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Efficacy of Using Foot Orthoses in Severs Disease

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Shalom, Jun 4, 2011.

  1. Shalom

    Shalom Active Member


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    What are clinicians thoughts on the use of orthoses in the chronic phases of severs disease?
    1.Orthoses use is mandatory
    2.Orthoses use should be in conjunction with stretching and RICE method + Heel raises.
    3.Orthoses are not warranted as it is a self-limiting condition.


    Kind regards,
    Shalom
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    Re: Efficacy of Using Orthoses in Severs Disease

    My answer would be 2.5

    See all the other threads on severs. There are a couple of studies there on the use fo foot orthotics in severs
     
  3. dragon_v723

    dragon_v723 Active Member

    Hi Craig thx for ur search link for Sever's, read the thead where u and a few debated with GNelson selling Oscon, thats a real education from all the refs u posted.
    wonder whether he posted u some to try lol
     
  4. Shalom

    Shalom Active Member

    Thanks for that information Craig. As I've done a quick-read of posts on the topic, I came across this;

    'I treat many cases of Sever's disease. Most cases of Sever's disease respond well to reducing the tensile force on the Achilles tendon so that the shearing stress is reduced on the calcaneal apophysis. I first of all give them 1/4" (6 mm) heel lifts to wear at all times, have them do gastrocnemius and soleus stretches 2-3 times per day, have them ice the posterior heel 20 minutes twice a day, avoid barefoot activities and reduce their running activities initially. If they do not respond to this protocol, then I will try an over-the-counter foot orthosis or custom foot orthosis and may have them totally cut out all running activities for at least 2 weeks. In more extreme cases, I will put them into a below-knee fiberglass cast for 3-6 weeks which works quite well for the more severe cases of Sever's disease.' - Kevin Kirby-

    Now the question I propose is, how much in pain reduction have you achieved with comcomitant use of orthoses and the priliminary stretching and RICE method? Have you used any VAS scales or qualitative measures to measure pain levels and Quality of life for patients with the use of orthotics or is it a method used to control-foot mechanics IE- STJ pronation, excessively medially deviated STJ, Varus strike, FF-RF relationship?

    Kind regards,

    Shalom.
     
  5. I would go a 2 90% of the time.

    Reduce activities
    Ice
    Heel lift
    Stretching program

    All designed to reduce loads on the insertion of the Achilles and a reduction in tensile stress of the Gastroc/sol complex during activity.

    If above program is unsuccessful after 4 - 6 weeks orthotic device used.

    As for your question re VAS 90-95% of patients with Severs who follow the 1st stage of the program improve to a point where normal activity levels do not cause any symptoms I find.
     
  6. Shalom

    Shalom Active Member

    Thanks Mike. I agree with you there. The use of orthoses should be warranted where there is actual significant pathology that is going to affect an individual with the conditions on mechanical grounds and not for the sole purpose of treating Sever's disease. So, if there is no improvement with physical therapy at 4 weeks then orthoses are possible.

    Does everyone concur? Disagreements are accepted.

    Now from a clinical stand-point, the usual exclamation by a patient suffering with sever's is 'wow that feels good and supportive' upon the use of heel-lifts.There is an instantaneous effect as we know by the reduction in moment arm of the Achilles tendon contractile force. Now my question to clinicians out there is, is this 'wow' factor increased in using orthoses? Ie- is there a significant reduction in pain and symptomatology with the use of orthoses verses the use of physical and anti-inflammatory therapy only?

    Shalom.
     
  7. Dananberg

    Dananberg Active Member

    I have been successfully treating Seaver's Disease with orthotics for over two decades. Can't remember the last cast I had to apply for this diagnosis. The key, however, is to either use prefab orthotics or taping for at least 10 days to two weeks prior to taking the cast impression for a CFO. When a Seaver's case is "hot", the heel is swollen and must be calmed down or else the orthotic will not fit appropriately shortly after they are dispensed.

    Howard
     
  8. Shalom

    Shalom Active Member

    Thanks for that input Howard, so in terms of the Saggital plane then, you do think that the use of orthoses is warranted? What about long-term use of orthoses with heel-lifts, would you expect a detrimental effect of the achiles tendon over time? Ie shortening of the achiles tendon? And also you are assuming that the condition is in the acute phase for it to be 'hot and swollen'? In the case of a child presenting with chronic presentation Ie- parents present after 6-8- months of condition being present, would treatment be different?



    Shalom.
     
  9. Dananberg

    Dananberg Active Member

    When there is limited ankle joint dorsiflexion (which is often the case), I use an ankle manipulation to restore ROM. Once this is resolved, it is often the beginning of the end of the problem. Then, with the use of a prefab orthotic (and one which can be repeatedly reheat/remolded), I control the other biomechanical issues which may be contributory. Unless the limb is truly on the shorter of the two sides, I do not routinely use heel lifts. Once the swelling has reduced in the heel, and depending on how they are doing, their either stay with the prefab, or are switched to a CFO. The chronic nature of the symptoms is often related to the above....and these two resolve rapidly.

    Howard
     
  10. Shalom

    Shalom Active Member

    Sounds plausible and justified. Thanks for that Howard. So you would disagree with those who perceive that Severs is a stress fx rather than a traction injury? And would the use of heel-lifts giving therapeutic benefit Ie - VAS from 8 to a 3 with concomitant stretching and icing, contraindicate the prescription of an orthoses, considering the condition is self limiting and that there are no significant biomechanical complexities that call for orthotic treatment?
     
  11. Dananberg

    Dananberg Active Member

    In 35 years of practice, I have seen only one case which appeared as Seaver's but was a stress fracture. So, while it can occur, my sense is its rare.

    When I see children who have heel pain of a few weeks duration, manipulations, icing and stretching is fine. When they are in the 2nd year of heel pain, I would say that their biomechanics are not ideal, and that they would benefit from appropriate CFO care. My preference for this in children is the use the Vasyli line of products, as the heat moldable ability does premit remolding as the edema in the heel decreases over time. Yearly replacements are more reasonable when compared to CFO's.

    As a disclaimer, I am a paid consultant for Vasyli.

    Howard
     
  12. Shalom

    Shalom Active Member

    You are warranting the use of off-the shelf devices to custom made orthoses? The financial cost of a custom made device, that can be enhanced and reduced at the heel-cup with compressive material such as ppt, poron and adjusted to edema amounts can also be used in this case I am sure, rather than purchasing new off-the shelf devices every year to an accumulated cost of more or equal to that of a custom orthoses.
    One must keep in mind the growth rate of the patient, most likely very high at the age of severs onset and where parents are burdened with the cost of purchasing new shoes at least twice annually to match the growth rate of the child.

    Shalom.
     
  13. Hi Howard, what taping are you using here ?

    Low dye type ┬┤anti┬┤pronation taping or Kinesio Tape to reduce the tension in the Achilles Tendon ?
     
  14. Shalom

    Shalom Active Member

    Re- Strapping/tapping for severs, please see attachment.
     

    Attached Files:

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