The purpose of this study was to investigate whether the identification of Sever's disease is reliable with radiographs alone. Eighty foot radiographs (50 boys with calcaneal apophysitis and 30 healthy boys) were included in this study. Two consultant orthopaedic surgeons were instructed to make a diagnosis without clinical information on the patients. Radiologic assessments were performed in random order by each observer on two separate occasions, at least 3 weeks later. kappa-statistics were used to establish a relative level of agreement between observers for the two readings and between separate readings by the same observer. Observer A made 22 true (27.5%) diagnoses, whereas observer B made 56 true (70%) diagnoses at the first assessment. Interobserver agreement was rated as slight (kappa-value, 0.190). Observer A made 40 true (50%) diagnoses, whereas observer B made 52 true (65%) diagnoses at the second assessment. Interobserver agreement was rated as slight (kappa-value, 0.039). Intraobserver reproducibility was rated as fair for both observers (kappa-value, 0.369 for observer A and 0.253 for observer B). The results of this study showed that the radiologic identification of calcaneal apophysitis without the absence of clinical information was not reliable. Radiologic findings that were attributed to Sever's disease showed a wide variation between independent observers and between separate readings by the same observer. The diagnosis of calcaneal apophysitis is a clinical decision and radiographic assessment seems to be unnecessary.

Biomechanical imbalance between the hallux and the second toe and external compression of the lateral nail fold are proposed as the main reasons for ingrown toenail. Therefore, any anatomical predisposition facilitating this compression may play a role in the occurrence of ingrown toenail. The purpose of this study is to investigate the relationship between forefoot alignment and ingrown toenail. The authors retrospectively reviewed radiographs of 81 patients with ingrown toenails and compared them with 100 healthy subjects regarding forefoot alignment. Hallux valgus angle (HVA), intermetatarsal angle (IMA), and interphalangeal angle (IPA) were measured, and feet were classified according to digital formula as Egyptian, Greek, and square. The mean HVA was 14.5° ± 5.0° in the case group and 13.2° ± 5.9° in the control group. The mean IMA was 9.1° ± 2.5° in the case group and 8.6° ± 3.1° in the control group. The mean IPA was 11.9° ± 4.1° in the case group and 12.0° ± 5.1° in the control group. There was no statistically significant difference between the groups regarding HVA, IMA, or IPA (P = .123, P = .198, and P = .925, respectively). The distribution of foot types between groups was also similar (P = .967). This study has failed to demonstrate any abnormality in forefoot alignment in patients with symptomatic ingrowing toenails, and it is suggested that treatment should not be based on the correction of the anatomy if no abnormality exists.

Aims Osteopetrosis (OP) is a rare hereditary disease that causes reduced bone resorption and increased bone density as a result of osteoclastic function defect. Our aim is to review the difficulties, mid-term follow-up results, and literature encountered during the treatment of OP. Methods This is a retrospective and observational study containing data from nine patients with a mean age of 14.1 years (9 to 25; three female, six male) with OP who were treated in our hospital between April 2008 and October 2018 with 20 surgical procedures due to 17 different fractures. Patient data included age, sex, operating time, length of stay, genetic type of the disease, previous surgery, fractures, complications, and comorbidity. Results The mean follow-up period was 92.5 months (25 to 140). Bony union was observed in all of our patients. Osteomyelitis developed in two patients with femoral shaft fractures, and two patients had peri-implant stress fractures. Conclusion Treatment of fractures in OP patients is difficult, healing is protracted, and the risk of postoperative infection is high. In children and young adults with OP who have open medullary canal and the epiphyses are not closed, fractures can be treated with surgical techniques such as intramedullary titanium elastic nail (TENS) technique or fixation with Kirschner (K)-wire. Cite this article: Bone Joint J 2020;102-B(8):1082–1087.