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Taping and Sever's Disease

Discussion in 'Pediatrics' started by NewsBot, Oct 30, 2007.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Arch taping as a symptomatic treatment in patients with Sever's disease: A multiple case series
    Gary C. Hunta, Thomas Stowell, Gregory M. Alnwick and Shaun Evans
    The Foot
    Volume 17, Issue 4, December 2007, Pages 178-183

  2. Bruce Williams

    Bruce Williams Well-Known Member

    Works for me with a felt heel lift most of the time. I will usually get them into an orthotic after that.
  3. Admin2

    Admin2 Administrator Staff Member

  4. drdebrule

    drdebrule Active Member

    I always perform ankle manipulation and get these kids stretching. Orthotics can work very well also. I have never tried taping for Severs beause the tape comes off eventually and does not seem to last very long.

    Michael B. DeBrule, DPM
    Marshall, MN
  5. Boots n all

    Boots n all Well-Known Member

    We use the tape and a 4mm heel lift just to show what the Orthosis can do as far as relieving the pain, some parents need to be convinced, it will also give them some pain free time until the Orthosis is ready, whilst stretching is started immediately and the slip on runners are burnt at the stake.

    Sadly some football boots our young boys wear struggle to hold the foot and most wont hold an Orthosis, so we do a heel lift between the sole and the upper.

    We currently do work with an AFL team (Pro Aussie rules football) in the same manner for posterior leg injuries
  6. twirly

    twirly Well-Known Member

    Hello David & Boots,

    I am reading this thread with interest but I would like to enquire have you a particular heel raise material of choice? I note one poster advised felt, which I personally find may be of limited value with adolescents (sweaty individuals usually). Can you recommend a particular product or material for use as a heel raise.

    Apologies if anyone feels the need to roll eyes at this post, just enquiring to those with greater experience than my own. :eek:

    Thank you,

  7. Mark Smith

    Mark Smith Member

    Hi All

    We rarely use taping for the reason Michael has mentioned.

    Depending on ankle ROM and foot posture, orthoses with 6mm or 4mm eva heel raises are supplied alongside stretching for gastroc and soleus, but also hamstring.
    Patients are then reviewed and raises are reduced as Ankle ROM increases and symptoms subside with good results.

    I find similar problems as "boots n all" states that football boots lead to fitting problems, so i may re-visit the use of taping for these patients.

    Any other materials used by anyone?

    Does anyone have sucess with simple silicone heel raises??


  8. Boots n all

    Boots n all Well-Known Member

    Pending on what is at hand, say cork or EVA, but then again they will only have that heel lift for 1 week whilst l make the Orthosis, which is from a 400 EVA, with a heel lift attached too.
    The amount of elevation is relative the the level of pain/tightness and reviewed in a couple of weeks.
    As for the footballers, send me their boots and l will wave my magic wand for you
  9. twirly

    twirly Well-Known Member

    Thanks Mark & David.

    Much appreciated.

  10. moe

    moe Active Member

    Hi Twirly
    I usually use a prefabricated eva heel lift 6mm or 4mm and prescribe stretches with a review in 6 weeks. At the 6 week review if pain is gone I advise the removal of the heel lift and review in 2 weeks most often the pain hasn't returned, but if it has we try another couple of weeks in heel lifts and then on to orthotics if pain is still present.
    I may also perform mobilisation at the first consult depending on the individual case.
  11. twirly

    twirly Well-Known Member

    Thanks Iona,

    Methinks this forum is possibly the best thing to happen in our profession in years.

    Regards. :drinks
  12. Kent

    Kent Active Member

    I see a few people on here use orthoses with a heel lift. Is there any evidence to suggest that this is better than just a simple heel lift with calf stretching?

  13. Mark Smith

    Mark Smith Member

    Hi Kent,

    My only evidence is via experience of patient outcomes, in that I find controlling any pronatory elements along side reduction of tensile stress to achilles insertion with the use of additional heel raise has yeilded faster results than simply with the use of a heel raise.

    I also find better compliance as heel raises alone sometimes slip forward in footwear causing the patients to get fed up with having to remove footwear to re-adjust.

