Some time ago 10 year old Thomas was successfully managed with the use of orthotics for Sever's and general biomechanical issues. I have followed him up yearly since (3 years now) and he still is entirely symptom free and will not be active without his orthotics. I have remade them twice since (foot growth).
Today I received an email from his mom,
"Please will you advise what we should do in the following situation:
Thomas played a game of touch rugby barefoot during PT at school just over two weeks ago. Later that afternoon he played a hockey match and his right foot suddenly became very painful causing him to come off the field for a while before going back on again. We assumed he must have hurt it by running around barefoot during the touch rugby and applied Voltaren Emugel and waited for it to heal. When it was still very painful a week later, I took him to our GP who thought it was a soft tissue injury and prescribed anti-inflammatories. He was of the opinion that Thomas shouldn't wear his orthotics all the time as the muscles/ligaments would not strengthen to support the foot properly and he didn't think playing barefoot would have caused the problem.
When it was still very painful a week later (it was fine to walk on, but was very sore when he played hockey), I took him for an x-ray where they said the following:
"A healing fracture of the third metatarsal mid shaft is noted. Endosteal and periosteal callus formation is present. The general alignment of the metatarsal bone is good. No intra-articular extension."
A healing fracture is noted. This may be stress related."
The GP then conceded that the barefoot touch rugby probably caused a stress fracture, maybe because his foot was weak because he usually plays all sport in his orthotics. He has been booked off hockey for about four weeks, but he is still attending his swimming training (using a pull buoy and not kicking at all). One of the swimming moms is a GP and she didn't think he should wear his orthotics now while the bone is healing.
Please advise on whether he should or should not still be wearing the orthotics in his shoes all the time (he had Kohler's disease and Severs about three years ago - both totally resolved - but he is also extremely pro-nated), and also whether there is anything we should be doing to facilitate the healing process.[/color]
Besides the obvious
, I would like the opportunity to 'educate' the GP and so need any and all studies (more than the few I have been able to find) that prove the opposite.