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Background
Sever's disease, is a musculoskeletal condition occurring in adolescence that symptomatically manifests as posterior heel pain during ambulation. Often participation in physical activity is severely limited resulting in frustration for children and parents alike. Conservative treatment options have included rest, abstinence from athletic activity, heel lifts, foot orthotic devices, ice, and calf-stretching exercise. The authors are proposing arch taping as an additional viable treatment option for controlling heel pain during athletic and other weight-bearing activities in patients with Sever's disease.
Objective
To assess the immediate impact of arch taping in controlling heel pain during ambulation in a group of subjects with Sever's disease and to discuss possible biomechanical explanations.
Methods and measures
Eleven subjects diagnosed with Sever's disease with a history of posterior heel pain were evaluated and treated by three different therapists in three different regions in the USA. Level of perceived pain during ambulation was reported before and immediately after arch tape application. The Wilcoxon Signed Ranks Test was utilized to assess pain reduction with significance set at p < 0.05 level and effect size was determined with Cliff's delta statistic.
Outcomes
Each subject reported an immediate reduction in heel pain during ambulation with arch taping. The median reduction in pain was 5 levels. Wilcoxon's statistic was significant with p = 0.001 and Cliff's delta revealed a value of 0.97 indicating a large pain reduction effect with arch taping.
Conclusions
The arch taping technique applied in this case series was effective in the immediate reduction of posterior heel pain during ambulation and allowed an early return to sports activities for those involved in athletics. This technique could be considered an additional treatment option for others with similar clinical presentations. Possible biomechanical explanations may relate to a windlass effect provided through the taping technique.
I always perform ankle manipulation and get these kids stretching. Orthotics can work very well also. I have never tried taping for Severs beause the tape comes off eventually and does not seem to last very long.
We use the tape and a 4mm heel lift just to show what the Orthosis can do as far as relieving the pain, some parents need to be convinced, it will also give them some pain free time until the Orthosis is ready, whilst stretching is started immediately and the slip on runners are burnt at the stake.
Sadly some football boots our young boys wear struggle to hold the foot and most wont hold an Orthosis, so we do a heel lift between the sole and the upper.
We currently do work with an AFL team (Pro Aussie rules football) in the same manner for posterior leg injuries
I am reading this thread with interest but I would like to enquire have you a particular heel raise material of choice? I note one poster advised felt, which I personally find may be of limited value with adolescents (sweaty individuals usually). Can you recommend a particular product or material for use as a heel raise.
Apologies if anyone feels the need to roll eyes at this post, just enquiring to those with greater experience than my own.
Thank you,
Regards,
__________________
:)
twirly
Mandy Brooks
Brooks Podiatry
S64 0DE
Suffering a fondness for odd things.
We rarely use taping for the reason Michael has mentioned.
Depending on ankle ROM and foot posture, orthoses with 6mm or 4mm eva heel raises are supplied alongside stretching for gastroc and soleus, but also hamstring.
Patients are then reviewed and raises are reduced as Ankle ROM increases and symptoms subside with good results.
I find similar problems as "boots n all" states that football boots lead to fitting problems, so i may re-visit the use of taping for these patients.
Any other materials used by anyone?
Does anyone have sucess with simple silicone heel raises??
Pending on what is at hand, say cork or EVA, but then again they will only have that heel lift for 1 week whilst l make the Orthosis, which is from a 400 EVA, with a heel lift attached too.
The amount of elevation is relative the the level of pain/tightness and reviewed in a couple of weeks.
As for the footballers, send me their boots and l will wave my magic wand for you
Hi Twirly
I usually use a prefabricated eva heel lift 6mm or 4mm and prescribe stretches with a review in 6 weeks. At the 6 week review if pain is gone I advise the removal of the heel lift and review in 2 weeks most often the pain hasn't returned, but if it has we try another couple of weeks in heel lifts and then on to orthotics if pain is still present.
I may also perform mobilisation at the first consult depending on the individual case.
Cheers
Iona
I see a few people on here use orthoses with a heel lift. Is there any evidence to suggest that this is better than just a simple heel lift with calf stretching?
My only evidence is via experience of patient outcomes, in that I find controlling any pronatory elements along side reduction of tensile stress to achilles insertion with the use of additional heel raise has yeilded faster results than simply with the use of a heel raise.
I also find better compliance as heel raises alone sometimes slip forward in footwear causing the patients to get fed up with having to remove footwear to re-adjust.
reduction of tensile stress to achilles insertion with the use of additional heel raise has yeilded faster results than simply with the use of a heel raise.
