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Hi

I am in a bit of a quandary about how to go about treating a 14 year old male with the use of orthotics. The patient has been initially diagnosed with Sever's disease and Osgood Schlatters. In dynamic assessment the foot pronates a little in stance but pronates more when the heel lifts off the ground-which occurs prematurely. He plays a lot of soccer and also presents with tight gastroc, soleus and hamstrings. I'm ok with stretching techniques but am unsure on what is the most important aspect to manage with the orthotics and what post etc to use?

Any help would be appreciated.

 

Bilateral heel raises

 

Thank you-I did think that they might be the best option but as a student I was unsure. I have been reading that sometimes a deep heel cup with the heel raise is used-is this worth doing? Also should any type of valgus be added to the orthoses?

 

Craig,

We're gonna need some more information about the patient before discussing various prescription variables. More often than not in these developmental traction apophysitis conditions such as Sever's and Osgood-Schlatter's bilateral heel raises with a religious soft tissue stretching programme and maybe some short term activity modification and these kids will do just fine.

Attached some reading for you - just what I could find on my laptop that looked related; I'm sure a bit of a search and you'd find plenty more.

Ian

 

Hi Craig,

Purely anecdotal evidence.

I was diagnosed with Osgood Schlatters in my early teens. (Circa 1979ish)

Referred to the local military hospital Orthopaedic consultant.

Prescribed therapy was heat lamp treatment 3 x weekly to both knees for around 30 mins.

Also paracetamol as required.

Consultant also advised reduce activity. No stretching! :hammer:

My passion at the time was skateboarding. So my parents took it away :confused:

I stole my brothers :D

Consequence was the consultant placed my left leg in plaster for a total of 6 months to prevent my activity. :eek:

Result was muscle wasting due to the cast :boohoo:

I understand that these barbaric techniques are no longer recommended (thankfully)

My recommendation (in conjuction with orthotic devices) would be stretches & icing the local area. Also a temporary reduction in activity (although not in an ankle to thigh cast!) :wacko:

Regards,

Mandy