  14. Craig Payne

    Craig Payne Moderator

    Heel raises do not decrease the tension in the achilles tendon and actually may increases it. See:
  15. Lawrence Bevan

    Lawrence Bevan Active Member

    Anyone tried the Asics Gel Lethal football boot??
  16. Mark Smith

    Mark Smith Member

    Hi Craig,

    Have only managed to gain access to the abstract for "Sharon J. Dixon; David G. Kerwin: The Influence of Heel Lift Manipulation on Achilles Tendon Loading in Running. JAB, 14(4), November 1998 ".

    Does the study suggest a mechanism/reason for this increased loading?

    It is a fairly small study, but if it is the case that heel raises can lead to incresed loading, what can we attribute the reduction in symptoms gained with use of heel raises to (specifically for severs)?

    • Bad Spelling Bad Spelling x 1
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  17. Craig Payne

    Craig Payne Moderator

    Think about it intuitively .... why would the calf muscles contract with any less effort during gait, just because there is a heel raise in the shoe? Just because we have shortened the distance between origin and insertion does not mean that the effort expended by the calf muscles during gait is reduced. I started thinking about this a few years ago, but only met up with Sharon Dixon earlier this year and she pointed out the publication I missed. Yes it was a small sample, but the results are not necessarily counter-intuitive if you think about it.
    Shock attenuation
  18. Craig Payne

    Craig Payne Moderator

    ASICS have high hope for this as part of the management of Sever's - I see no reason why it would not be helpful
  19. Asher

    Asher Well-Known Member

    I wouldn't expect that it would change the way the muscle contracts. But surely it would decrease the tension in the tight musculotendinous unit comparatively throughout gait. Though I haven't read the article.

  20. Craig Payne

    Craig Payne Moderator

    I am not convinced that tight calf muscles are an issue in Severs. Afterall we are talking about a group of people in an age group which is generally pretty flexible. And don't forget what we now know about the subject specificness of ankle joint ROM and what is tight and what is not.

    I know a lot of people claim they see tight calf muscles ....how do you know its just not appearing tight because of some sort of 'protective splinting' due to the painful heel ???
  21. Mark Smith

    Mark Smith Member


    I agree with the above statement, but could it be argued that due to the shorteded distance, the effort expended is done so for a shorter time period and therefore the total effort/force is less than without the raise??

    (not sure if my terminology is in the correct context here but I hope you can see the point i am trying to make???)
    Last edited by a moderator: Dec 5, 2007
  22. DaVinci

    DaVinci Well-Known Member

    Geeeez paynie. There you go again provoking us; challenging us; pushing the envelope. :bash: Life was simple before you came along. Everyone had a forefoot varus; 10 degrees was the normal range for the ankle joint; heel raises worked; pronation caused HAV; the foot on the long leg pronated more to compensate :bang:

    Seriously though, I envy your students. I just wish I had teachers that were this intellectually stimulating, while not necessarily agreeing with them :drinks
  23. Craig Payne

    Craig Payne Moderator

    You could be right. It could be suggested that this is the case, but I am not aware of any EMG data that shows this, so we have to be cautious at jumping to any conclusions.
  24. Mark Smith

    Mark Smith Member

    Perhaps an interesting piece of work for someone here, any takers??
  25. Mark Smith

    Mark Smith Member

    Agreed that we cannot make assumptions as to "normal ankle ROM" but there does seem to be correlation between what appears to be tight posterior muscle groups (hamstrings included) and incidence of Severs.

    So much as we cannot say that these groups are specifically tight, because there is not a "normal" to compare with, there is correlation with onset of symptoms in some cases where parents quote a "growth spurt" - I know this may be subjective and contenscious, however rapid elongation of long bone in short time periods may, if there is any presence of it, lead to a comparative short term "shortening" of the musculature?

    I have a feeling that with this statement i may be opening a can of worms, but hey the debate is interesting!!!:D
  26. Craig Payne

    Craig Payne Moderator

    Anyone have any idea how this is supposed to work any better than a placebo:
  27. NewsBot

    NewsBot The Admin that posts the news.