Heel raises do not decrease the tension in the achilles tendon and actually may increases it. See:
Quote:
Sharon J. Dixon; David G. Kerwin: The Influence of Heel Lift Manipulation on Achilles Tendon Loading in Running. JAB, 14(4), November 1998
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Have only managed to gain access to the abstract for "Sharon J. Dixon; David G. Kerwin: The Influence of Heel Lift Manipulation on Achilles Tendon Loading in Running. JAB, 14(4), November 1998 ".
Does the study suggest a mechanism/reason for this increased loading?
It is a fairly small study, but if it is the case that heel raises can lead to incresed loading, what can we attribute the reduction in symptoms gained with use of heel raises to (specifically for severs)?
Think about it intuitively .... why would the calf muscles contract with any less effort during gait, just because there is a heel raise in the shoe? Just because we have shortened the distance between origin and insertion does not mean that the effort expended by the calf muscles during gait is reduced. I started thinking about this a few years ago, but only met up with Sharon Dixon earlier this year and she pointed out the publication I missed. Yes it was a small sample, but the results are not necessarily counter-intuitive if you think about it.
Quote:
what can we attribute the reduction in symptoms gained with use of heel raises to (specifically for severs)?
Shock attenuation
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
ASICS have high hope for this as part of the management of Sever's - I see no reason why it would not be helpful
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Think about it intuitively .... why would the calf muscles contract with any less effort during gait, just because there is a heel raise in the shoe? Just because we have shortened the distance between origin and insertion does not mean that the effort expended by the calf muscles during gait is reduced.
I wouldn't expect that it would change the way the muscle contracts. But surely it would decrease the tension in the tight musculotendinous unit comparatively throughout gait. Though I haven't read the article.
I am not convinced that tight calf muscles are an issue in Severs. Afterall we are talking about a group of people in an age group which is generally pretty flexible. And don't forget what we now know about the subject specificness of ankle joint ROM and what is tight and what is not.
I know a lot of people claim they see tight calf muscles ....how do you know its just not appearing tight because of some sort of 'protective splinting' due to the painful heel ???
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
Think about it intuitively .... why would the calf muscles contract with any less effort during gait, just because there is a heel raise in the shoe? Just because we have shortened the distance between origin and insertion does not mean that the effort expended by the calf muscles during gait is reduced.
I agree with the above statement, but could it be argued that due to the shorteded distance, the effort expended is done so for a shorter time period and therefore the total effort/force is less than without the raise??
(not sure if my terminology is in the correct context here but I hope you can see the point i am trying to make???)
Last edited by Admin : 5th December 2007 at 06:16 AM.
Reason: fixed quote
Heel raises do not decrease the tension in the achilles tendon and actually may increases it.
Quote:
Originally Posted by Craig Payne
I know a lot of people claim they see tight calf muscles ....how do you know its just not appearing tight because of some sort of 'protective splinting' due to the painful heel ???
Geeeez paynie. There you go again provoking us; challenging us; pushing the envelope. Life was simple before you came along. Everyone had a forefoot varus; 10 degrees was the normal range for the ankle joint; heel raises worked; pronation caused HAV; the foot on the long leg pronated more to compensate
Seriously though, I envy your students. I just wish I had teachers that were this intellectually stimulating, while not necessarily agreeing with them
I agree with the above statement, but could it be argued that due to the shorteded distance, the effort expended is done so for a shorter time period and therefore the total effort/force is less than without the raise??
You could be right. It could be suggested that this is the case, but I am not aware of any EMG data that shows this, so we have to be cautious at jumping to any conclusions.
__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________ God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University This is where I am, where are you?
I am not convinced that tight calf muscles are an issue in Severs. Afterall we are talking about a group of people in an age group which is generally pretty flexible. And don't forget what we now know about the subject specificness of ankle joint ROM and what is tight
Agreed that we cannot make assumptions as to "normal ankle ROM" but there does seem to be correlation between what appears to be tight posterior muscle groups (hamstrings included) and incidence of Severs.
So much as we cannot say that these groups are specifically tight, because there is not a "normal" to compare with, there is correlation with onset of symptoms in some cases where parents quote a "growth spurt" - I know this may be subjective and contenscious, however rapid elongation of long bone in short time periods may, if there is any presence of it, lead to a comparative short term "shortening" of the musculature?
I have a feeling that with this statement i may be opening a can of worms, but hey the debate is interesting!!!
Taping and Sever's Disease
Life was simple before you came along. Everyone had a forefoot varus; 10 degrees was the normal range for the ankle joint; heel raises worked; pronation caused HAV; the foot on the long leg pronated more to compensate 
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