal Patella 1, 2Patellar TendonSinding-Larsen-JohanssonSyndrome
Tibial Tuberosity 1, 2,10Patellar TendonOsgoode-Schlatter Disease
Calcaneus 1,2Achilles tendon insertionSever Disease
5th Metatarsal 1,11Peroneal insertionIselin Disease





2) Atanda A Jr1, Shah SA, O’Brien K. Osteochondrosis: common causes of pain in growing bones. Am Fam Physician. 2011 Feb 1;83(3):285-91.

3) Kivel CG1, d’Hemecourt CA, Micheli LJ. Treatment of iliac crest apophysitis in the young athlete with bone stimulation: report of 2 cases. Clin J Sport Med. 2011 Mar;21(2):144-7. doi: 10.1097/JSM.0b013e31820ebcef.

4) Pointinger H1, Munk P, Poeschl GP. Avulsion fracture of the anterior superior iliac spine following apophysitis. Br J Sports Med. 2003 Aug;37(4):361-2.

5) Kujala UM1, Orava S, Karpakka J, Leppävuori J, Mattila K. Ischial tuberosity apophysitis and avulsion among athletes. Int J Sports Med. 1997 Feb;18(2):149-55.

6) Yamamoto T1, Akisue T, Nakatani T, Kawamoto T, Hitora T, Marui T, Kurosaka M.  Apophysitis of the ischial tuberosity mimicking a neoplasm on magnetic resonance imaging. Skeletal Radiol. 2004 Dec;33(12):737-40. Epub 2004 Jun 15.

7) Holmstrom MC1, Greis PE, Horwitz DS. Chronic ischial apophysitis in a gymnast treated with transapophyseal drilling to effect “apophysiodesis”. A case report. Am J Sports Med. 2003 Mar-Apr;31(2):294-6.

8) Young SW1, Safran MR. Greater Trochanter Apophysitis in the Adolescent Athlete. Clin J Sport Med. 2014 Jun 17. [Epub ahead of print]

9) Espejo-Baena A1, Urbano-Labajos V, López-Arévalo R, Luna-González F, Márquez-Moreno A. A case of apophysitis of the proximal patella. Am J Sports Med. 2000 Jul-Aug;28(4):583-5.

10) Gholve PA1, Scher DM, Khakharia S, Widmann RF, Green DW. Osgood Schlatter syndrome. Curr Opin Pediatr. 2007 Feb;19(1):44-50.

11) Deniz G, Kose O, Guneri B, Duygun F. Traction apophysitis of the fifth metatarsal base in a child: Iselin’s disease. BMJ Case Rep. 2014 May 15;2014. pii: bcr2014204687. doi: 10.1136/bcr-2014-204687.