Effectiveness of Custom-Made Foot Orthoses vs. Heel-Lifts in Children with Calcaneal Apophysitis (Sever’s Disease): A CONSORT-Compliant Randomized Trial

Abstract

The aim of the present research was to determine the effectiveness of relieving calcaneal apophysitis pain using “off-the-shelf” heel-lifts and custom-made orthotics. Two intervention modalities were evaluated and compared in a 12-week follow-up trial. Inclusion criteria included 9- to 12-year-old children diagnosed with calcaneal apophysitis. Children were randomly stratified into treatment A (custom-made polypropylene foot orthoses) and treatment B (“off-the-shelf” heel-lifts) groups. Treatment effectiveness was measured by algometry and the visual analogical scale (VAS). A total of 208 patients were included. The treatment A group showed an increase in threshold algometry of 53.4% (95% CI 47.1% to 59.7%) and a decrease in VAS of −68.6% (95% CI −74.5% to −62.7%) compared with the treatment B group (p < 0.001). Calcaneal apophysitis pain perception was improved in both groups, but children who used custom-made foot orthoses showed a greater improvement.

Conservative Treatment of Sever’s Disease: A Systematic Review

“…The mean methodological quality of all eight articles [ 26 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] demonstrated good methodological quality [ 31 ], with a mean PEDro score of 6.75 points, ranging from 4 to 11 points ( Table 2 ). In terms of bias, four articles were low risk [ 35 , 36 , 37 , 38 ], three were high risk [ 32 , 33 , 34 ], and one had some concerns [ 26 ] ( Figure 2 ).…”

“…In four of the articles studied [ 32 , 33 , 34 , 35 ], the sample was entirely male. In two others, it did not reach 30% of women [ 37 , 38 ]; in one of them, the percentage of females was 90.6% [ 36 ], and in just one, the sample was balanced, with 42% females [ 26 ]. In relation to age ranges, these ranged from 7 to 15 years old, with mean ages ranging from 10.3 ± 1.6 years [ 36 ] to 13.18 ± 2.15 [ 32 ].…”

“…Subjects were mostly recruited through clinics or hospital services, with medical diagnoses. Similarly, in most of the studies, the participants presented physically active subjects, specifying that they practiced physical activity between 2.7 and 3.7 h per week [ 38 ], which was unspecified but used as an inclusion criterion [ 37 ]. Also, children were recruited from different sports like soccer [ 32 ], high-level athletics [ 33 ], or barefoot sports (gymnastics, acrobatics, dance, or martial arts) [ 36 ].…”

Foot pain in children and adolescents: a problem-based approach in musculoskeletal ultrasonography

“…Treating Sever’s disease consists of a combination of multiple treatment modalities. Activity restriction, icing, heel cord stretching, immobilization, nonsteroidal anti-inflammatory drugs (NSAIDs), heel cups [ 22 , 23 ], and an X-brace [ 24 ] can be utilized to relieve pain [ 8 , 25 ].…”

‘Severs Disease’ – Manifestations & Management

“…A study comparing the utility of orthoses to physical therapy and rest and showed a significant reduction in pain levels with all modalities with no significant differences between them [16]. A randomized trial conducted among 208 children compared the effectiveness of heel lifts against custom orthotics and showed similar pain improvement but better overall outcomes with custom orthotics [17].…”