Interventions for Severs Disease

NewsBot · May 4, 2013

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Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review
Alicia M James, Cylie M Williams and Terry P Haines
Journal of Foot and Ankle Research 2013, 6:16

Background
Calcaneal apophysitis, also commonly known as sever's disease, is a condition seen in children usually aged between 8--15 years. Conservative therapies, such as taping, heel lifts and orthotic intervention are accepted management practices for calcaneal apophysitis, though there is very little high quality research examining the efficacy of such treatment modalities. Previous narrative literature reviews and opinion pieces provide some evidence for the use of heel raises or orthoses. The aim of this manuscript was to complete a systemic review on the treatment options for calcaneal apophysitis as measured by pain reduction and maintenance of physical activity.

Methods
A search strategy completed by two reviewers examined nine databases from inception to May 2012. Search terms included heel pain, children, adolescent, calcaneal apophysitis, sever's disease, treatment, and management (full text publications, human studies). Systematic reviews, randomised control trials, case series, and case studies were included. The reference lists of the selected articles were also examined. The methodology, quality and risk of bias was examined and assessed using the PEDro scale.

Results
Nine articles were retrieved including three clinical trials involving randomisation, two case series, two retrospective case reviews, and two case reports. Effect size calculations and a meta analysis were unable to be completed due to the limited data reported within the literature. Numerous treatment options were reported throughout the literature, though few were examined against a control or alternate treatment option in well-designed trials. The limited evidence indicated that orthoses provided greater short-term pain relief than heel raises. Health practitioners should view these results with caution, as there were apparent methodological problems with the employed study design and limited follow-up of participants.

Conclusion
There is limited evidence to support the use of heel raises and orthoses for children who have heel pain related to calcaneal apophysitis. Further research is needed to generate higher quality evidence with larger sample sizes, and validated measures of pain and function to establish effective treatment approaches for children with calcaneal apophysitis.
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Admin2 · May 4, 2013

Related Threads:
Other threads tagged with calcaneal apophysitis and severs disease
Insoles effective for Severs Disease
Severs disease: is it impact related or from the achilles pull?
Efficacy of Using Foot Orthoses in Severs Disease
Reflexology for Severs Disease
Severs Disease Treatment with a Heel Cup
Sever’s disease—Does it effect quality of life?
Severs disease treatment
Taping and Sever's Disease

NewsBot · Aug 26, 2014

Heel Pain in Youth: A Guide to Potential Management Strategies
Michelle L. Weber, Kelsey J. Picha, Tamara C. Valovich McLeod
IJATT Volume 19, Issue 5, September

Calcaneal apophysitis, or Sever’s disease, is common among physically active youth between the ages of 8–15. This condition is related to skeletal growth during maturation and relief often comes once growth is complete. However, it is not feasible to limit participation in physical activity until growth ceases; therefore, it is important to determine effective interventions to regulate pain while continuing participation. A search of the literature yielded nine studies that met the inclusion criteria and were included for data analysis. Within these publications, many treatment methods were suggested, including nonsteroidal anti-inflammatory drugs (NSAIDs), taping, orthoses, heel lifts, stretching, activity modification, and ice. However, few of the treatment options were compared with a control group. Analysis revealed that clinicians should provide treatments with caution when treating patients suffering from Sever’s disease, understanding that strong evidence is not supportive of one treatment option alone. Data are limited for individual treatments related to calcaneal apophysitis and more research in this area is warranted. Clinicians should work with patients on an individual basis to determine if one form of treatment provides a reduction of pain and allows that patient to continue with activity.
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Craig Payne · Sep 22, 2016

For what its worth, here is a video on how to use Kinesio tape for severs disease

gotta love the bit where he calls it a "growth plate deformity" and says about the movement between the two bits of bone .... the Dunning–Kruger is strong in this one.

