Prevalence and Associated Factors of Sever's Disease in an Athletic Population

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

Various etiologies and risk factors contribute to foot pain in children and adolescents, including conditions such as Kohler's disease, Sever's disease, Iselin's disease, rigid flat foot, accessory navicular, Freiberg's disease, sesamoiditis, os trigonum syndrome, and more. High-frequency musculoskeletal ultrasonography can show both the bone surface and the surrounding soft tissue clearly from various angles in real-time, thereby providing a higher level of detail that is helpful for identifying the etiology of foot pain and monitoring disease progression compared with other imaging modalities. This review provides an overview of the epidemiology, pathophysiology, clinical manifestations and characteristic ultrasonographic findings of select foot pain conditions in children and adolescents.

Conservative Treatment of Sever's Disease: A Systematic Review

Background: Sever's disease, or calcaneal apophysitis, stands as the most prevalent cause of heel pain in children, often linked to sports like soccer, Australian football, and basketball. While various therapies are documented in the scientific literature, the standard choice is conservative treatment. Thus, the objective of this research was to assess the effectiveness of diverse conservative methods and techniques in alleviating Sever's disease symptoms. Methods: Systematic searches were conducted in October 2023 in PubMed, Web of Science, Scopus, SportDiscus, and PEDro, using terms like Osteochondritis, Osteochondrosis, Apophysitis, Sever's disease, Calcaneus, Adolescent, Child, and Childhood. The PEDro scale gauged methodological quality, and the Cochrane Risk of Bias tool evaluated the risk of bias. Results: Eight randomized controlled studies were included, featuring commonly used treatments such as insoles, therapeutic exercises, Kinesio taping, and foot orthoses. The methodological quality was generally good, with an average PEDro score of 6.75 points. Regarding bias, four articles had low risk, three had high risk, and one had some concern. Conclusions: Conservative treatment emerges as an effective option for alleviating symptoms associated with Sever's disease.

Characteristics of Pressure on the Apophysis in the Course of Paediatric Heel Pain-Preliminary Report

Increased pressure on the heel apophysis is often implicated as a cause of paediatric heel pain. However, there are few reports on the causes of the increased pressure and its origin. Therefore, the aim of this study was to analyse the distribution of pressure on the feet in children with heel pain. The study included 33 paediatric patients with non-traumatic heel pain, i.e., 24 boys (73%) and 9 girls (27%), aged on average 11.2 years (±3 years). Pedobarographic diagnostics proved a decrease in the pressure on the heels in relation to the ground and the transfer of the projection of the centre of gravity to the forefoot. While standing, the average contribution of the pressure on the heel was 0.52, SD = 0.14 in children with normal and reduced weight. In overweight children, the average pressure on the heel was higher (0.60, SD = 0.08), but the small number of children with this characteristic (n = 4) did not allow conclusions to be drawn in this area. Heel underload was also demonstrated during gait. However, the assessment of this aspect requires additional observational analyses in the field of propulsion and gait phases. The reduced pressure on the heel promotes apophysis traction, causing intracanal compression. Studies have shown that the causes of apophysis traction may be postural defects (in particular, forward inclination of body posture) and overpronation of the foot, or defects in the metatarsal area.

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.