Abstract
The aim of the present research was to determine the effectiveness of relieving calcaneal apophysitis pain using “off-the-shelf” heel-lifts and custom-made orthotics. Two intervention modalities were evaluated and compared in a 12-week follow-up trial. Inclusion criteria included 9- to 12-year-old children diagnosed with calcaneal apophysitis. Children were randomly stratified into treatment A (custom-made polypropylene foot orthoses) and treatment B (“off-the-shelf” heel-lifts) groups. Treatment effectiveness was measured by algometry and the visual analogical scale (VAS). A total of 208 patients were included. The treatment A group showed an increase in threshold algometry of 53.4% (95% CI 47.1% to 59.7%) and a decrease in VAS of −68.6% (95% CI −74.5% to −62.7%) compared with the treatment B group (p < 0.001). Calcaneal apophysitis pain perception was improved in both groups, but children who used custom-made foot orthoses showed a greater improvement.
Highlights
Calcaneal apophysitis (Sever s disease) is a very common ailment present in the heels of children between 7 and 15 years old [1,2,3,4,5]
104 children were allocated to both treatment A and B groups
Our findings suggest the children with calcaneal apophysitis of the present research have higher body mass index (BMI) compared with population norms and flat feet [2,18,25], but no ankle dorsiflexion restriction according to the normative reference values provided by McKay et al [17]
Summary
Calcaneal apophysitis (Sever s disease) is a very common ailment present in the heels of children between 7 and 15 years old [1,2,3,4,5]. The mechanical etiology relates the injury to the traction forces of triceps surae and plantar fascia on the calcaneus bony surface [3,4,5,6]. The anatomical unit named the “Achilles–calcaneus–plantar System” (ACPS) describes the functional connection among the Achilles tendon, the calcaneus bone, and the plantar fascia [6]. Repetitive stress of the Achilles tendon and the plantar fascia is transmitted onto the calcaneus surface affecting bone remodeling, creating perpendicular fibrous bands of cartilage in the secondary ossification center of the calcaneus [7]. This, in addition to repetitive impacts on the bony surface, constitutes the focus of calcaneal apophysitis [5,6,7,8]
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