Purpose of Study To retrospectively determine the applicability of the calcaneal ossification staging system in the modern pediatric population. Approach Lateral foot radiographs of 1,327 children (455 black and 872 white, 665 females and 662 males) 18 and below (mean 11.55 ± 4.39 years), who had visited the authors' institution between September 1 and December 31, 2014 were reviewed. Each patient's calcaneal apophysis was graded based on the calcaneal ossification staging system (proposed by Nicholson et al. in 2015), which was based on a historical cohort comprised of 92% white children and 7.7% black children. Patients with congenital foot abnormalities or bony pathology involving the calcaneus were excluded. Radiographs were viewed on a high-resolution monitor to grade calcaneal stage. The same set of 20 radiographs were graded a month later to assess intra-rater reliability.
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