NewsBot · Dec 20, 2015

Sever’s Disease: An Underdiagnosed
Foot Injury in the Pediatric
Emergency Department
Michael Marchick, Henry Young, Mathew F. Ryan
Open Journal of Emergency Medicine, 3, 38-40. 2015

Sever’s disease—also known as calcaneal apophysitis—is a common cause of heel pain in pediatric
patients typically aged 7 - 14 years old. Sever’s disease can be painful and limit a child’s function
as well as participation in physical activity. Herein, we described a case of delayed presentation of
chronic Sever’s disease in a child who had been experiencing heel pain for over one year which
worsened substantially when the child began to participate in sports. This is important for the
emergency medicine physician because Sever’s disease represents an underdiagnosed cause of
foot and heel pain in the pediatric patient and may be often missed. We describe the diagnosis and
treatment options of Sever’s disease as well as associated controversies, e.g., whether activity is
indeed the cause of Sever’s disease and whether imaging is needed for a diagnosis.
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Craig Payne · Dec 20, 2015

NewsBot said: ↑

Sever?s Disease: An Underdiagnosed
Foot Injury in the Pediatric
Emergency Department
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"Underdiagnosed"! WTF is someone with severs doing in an emergency department!

NewsBot · Mar 11, 2016

Physiological and Pathological Development of calcaneal apophysis in Children
[Article in German]
D?derlein L, Dussa C
Orthopade. 2016 Mar 8

BACKGROUND:
The apophysis of the calcaneal bone forms an insertional region for the strong plantarflexors with the Achillis tendon and serves as an origin for the plantar aponeurosis and the short intrinsic foot muscles. Both components create a tendinous sling whithin which the apophysis acts as a pivot, which functions when it runs a straight course and its tension is adequate. This mechanism results in combined tractional and compressional forces which work together with the ground reaction forces during gait as molding elements of the calcaneous bone. Every longer lasting change in the magnitude and distribution of these forces can be followed by structural adaptations especially during the growth period. Furthermore the calcaneal apophysis functions as a connecting link between the ankle and thigh bones on one side and the mid- and forefoot region on the other side. When studying the causal relationships which influence the apophyseal growth and shape intrinsic and extrinsic components must be distinguished.
CLINICAL DIAGNOSTICS:
Every analysis of calcaneal pathologies should use clinical and instrumented diagnostics. Any classification must separate between bony and soft tissue elements and consider structural and functional influences in three planes. If an exact classification can be established an individual hypothesis must be formulated out of which therapeutic measures can be developed.
THERAPY:
Treatment must focus on the pathologic changes of shape as well as on functional aspects. A thorough knowledge of the normal development and function of the calcaneal apophysis serves as a basis for further understanding and treating pathologic changes of this hitherto only sparsely investigated functional region.
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NewsBot · Oct 11, 2021

Current concept review of Sever's disease in paediatric age group
G.A.Hosny, M.I.Al-Ashhab, M.A.Moeselhy and M.M.Abdrabboh
Benha Journal of Applied Sciences (BJAS)

Background: Sever's disease is directly associated with excessive usage of the heel bone and tendons. This may
occur from any sports involving a lot of heel movement. The commencement of new sport or the beginning of new
season may be linked with it. Children through puberty are particularly at danger since the heel bone is growing faster
than the leg. The objective of this research was to conduct a current concept study on severity in the paediatric age
range. Methods: This is an article of review, Searches in MEDLINE and Embase, Pubmed and CINAHL Plus were
carried out within the same date period as follows: "Sever's disease; paediatric; orthopaedics." The most obvious sign
of severe illness is heel discomfort, typically exacerbated by physical activity like walking, jogging, or skipping.
Sometimes the discomfort may be so intense that it limps and affects physical performance in athletics. Sever's
disease is most often clinically diagnosed and many doctors feel that radiographic assessment is unnecessary, however
if calcaneal apophysitis is not identified without x-rays, an injury needing more severe treatment may be overlooked.
Edematous alterations in calcaneal apophysis may occur via MRI, which may spread to neighbouring calcaneal
tuberosity, The research indicates that most people with the Sever illness are able to return to sport in a few weeks to
two months with appropriate management.
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NewsBot · Sep 13, 2022

Comparison of Braces for Treatment of Sever's Disease in Barefoot Athletes: A Randomized Clinical Trial
Emily A Sweeney, MD; Casey C Little, BS; Julie C Wilson, MD; Morgan N Potter, DPT; Corrine N Seehusen, BA; David R Howell, PhD, ATC
J Athl Train (2022)

Context:
Sever's is a common condition in youth athletes, including those who participate in barefoot sports. Health care professionals often recommend that young athletes with Sever's should wear heel cups in their shoes while active, but barefoot athletes are unable use heel cups.

