Clinical and Diagnostic Characteristics of Calcaneal Apophysitis: A Systematic Review and Thematic Analysis.

BACKGROUND: Calcaneal apophysitis is an overuse injury in pediatric patients that causes heel pain and reduction in function. The aim of this study is to explore this condition and offer medical insight into its presentation and symptomatology, along with current treatment options. METHODS: We explored PubMed/Medline for studies involving calcaneal apophysitis in pediatric patients. The search included all articles published from database inception until June 1, 2021. We only included articles published in English. Clinical information and demographics extracted from the reported studies were analyzed and assessed. RESULTS: Only 28 studies met our criteria, with a total of 1,362 cases. Of the cases reported, 973 affected boys (71.4%). Presentation was bilateral in 589 cases (43.2%) and unilateral in 433 cases (31.8%). Radiographic imaging was used for the diagnosis of 358 cases (26.3%). All reported treatment modalities were conservative, and these included physical therapy and rest, kinesiotherapy and taping, and orthotic devices. A total of 733 cases (53.7%) reported improved outcomes,32 cases (2.3%) reported no improvement, and the remainder of cases did not report prognostic outcomes (44%). CONCLUSIONS: Calcaneal apophysitis is an overuse disease commonly found in the pediatric population. Educating parents and coaches with regard to its symptomatology, etiology, and treatment is essential to diagnose the condition earlier and provide better outcomes.

Subacromial Balloon Spacers for Massive Irreparable Rotator Cuff Tears.

Massive irreparable rotator cuff tears are difficult to treat. Several different treatment options have been explored in the orthopedic realm. A 69-year-old male with a massive irreparable rotator cuff tear was originally treated with a subacromial balloon spacer around five years prior to presentation. The patient started having increasing shoulder discomfort. Treatment options were discussed following review of MRI results and the patient decided to move forward with a second balloon spacer. The patient underwent his revision procedure and noted significant improvement in his pain and function on follow-up. Revision subacromial balloon spacers constitute an effective surgical treatment option that may slow the progression of rotator cuff arthropathy and relieve pain and dysfunction in the setting of massive irreparable rotator cuff tears.