Today’s topic arises from a question from a patient regarding our last blog and the appearance of a lovely young lady with a very sore posterior heel.
Sever’s Disease may considered an old fashioned term, and rightly so since it was first described in 1912 by J W Sever. Calcaneal Apophysitis may be more appropriate clinical diagnosis for today.
When we search online Cleveland Clinic offers the following:
During a growth spurt, children can experience pain as the tendons, bone and cartilage grow. Sever’s disease is a common condition in growing children. It’s characterized by heel pain and can be relieved by both time (children outgrow this condition) and stretching the Achilles tendon. Sever’s disease is also called Calcaneal Apophysitis.
Not unlike our last blog on Growing pains there is a definite suggestion that the pain is natural and somehow attributable to rapid growth and will simply pass with time. We would like to disagree!
Even way back 112 years ago Sever’s identified that excessive pronation was a direct factor in the origin of this condition. The treatment of choice was complete rest for six weeks, and back then they meant COMPLETE rest. I can only imagine the roar of protest at this suggested treatment today.
So instead of accepting this, let’s see what the real science has to say about treating this condition.
Well, a very recent paper out of Spain (home to some really excellent podiatrists) entitled
Effectiveness of Custom-Made Foot Orthoses vs. Heel-Lifts in Children with Calcaneal Apophysitis (Sever’s Disease): A CONSORT-Compliant Randomized Trial
attempts to find an answer to this question for the ages. You may read the paper in its entirety here.
It was a really well-constructed piece of research intended to examine the effect of custom-made foot orthoses versus using heel-lifts in children with calcaneal apophysitis.
Spoiler alert if you want to check out the link above to this research:
“this study highlights that the use of custom-made foot orthoses instead of heel-lifts for calcaneal apophysitis (Sever´s disease), applied during a 12-week follow-up period, may have a substantial effect on calcaneal apophysitis pain relief”
The actual data revealed that for patients who received a heel lift, 20-30% reported improvement, while for those in the custom orthotic group 70-90% reported significant improvement.
As always with any condition caused by biomechanical dysfunction the treatment is only as good as the diagnosis of the underlying cause. In the case that spawned this blog, our video gait analysis (pedi-gait) made the diagnosis crystal clear in slow motion as can be seen in the video below.
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