Incidence of calcaneal apophysitis in Northwest Istanbul

International differences and inaccuracies in the public advertising about calcaneal apophysitis: an audit of websites originating in Australia, UK and USA

BACKGROUND

Calcaneal apophysitis is a common condition in childhood. Parents often seek online information for children's' health care concerns prior to seeking care. Therefore, we aimed to evaluate the credibility, readability, and accuracy of calcaneal apophysitis advertising on popular websites in three countries.

METHODS

We used content analysis of publicly accessible data. This involved identifying the top 50 websites in each country from their hit rates. We used elements of validated tools to audit and determine frequencies relevant to credibility (e.g. publisher), readability (e.g. literacy score) and accuracy (e.g. alignment with evidence). Data were analysed quantitatively and reported against each element.

RESULTS

Websites were predominantly hosted by private health services (n = 118, 79%). The mean (SD) SMOG (readability) score was 9.3 (4.5). The majority of websites (n = 140, 93%) provided at least one treatment recommendation, and less than 10% (n = 11) of websites advertised treatments fully aligned with evidence. Use of treatment modalities without evidence and with high risk to children were also found including surgery, extracorporeal shock wave therapy and laser.

CONCLUSIONS

Calcaneal apophysitis online advertising is mostly curated by clinicians. Clinicians should consider revising online advertising to increase understandability and accuracy to reduce health care wastage, risk, and low value care.

Describing Frequencies of Lower-Limb Apophyseal Injuries in Children and Adolescents: A Systematic Review

OBJECTIVE

To describe the frequency with which children are affected by lower-limb apophyseal injuries, and subgroups at greater risk.

DESIGN

Systematic review.

SETTING

N/A.

PARTICIPANTS

N/A.

INTERVENTIONS

N/A.

MAIN OUTCOME MEASURES

Systematic review of Medline OVID, PsycINFO, Cinahl, and PubMed from inception until February 21st, 2020. Articles reporting prevalence and/or incidence of an apophyseal injury (eg, calcaneal apophysitis) or its eponym (Severs or Sever disease). Per person data relating to the incidence or prevalence. Subgroup comparisons were made between sex groups and between activity participant groups.

RESULTS

There was wide variation in measurement approaches and follow-up timeframes with the majority of studies reporting on traction apophysitis of the tibial tubercle (Osgood-Schlatter disease). This condition had a point prevalence of 10% in the general population of children between the ages of 12 and 15 years, whereas the lifetime incidence has been reported as 13%. Point prevalence was higher among those who participated in sport compared with those who did not {relative risk [95% confidence interval (CI): 1.98 (1.31-2.99)]}, whereas lifetime incidence was higher among those who participated in sport at the age of 13 years compared with those who did not [relative risk (95% CI): 4.63 (2.31-9.26)]. Other apophyseal injuries did not report enough data to permit comparisons.

CONCLUSION

Sports participation is likely to substantially increase the frequency of traction apophysitis of the tibial tubercle. Further research is required with standardized approaches to compare frequencies between different apophyseal injuries and subgroups of interest.

Incidence of calcaneal apophysitis (Sever's disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years

Background

Calcaneal apophysitis, or Sever's disease, is the most common cause of heel pain in childhood and adolescence. It is regarded as an overuse syndrome. Studies on the incidence of calcaneal apophysitis in young athletes and their associated return-to-play time are lacking in the current literature. The aim of our current study was to identify the incidence of calcaneal apophysitis in professional youth soccer, the associated time to return-to-play, predisposing factors and their impact on time to return-to-play.

Methods

Retrospective evaluation of injury data gathered from a German youth soccer academy in the years 2009–2018. In total, 4326 injury cases in 612 players were included in the study. The diagnosis and the follow-up visits were carried out in a weekly consultation hour at the youth academy.

Results

During the observation period of 10 years, 22 cases of calcaneal apophysitis were detected. The incidence of calcaneal apophysitis per 100 athletes per year was found to be 0.36. The mean age of the affected athletes at the time of diagnosis was 11.8 ± 2.1 years (MW ± SD). The complaints were unilateral in 20 and bilateral in two cases. Three of the 22 detected cases of calcaneal apophysitis (13.6%) were recurrent injuries. The mean time to return-to-play of the affected athletes was 60.7 ± 64.9 days (MW ± SD). Athletes with recurrent complaints showed longer recovery time and time to return-to-play when compared to players with primary diagnosed disease. Our results could show that neither age nor body mass index at the time of diagnosis had an impact on time to return-to-play.

Conclusions

This is the first study investigating the incidence of calcaneal apophysitis and the associated time to return-to-play in youth elite soccer. Calcaneal apophysitis results in substantial time loss for the athletes. Further prospective clinical studies are required to fully understand the etiology and risk factors for calcaneal apophysitis and therefore develop preventive strategies.

Effects of custom-made insoles on foot pressure redistribution, gait parameters, and pain in calcaneal apophysitis-a pretest and posttest study

BACKGROUND

Calcaneal apophysitis is a self-limiting disorder that often affects adolescents with a high level of activity and leads to increased pain severity, impairments in gait parameters, and poor health-related quality of life.

OBJECTIVE

To investigate the combination of custom-made insoles and exercise on foot pressure distribution, spatial-temporal gait parameters, and pain intensity in patients with calcaneal apophysitis.

STUDY DESIGN

A one-group pretest-posttest design.

METHODS

Forty patients, aged between 8 and 15 years, diagnosed with calcaneal apophysitis, were included in this study. Patients were asked to use the custom-made insoles and to perform a home exercise program for 3 days a week. The duration of treatment was 4 weeks. The pain severity was evaluated with the Visual Analog Scale. The spatial-temporal gait parameters and foot pressure distribution were assessed with the Zebris FDM-THM-S treadmill system before and after the treatment.

RESULTS

At posttreatment assessment, there were significant changes in step length, stance phase percentage, swing phase percentage, and gait speed (P < 0.05), except step width and cadence (P > 0.05). Moreover, significant differences were found in forefoot, midfoot, and rearfoot pressure distribution (P < 0.05). There was also a significant decrease in pain intensity during activity compared to the pretreatment (P < 0.05).

CONCLUSION

Our study results suggest that the combination of the custom-made insoles and exercise program created improvements in spatial-temporal gait parameters and foot pressure distribution by reducing the pain severity.

Radiographic study of Sever's disease

X-ray and MRI differences of calcaneal epiphysis between Sever's disease patients and normal children were compared and analyzed to raise awareness of Sever's disease. A total of 98 children with Sever's disease were enrolled in the study, including 72 males and 26 females. Among them, 6 patients underwent MRI. There were 120 patients in the control group, including 73 males and 47 females, aged 8 to 15 years. The calcaneus epiphysis density (compact and cancellous bone type), the difference of the radiolucent line and the signal changes of Sever's disease on MRI of the two groups were observed and analyzed. Among the patients with Sever's disease, the male incidence rate was 79.59%, the female incidence rate was 20.41%, the average age of onset was 11.35, the average age of onset for male was 11.49, and the average age of onset for female was 10.80. There were significant statistical differences between the two groups in terms of epiphysis density (compact and cancellous type) and translucent line (χ²=38.85, 137.51, P<0.05). Six cases of MRI showed partial or complete different degrees of bone marrow, ligament, soft tissue edema, and joint effusion. Sever's disease is mainly characterized by increased density of the calcaneus epiphysis and a radiolucent line of the epiphysis. It manifests as heel edema on MRI image.