Objective:
We wanted to compare the efficacy of two braces used by barefoot athletes with Sever's disease.

Design:
Randomized controlled clinical trial.

Setting:
Pediatric sports medicine clinic.

Participants:
Barefoot athletes 7–14 years old with Sever's disease completed self-reported assessments after diagnosis (baseline), and again 1-month, 2-months, and 3-months later.

Interventions:
Participants were randomized to Cheetah heel cup™ or X-brace™ groups for use during barefoot sports over the 3-month study period.

Main Outcome Measures:
Primary outcome: Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical score (3-months post-enrollment). Secondary outcomes: OxAFQ-C school/play and emotional scores, and Visual Analog Scale (VAS) pain scores.

Results:
We enrolled 43 participants and 32 completed the study (n=16/group; age=13.3±1.6 years; 91% female). The Cheetah heel cup™ and X-brace ™ groups spent a non-significantly different percentage of time wearing the brace during barefoot sport (81% vs 64% of time in-sports, p=0.08). At 3-months, there were no significant differences for OxAFQ-C physical, (0.79 vs 0.71, p=0.80: Hedge's g=0.06), school/play (0.94 vs 1.00, p=0.58, Hege's g=0.26) or emotional (1.00 vs 1.00, p=0.85, Hedge's g=0.21) scores. VAS pain scores during ADLs and sports were significantly lower (better) at 2- and 3-month time points as compared to baseline (p<0.001).

Conclusions:
Both groups demonstrated improvements in ankle/foot function across time, however, no between-group differences were observed at 3 months. Given these results, barefoot athletes with Sever's disease may consider using either brace with barefoot activity to help improve pain and functional status.
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NewsBot · Feb 3, 2024

Sever Disease (Calcaneal Apophysitis)
James M. Smith; Matthew Varacallo.
StatPearls [Internet].: January 11, 2024.

Sever disease, or calcaneal apophysitis, is a common cause of heel pain in children or young athletes aged 8 to 15 with immature skeletons. Sever disease results from repetitive microtrauma to the secondary ossification center by traction of the Achilles tendon insertion on the calcaneus. This overuse injury manifests as traction apophysitis at the heel, directly associated with the insertion site of the Achilles tendon. Children and adolescents experiencing a rapid growth spurt or engaging in sports that entail running and jumping may develop heel pain, which subsides with rest or inactivity. Sever disease follows a self-limited course, and its management involves activity modification or relative rest guided by pain levels. Symptom control incorporates the use of anti-inflammatory medications, ice, heel cups or heel lifts, and, in severe instances, immobilization. This activity delves into the etiology and pathophysiology of Sever disease and explores its evaluation and management while highlighting the crucial role of the interprofessional healthcare team in enhancing care for individuals affected by this condition.
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NewsBot · Apr 25, 2024 at 4:52 AM

Conservative Treatment of Sever’s Disease: A Systematic Review
Pablo Hernandez-Lucas et al
J. Clin. Med. 2024, 13(5), 1391; https://doi.org/10.3390/jcm13051391

Background: Sever’s disease, or calcaneal apophysitis, stands as the most prevalent cause of heel pain in children, often linked to sports like soccer, Australian football, and basketball. While various therapies are documented in the scientific literature, the standard choice is conservative treatment. Thus, the objective of this research was to assess the effectiveness of diverse conservative methods and techniques in alleviating Sever’s disease symptoms. Methods: Systematic searches were conducted in October 2023 in PubMed, Web of Science, Scopus, SportDiscus, and PEDro, using terms like Osteochondritis, Osteochondrosis, Apophysitis, Sever’s disease, Calcaneus, Adolescent, Child, and Childhood. The PEDro scale gauged methodological quality, and the Cochrane Risk of Bias tool evaluated the risk of bias. Results: Eight randomized controlled studies were included, featuring commonly used treatments such as insoles, therapeutic exercises, Kinesio taping, and foot orthoses. The methodological quality was generally good, with an average PEDro score of 6.75 points. Regarding bias, four articles had low risk, three had high risk, and one had some concern. Conclusions: Conservative treatment emerges as an effective option for alleviating symptoms associated with Sever’s disease.
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