    Assessment of the kinesiotherapy's efficacy in male athletes with calcaneal apophysitis.
    Kuyucu E et al
    J Orthop Surg Res. 2017 Oct 6;12(1):146. doi: 10.1186/s13018-017-0637-5.
  28. Craig Payne

    Craig Payne Moderator

  29. Boots n all

    Boots n all Well-Known Member

    Back to your video, l would like to know what his 10% is? 10% of what?
    "Paper off tension is equal to 10%"
  30. Seamus McNally

    Seamus McNally Active Member

    Yes, jumping to conclusions could exacerbate Severs.
  31. Seamus McNally

    Seamus McNally Active Member

    Hi Craig. Curiosity got the better of me recently and I started trying out kinesiology tape. The 'experts' (Commas: is an expert in pseudoscience an oxymoron?) will say that the tape has nothing to do with support like ordinary tape. But I think that it has, especially a shed load like in the video. Anyways at the price there's about $10 worth on that foot.
  32. Dieter Fellner

    Dieter Fellner Well-Known Member

    holy molly ... looks damn pretty and surely worth $10?

    how about a heel raise with an Unna boot ... looks damn ugly

    Craig, how would a heel raise increase tension in the achilles tendon?
  33. efuller

    efuller MVP

    I think what Craig said was that a heel lift would not necessarily reduce Achilles tendon tension. When you walk, you contract your calf muscles whether or not you have a heel lift in your shoe. It's the muscle contraction that causes the tension in the Achilles.

    Or looking at it statically, you measure five degrees of dorsiflexion of an ankle and you conclude the patient has an equinus. Now with that patient standing with their ankle at 90 degrees, is there tension in the Achilles? Or, with the patient standing on a heel lift with their ankle 5 degrees plantar flexed, is there more or less tension on the tendon?
  34. Dieter Fellner

    Dieter Fellner Well-Known Member


    That's a nice hypothesis - is there any quantitative data?

    When I dorsiflex the foot at the ankle (knee extended bla bla) I can palpate the achilles tendon and manually sense increased tension. Conversely if I plantar-flex the foot at the ankle the converse is true.

    When there is an achilles tendinosis the same maneuver will provoke pain in the patient.

    When the achilles tendon is repaired the foot is maintained in a plantarflexed position so as to reduce the tension on the surgical repair.

    When I elevate the heel with a raise, is it not logical the tension in the tendon is reduced?

    Why would a heel raise induce increased motor activity from the muscle complex? Makes no sense, to me.
  35. efuller

    efuller MVP

    Med Sci Sports Exerc. 1995 Mar;27(3):410-6.
    Influence of heel height on ankle joint moments in running.

    Reinschmidt C1, Nigg BM.
    Author information


    Clinically, heel lifting or heel wedging in running shoes has been proposed as a prevention and treatment of Achillestendinitis. It has been speculated that heel lifting decreases the Achilles tendon forces. The purpose of this study was to determine the effect of heel height on resultant ankle flexion moments during running. It was assumed that plantarflexion moments at the ankle joint would indicate Achilles tendon loading. Each of the five subjects performed five running trials (4.6 m.s-1) for each of the five shoes, differing only in heel height (2.1-3.3 cm). Resultant plantar-/dorsiflexion moments were calculated using a standard three-dimensional inverse dynamics analysis. The results showed that, typically, a small initial dorsiflexion moment took place changing into a larger plantarflexion moment before 20% of stance phase. The magnitude and time of occurrence of the initial dorsiflexion moment were significantly affected by heel height changes, but the maximum plantarflexion moment and its time of occurrence were not significantly affected. The results did not support the speculation that a heel lift generally decreases the Achilles tendon loading during running. However, single subject analyses indicated that for two subjects the plantarflexion moments decreased with increasing heel height.

    Dieter, your thought experiments were correct, but they are only looking at passive tension. There is also active tension. Here's another thought experiment to add. Put a lift in both shoes. Go up on your tip toes. There is tension in the tendon.

    Also, I did not say that a heel lift would increase tension. What I am saying is that it would stay the same because there is active contraction of the gastroc and soleus in gait and other activities, whether or not there is a heel lift in the shoe.
  36. Dieter Fellner

    Dieter Fellner Well-Known Member


    Thank for your thoughts about that.

    I am not planning on reading this paper - I don't care much for this type of analysis with information extrapolated from some mathematical model in a healthy patient population, and further data extrapolated and assumed from AJ moments, instead of in vivo-measurements on real tension within a tendon.

    I will, for the time being, continue to follow the accepted standard of care, and will continue to rely instead on the feedback from our patients and response to treatment.

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