Foot Mobility Magnitude and Stiffness in Children With and Without Calcaneal Apophysitis

NewsBot · Jan 19, 2018

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Foot Mobility Magnitude and Stiffness in Children With and Without Calcaneal Apophysitis
Simon Christopher McSweeney, BHlthSci (Pod), MSc (Pod Med), Lloyd Reed, PhD, Scott Wearing, PhD First Foot and Ankle International January 17, 2018

Background:
This study evaluated quasi-static measures of foot mobility magnitude (FMM) and foot stiffness (FS) in children, aged 8 to 14 years, with and without calcaneal apophysitis.

Methods:
Between 2016 and 2017, FMM and FS measurements were captured on 41 children (22 cases and 19 controls) using a custom-built foot assessment platform. The platform incorporated a portable force plate that allowed quantification of vertical force during double-limb stance (DLS).

Results:
There was no significant difference in FS in children with and without calcaneal apophysitis (P = .459). FMM was significantly greater (+19%) in children with calcaneal apophysitis than in those without (P = .045). The mean difference in FMM between groups (1.4 mm), however, did not exceed the minimum detectable change at the 95% confidence level (MDC95%) for the measurement (±2.5 mm).

Conclusion:
Differences in FMM in children with calcaneal apophysitis were small and within the observed error of measurement. Clinical measures of FS did not differ in children with and without calcaneal apophysitis during quasistatic loading. Further research evaluating the level of uncertainty of the measurement techniques in children and under dynamic loading conditions is recommended. These findings question the rationale behind interventions which aim to modify quasistatic foot mobility and stiffness in children with calcaneal apophysitis.
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Admin2 · Jan 19, 2018

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NewsBot · Feb 7, 2018

Relationship Between Sever Disease and Skeletal Maturity
Duong, Mindy M et al
Journal of Pediatric Orthopaedics: February 06, 2018 - Volume Publish Ahead of Print - Issue - p

Background: Sever disease is a common condition in active, growing children. This condition presents as pain in the heel and is thought to be an overuse condition of the calcaneal apophysis. There are currently no defined radiographic diagnostic criteria for evaluation of Sever disease, with radiographs generally showing normal appearance of the calcaneal apophysis. A better understanding of the relationship of Sever disease and skeletal maturity may allow for improved interpretation of radiographs when trying to diagnose this condition.

Methods: ICD-9 code 732.5 was used to search for patients diagnosed with Sever disease from 2007 to 2015 at a single hospital. For every patient with Sever disease with available calcaneal imaging within 40 days of diagnosis, heel x-rays were staged for calcaneal maturity score using a previously described calcaneal skeletal maturity assessment system. Controls matched by age, race, and sex were evaluated for calcaneal stage to compare with the Sever patients.

Results: The chart review yielded 78 patients diagnosed with Sever disease by the orthopaedic attending, 39 of which have x-rays around the time of diagnosis. Calcaneal scores averaged 2.2±0.8 for all patients, 2.1±0.9 for male individuals, and 2.3±0.8 for female individuals. The average age for male individuals was 10.4±1.9 years and for female individuals, 9.2±2.2 years. The ages of diagnosis were similar for patients with and without x-rays. Twenty-two of 39 patients with Sever disease were calcaneal stage 2, and 37 of 39 were stages 1, 2, or 3. We calculated the absolute difference from stage 2 for the Sever and control groups. Mean difference from stage 2 was 0.51±0.68 for the Sever patients and 0.95±0.79 for control patients (P=0.01).

Conclusion: Sever disease occurs in a very narrow range of skeletal maturity, as measured by the calcaneal skeletal maturity assessment system and our observations with chronological age. When compared with age-matched and race-matched controls, stage 2 was seen more frequently in the Sever patients. If a child is not within calcaneal stages 1, 2, or 3, then a different diagnosis should be considered.
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