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Sever’s disease and unilateral heel raise

Discussion in 'Pediatrics' started by Boots n all, Apr 13, 2008.

  1. Boots n all

    Boots n all Well-Known Member

    Members do not see these Ads. Sign Up.
    l had a client in on Saturday, the mother asked "do we have school shoes to take orthotics?"
    Me "Yes most of our school shoes do."
    Mother "Great my daughter has severs in the left foot and has been fitted with an orthotic"
    l remove the left shoe to see a 15mm heel lift with mild medial arch support, l remove the right shoe to find no heel lift, nothing, so l ask where is the right foots orthotic, the response.."she only has severs in the left leg so she only needs the lift in the left shoe"

    Is this standard, have l been doing something wrong?

    There is no LLD, l would have put a heel lift possible orthotic in both shoes for a few reasons, one to keep the 12 year olds pelvis balanced and an unaltered even gait, to aid the shoe fit as the Orthosis provided changes the heel height(internal) and the mid foot fit to the shoe and the real possibility of severs appearing in the right foot.
  2. David:

    You have not been doing something wrong. It is not healthy for a 12 year old to be walking around with an iatrogenic limb length discrepancy caused by wearing one heel-lifted orthosis only. In this case, I would have given the child a heel lift to match the orthosis heel height to wear in the other shoe and told the parent that it would have been smarter and healthier to have the child not be given a limb length discrepancy by their treating physician.
  3. Boots n all

    Boots n all Well-Known Member

    Thanks Kevin, l didnt think so, but when the parent told me who supplied them l was starting to think l had missed something.

    l did at the time ask the clients mother to ring and talk to the prescriber to be certain that there was not an error made, she assured me that his qualifications were far above that of mine, which they are no questions there.
  4. Craig Payne

    Craig Payne Moderator

    Dave - Kevin is right. I would really struggle to find a reason to use a unilateral heel raise in Sever's in the absense of a LLD

    BTW: David and Kevin - how about adding flag to message. Update near bottom of your profiles.
  5. Boots n all

    Boots n all Well-Known Member

  6. Bug

    Bug Well-Known Member

    That is odd? I gently ask them to go back and question if this is an OK thing to do.
  7. Boots n all

    Boots n all Well-Known Member

    l agree Bug, as you can see l did that also, he is local to me and does refer a few across so l am been very gentle;)
  8. Aye aye, Captain Payne.......:rolleyes:
    Last edited: Apr 14, 2008
  9. Bug

    Bug Well-Known Member

    As an aside, David.....any plans for expansion. I could so do with your shoes down my neck of the woods. Plans for another in Southern suburbs of Melbourne?
  10. Adrian Misseri

    Adrian Misseri Active Member

    G'day David,

    I can see the prescribers rationalle for the heel lift, however as Kevin suggested, it kinda makes no sense not to balance both limbs. Just curious as to the material it was made of. I have used 9mm PPT poron heel pad with an arch cookie/filler as both a heel lift as well as a cushon in patients with Sever's to reduce impacct through the growth plate, with generally good results. Certainly it is discontinued when symptoms cease. But my thought was that the reduction in GRF impulse to the heel was probably more important than the advantage gained in lifting the heel. Any opinions?
  11. Boots n all

    Boots n all Well-Known Member

    The wedge was EVA, l am going to guess and say 300-350 hardness with a ppt or poron cover, compressed it was about 12mm maybe 11.

    l dont know that l would agree with the ptt been any thicker as it may create a shearing action at heel strike between the collar of the shoe and the client= blister:hammer:

    Bug; thanks but no thank you, l have enough to do here for the moment
  12. Peter

    Peter Well-Known Member

    If the feet and lower limb function could be analogised to the eyes, This would be the same as prescribing someone a monocle.

    When did you last see a pt wearing a monocle?
  13. Adding a heel lift to only one side in a 12 year old child, without a limb length discrepancy, is not the standard of care. The ethical thing to do is to tell the parent to either have their child stop wearing only one lift or give the child a heel lift of equal height to wear in the opposite shoe. If the referring doctor doesn't approve, then ask him/her to provide a logical biomechanical rationale for producing an iatrogenic limb length discrepancy in a growing child. Would they have a growing child only wear one shoe??? Your job as a consultant is to do what is right for the patient, not to do what is right for the referring physician!
  14. Boots n all

    Boots n all Well-Known Member

    Firstly the refer is the guy the local GP refer them to, l would think he knows more than me:confused: l hope that an error has occurred and that is all it is, the mother had promised to get back to me with the answer sometime today?

    Considering his education, l tried to convince the mother to take a 10mm cork build up for the other foot, pending the answer she got from the local Osteopath
    that l asked her to see for another and l am sure unbiased opinion, she believes the
    refers opinion/education is better than mine, so would l:wacko:

    Side note
    l refer 60%(?) of my clients that l fit with an orthotic to one of our local Osteopaths and 100% of the ones that have a LLD before and after the orthotic device is fitted, l want to be sure it is a structural difference and not a functional one that can and should be treated in other ways

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