<?xml version="1.0" encoding="utf-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.0 20120330//EN" "JATS-journalpublishing1.dtd">
<article article-type="Case Report" dtd-version="1.0" xml:lang="en" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">jkfas</journal-id>
<journal-title-group>
<journal-title>Journal of Korean Foot and Ankle Society</journal-title>
<abbrev-journal-title>J Korean Foot Ankle Soc</abbrev-journal-title>
</journal-title-group>
<issn pub-type="ppub">1738-3757</issn>
<issn pub-type="epub">2288-8551</issn>
<publisher>
<publisher-name>Korean Foot and Ankle Society</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.14193/jkfas.2018.22.2.74</article-id>
<article-id pub-id-type="publisher-id">jkfas-22-74</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Calcaneal Apophyseal Avulsion Fractures with Achilles Tendon Rupture in a 10-Year-Old Patient: A Case Report</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name name-style="western" xml:lang="en"><surname>Lee</surname><given-names>Jun Young</given-names></name>
<xref ref-type="aff" rid="aff1-jkfas-22-74"/>
<xref ref-type="corresp" rid="c1-jkfas-22-74"/>
</contrib>
<contrib contrib-type="author">
<name name-style="western" xml:lang="en"><surname>Bak</surname><given-names>Yi Gyu</given-names></name>
<xref ref-type="aff" rid="aff1-jkfas-22-74"/>
</contrib>
<contrib contrib-type="author">
<name name-style="western" xml:lang="en"><surname>Lim</surname><given-names>Jae Hwan</given-names></name>
<xref ref-type="aff" rid="aff1-jkfas-22-74"/>
</contrib>
<aff id="aff1-jkfas-22-74" xml:lang="en">Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, <country>Korea</country></aff>
</contrib-group>
<author-notes>
<corresp id="c1-jkfas-22-74">Corresponding Author: Jun Young Lee Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea Tel: 82-62-220-3147, Fax: 82-62-226-3379, E-mail: <email>leejy88@chosun.ac.kr</email> ORCID: https://orcid.org/0000-0002-9764-339X</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>1</month><year>2018</year></pub-date>
<pub-date pub-type="epub"><day>19</day><month>1</month><year>2018</year></pub-date>
<volume>22</volume>
<issue>2</issue>
<fpage>74</fpage>
<lpage>77</lpage>
<history>
<date date-type="received"><day>25</day><month>10</month><year>2017</year></date>
<date date-type="revised"><day>02</day><month>03</month><year>2018</year></date>
<date date-type="accepted"><day>09</day><month>03</month><year>2018</year></date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2018 Korean Foot and Ankle Society</copyright-statement>
<copyright-year>2018</copyright-year>
<license><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/4.0">http://creativecommons.org/licenses/by-nc/4.0</ext-link>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license>
</permissions>
<abstract xml:lang="en"><p>Calcaneal apophysitis is a relatively common disease in young athletes. On the other hand, if not treated properly, it can lead to apophyseal avulsion fracture in rare cases. In the case of apophyseal avulsion fractures, it is often necessary to remove or preserve the bone fragment, which often requires a suture of the Achilles tendon. A 10-year-old badminton athlete visited the outpatients&#x2019; clinic with pain in both heels from 10 months ago without any trauma history. After conservative therapy, the pain in the left heel was relived but the right heel pain persisted. After 10 months of conservative therapy, the patient visited the outpatients&#x2019; clinic showing a calcaneal apophyseal avulsion fracture with a total rupture of the Achilles tendon. In the operation room, a bone fragment needed to be removed because of its poor viability and the fragment was too thin for fixation. After removing the bone fragment, the ruptured Achilles tendon was fixed with an anchor system.</p>
</abstract>
<kwd-group xml:lang="en">
<kwd>Achilles tendon</kwd>
<kwd>Calcaneal apophysitis</kwd>
<kwd>Sever&#x2019;s</kwd>
<kwd>disease</kwd>
<kwd>Avulsion fractures</kwd>
<kwd>Pediatric</kwd>
</kwd-group>
</article-meta>
</front>
<back>
<ref-list xml:lang="en">
<title>REFERENCES</title>
<ref id="b1"><element-citation publication-type="journal"><label>1.</label><person-group person-group-type="author"><name><surname>Schmidt</surname> <given-names>TL</given-names></name> <name><surname>Weiner</surname> <given-names>DS</given-names></name></person-group> <article-title>Calcaneal fractures in children. An evaluation of the nature of the injury in 56 children</article-title> <source>Clin Orthop Relat Res.</source> <year>1982</year><volume>171</volume> <fpage>150</fpage><lpage>5</lpage></element-citation></ref>
<ref id="b2"><element-citation publication-type="journal"><label>2.</label><person-group person-group-type="author"><name><surname>Mooney</surname> <given-names>V</given-names></name></person-group> <article-title>Avulsion of the epiphysis of the os calcis</article-title> <source>J Bone Joint Surg.</source> <year>1935</year><volume>17</volume> <fpage>1056</fpage><lpage>7</lpage></element-citation></ref>
<ref id="b3"><element-citation publication-type="journal"><label>3.</label><person-group person-group-type="author"><name><surname>Fernandez</surname> <given-names>JA</given-names></name> <name><surname>Vaquero</surname> <given-names>MV</given-names></name> <name><surname>Cimiano</surname> <given-names>JG</given-names></name></person-group> <article-title>Epiphysiolysis of the great tuberosity of the calcaneum</article-title> <source>J Bone Joint Surg Br.</source> <year>1989</year><volume>71</volume> <fpage>321</fpage></element-citation></ref>
