FPIN's Clinical Inquiries

Treatment for Calcaneal Apophysitis

 

Am Fam Physician. 2017 Jul 15;96(2):126-127.

Clinical Question

What are effective therapies for calcaneal apophysitis (Sever disease)?

Evidence-Based Answer

Several treatments for calcaneal apophysitis may produce modest short-term improvements in pain scores. Heel inserts and prefabricated orthotics may initially improve pain scores and dysfunction, but patients have equal improvement by three months with or without therapy. (Strength of Recommendation: B, based on a comparison study and secondary outcomes of an unblinded randomized controlled trial.)

Evidence Summary

A clinical trial comparing the effectiveness of inserts and footwear for persons with calcaneal apophysitis found that two inserts were associated with improved pain scores.1 The study included 124 children eight to 14 years of age with a clinical diagnosis of calcaneal apophysitis who were recruited from health clinics in Melbourne, Australia. Patients were randomized to one of four treatments: two types of shoe orthoses (heel inserts made of shock-absorbing ethylene vinyl acetate or prefabricated polyurethane orthotics) and two types of footwear (current footwear vs. new athletic shoes). The patients were followed for 12 months. The primary outcome was disability and pain as measured by the 24-point physical domain portion of the validated Oxford Ankle Foot Questionnaire for Children, which assesses pain, soreness, and leg fatigue while standing and during activity throughout the day. Scores improved for all patients by approximately 15% (absolute) at one month and by 30% at two months. Patients using heel inserts had statistically significant (P = .04) but clinically unimportant (3%) improvement at one and two months compared with those using orthotics, regardless of footwear. Footwear changes produced no difference. Scores did not improve in any group after two months.

One research team published three small trials on treatments for calcaneal apophysitis that showed modest short-term improvements in heel pain.24 The first compared two types of

Address correspondence to Katherine Uvelli, MD, at kuvelli@gmail.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. James AM, Williams CM, Haines TP. Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial. Br J Sports Med. 2016;50(20):1268–1275....

2. Perhamre S, Janson S, Norlin R, Klässbo M. Sever's injury: treatment with insoles provides effective pain relief. Scand J Med Sci Sports. 2011;21(6):819–823.

3. Perhamre S, Lundin F, Norlin R, Klässbo M. Sever's injury; treat it with a heel cup: a randomized, crossover study with two insole alternatives. Scand J Med Sci Sports. 2011;21(6):e42–e47.

4. Perhamre S, Lundin F, Klässbo M, Norlin R. A heel cup improves the function of the heel pad in Sever's injury: effects on heel pad thickness, peak pressure and pain. Scand J Med Sci Sports. 2012;22(4):516–522.

5. Wiegerinck JI, Zwiers R, Sierevelt IN, van Weert HC, van Dijk CN, Struijs PA. Treatment of calcaneal apophysitis: wait and see versus orthotic device versus physical therapy: a pragmatic therapeutic randomized clinical trial. J Pediatr Orthop. 2016;36(2):152–157.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review. The strength of recommendations and the level of evidence for individual studies are rated using criteria developed by the Evidence-Based Medicine Working Group (http://www.cebm.net/?o#1025).

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or e-mail: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at http://www.aafp.org/afp/fpin.

Copyright Family Physicians Inquiries Network. Used with permission.

 

 

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