Heel Pain in Youth: A Guide to Potential Management Strategies

Calcaneal apophysitis, or Sever\u27s disease, is common among physically active youth between the ages of 8~15. This condition is related to skeletal growth during maturation and relief often comes once growth is complete. However, it is not feasible to limit participation in physical activity until growth ceases; therefore, it is important to determine effective interventions to regulate pain while continuing participation. A search of the literature yielded nine studies that met the inclusion criteria and were included for data analysis. Within these publications, many treatment methods were suggested, including nonsteroidal anti-inflammatory drugs (NSAIDs), taping, orthoses, heel lifts, stretching, activity modification, and ice. However, few of the treatment options were compared with a control group. Analysis revealed that clinicians should provide treatments with caution when treating patients suffering from Sever\u27s disease, understanding that strong evidence is not supportive of one treatment option alone. Data are limited for individual treatments related to calcaneal apophysitis and more research in this area is warranted. Clinicians should work with patients on an individual basis to determine if one form of treatment provides a reduction of pain and allows that patient to continue with activity. © 2014 Human Kinetics

Sever's injury; treat it with a heel cup: a randomized, crossover study with two insole alternatives

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children. Common advice is to reduce physical activity. However, our previous study showed that application of insoles reduced pain in Sever's injury without having to reduce physical activity. The purpose of this study was to test which of the two insoles, the heel wedge or the heel cup, provided best pain relief during sport activity in boys with Sever's injury (n = 51). There was a crossover design in the first randomized part of the study. In the second part, the boys, 9-14 years, chose which insole they preferred. There was a reduction in odds score for pain to a fifth (a reduction of 80%) for the cup compared with the wedge (P&lt;0.001). When an active choice was made, the heel cup was preferred by &gt;75% of the boys. All boys maintained their high level of physical activity throughout. At 1-year follow-up, 22 boys still used an insole and 19 of them reported its effect on pain as excellent or good (n = 41).</p

A heel cup improves the function of the heel pad in Sever's injury: effects on heel pad thickness, peak pressure and pain

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. Treating Sever's injury with insoles is often proposed as a part of a traditional mix of recommendations. Using a custom-molded rigid heel cup with a brim enclosing the heel pad resulted in effective pain relief without reducing the physical activity level in our previous two studies. The purpose of this study was to assess the effect of the heel cup on heel pad thickness and heel peak pressure (n=50). The difference in heel pad thickness and in heel peak pressure using a sports shoe without and with a heel cup was compared. With the heel cup the heel pad thickness improved significantly and the heel peak pressure was significantly reduced. These effects correlated with a significant reduction in pain when using the heel cup in a sports shoe, compared with using a sports shoe without the heel cup. A heel cup, providing an effective heel pad support in the sports shoe, improved the heel pad thickness and reduced heel peak pressure in Sever's injury with corresponding pain relief.</p