<ref id="b4"><element-citation publication-type="journal"><label>4.</label><person-group person-group-type="author"><name><surname>Imai</surname> <given-names>Y</given-names></name> <name><surname>Kitano</surname> <given-names>T</given-names></name> <name><surname>Nakagawa</surname> <given-names>K</given-names></name> <name><surname>Takaoka</surname> <given-names>K</given-names></name></person-group> <article-title>Calcaneal apophyseal avulsion fracture</article-title> <source>Arch Orthop Trauma Surg.</source> <year>2007</year><volume>127</volume> <fpage>331</fpage><lpage>3</lpage></element-citation></ref>
<ref id="b5"><element-citation publication-type="journal"><label>5.</label><person-group person-group-type="author"><name><surname>Lee</surname> <given-names>KT</given-names></name> <name><surname>Young</surname> <given-names>KW</given-names></name> <name><surname>Park</surname> <given-names>YU</given-names></name> <name><surname>Park</surname> <given-names>SY</given-names></name> <name><surname>Kim</surname> <given-names>KC</given-names></name></person-group> <article-title>Neglected Sever&#x2019;s disease as a cause of calcaneal apophyseal avulsion fracture: case report</article-title> <source>Foot Ankle Int.</source> <year>2010</year><volume>31</volume> <fpage>725</fpage><lpage>8</lpage></element-citation></ref>
<ref id="b6"><element-citation publication-type="journal"><label>6.</label><person-group person-group-type="author"><name><surname>Cole</surname> <given-names>RJ</given-names></name> <name><surname>Brown</surname> <given-names>HP</given-names></name> <name><surname>Stein</surname> <given-names>RE</given-names></name> <name><surname>Pearce</surname> <given-names>RG</given-names></name></person-group> <article-title>Avulsion fracture of the tuberosity of the calcaneus in children. A report of four cases and review of the literature</article-title> <source>J Bone Joint Surg Am.</source> <year>1995</year><volume>77</volume> <fpage>1568</fpage><lpage>71</lpage></element-citation></ref>
<ref id="b7"><element-citation publication-type="journal"><label>7.</label><person-group person-group-type="author"><name><surname>Paley</surname> <given-names>KJ</given-names></name> <name><surname>Milem</surname> <given-names>CA</given-names></name> <name><surname>Ebraheim</surname> <given-names>NA</given-names></name> <name><surname>Merritt</surname> <given-names>TR</given-names></name></person-group> <article-title>Severe displacement of a calcaneal apophyseal fracture</article-title> <source>J Foot Ankle Surg.</source> <year>1994</year><volume>33</volume> <fpage>180</fpage><lpage>3</lpage></element-citation></ref>
<ref id="b8"><element-citation publication-type="journal"><label>8.</label><person-group person-group-type="author"><name><surname>Ogden</surname> <given-names>JA</given-names></name> <name><surname>Ganey</surname> <given-names>TM</given-names></name> <name><surname>Hill</surname> <given-names>JD</given-names></name> <name><surname>Jaakkola</surname> <given-names>JI</given-names></name></person-group> <article-title>Sever&#x2019;s injury: a stress fracture of the immature calcaneal metaphysis</article-title> <source>J Pediatr Orthop.</source> <year>2004</year><volume>24</volume> <fpage>488</fpage><lpage>92</lpage></element-citation></ref>
</ref-list>
<sec sec-type="display-objects">
<title>Figures</title>
<fig id="f1-jkfas-22-74" position="float">
<label>Figure 1.</label>
<caption xml:lang="en"><p>Representive T1-weighted (A) and T2-weighted (B) proton density sagittal magnetic resonance image illustrating complete rupture of Achilles tendon. Demonstrating avulsion fracture and Achilles tendon retraction.</p></caption>
<graphic xlink:href="jkfas-22-74f1.tif"/>
</fig>
<fig id="f2-jkfas-22-74" position="float">
<label>Figure 2.</label>
<caption xml:lang="en"><p>Skin dimpling of right heel. (A) Posterior aspct of ankle. (B) Lateral view.</p></caption>
<graphic xlink:href="jkfas-22-74f2.tif"/>
</fig>
<fig id="f3-jkfas-22-74" position="float">
<label>Figure 3.</label>
<caption xml:lang="en"><p>Bone fragment translation. (A) Initial simple radiograph. (B) Ten months later preoperative simple radiograph.</p></caption>
<graphic xlink:href="jkfas-22-74f3.tif"/>
</fig>
<fig id="f4-jkfas-22-74" position="float">
<label>Figure 4.</label>
<caption xml:lang="en"><p>(A, B) Operative findings with bone fragment at the proximal segment of Achilles tendon (arrows). (C) Bone fragment.</p></caption>
<graphic xlink:href="jkfas-22-74f4.tif"/>
</fig>
<fig id="f5-jkfas-22-74" position="float">
<label>Figure 5.</label>
<caption xml:lang="en"><p>Operative procedure with anchor system. (A) Insert anchor by pushing into calcaneal tuberosity. (B) Achilles repair by ankor suture.</p></caption>
<graphic xlink:href="jkfas-22-74f5.tif"/>
</fig>
<fig id="f6-jkfas-22-74" position="float">
<label>Figure 6.</label>
<caption xml:lang="en"><p>(A, B) Postoperative anteroposterior and lateral plain radiography. (C) Last follow-up, postoperative day 6 months lateral plain radiography.</p></caption>
<graphic xlink:href="jkfas-22-74f6.tif"/>
</fig>
</sec>
</back>
</article>