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Severs disease treatment

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  #1  
Old 8th February 2008, 01:38 AM
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Default Severs disease treatment

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I wish to tap the infinite wisdom of the community.

I have recently become aware of the case of a young lady of 8 yo who presents with a severe case of severs. She cannot "go out" at playtime much less do PE and her quality of life is being severely affected.

Her Podiatrist has (i am told) put her in a night splint to dorsiflex the foot to 90 degrees (which is the full available dorsiflexion).

This is not a treatment i have come across before and i am a little confused by it. I would have imagined dorsiflexing the foot will apply more tensile stress on the growth plate and impeed healing.

1. Is there anyone who can explain this technique to me?

2. If you use any AFO type devices for severs what have you found to be most effective?

3. What treatments have you found to be most effective.

Regards
Robert
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  #2  
Old 8th February 2008, 02:02 AM
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Default Re: Severs disease treatment

Related threads:
Taping and Sever's Disease
Is Severs Disease a stress fracture?
Ketoprofen and Severs Disease
Pronation control for in toeing adolescent with Severs disease
Risk factors for Sever's disease
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  #3  
Old 8th February 2008, 02:13 AM
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Default Re: Severs disease treatment

I seen a young girl recently who presented with severes disease.

Background

played a lot of sport on hard surfaces, netball, basketball and tennis

bio exam revealed fully comp R/F varus.

poor footwear.


Having never treated severs before i went to the uni notes. (never came accross AFOs in my search for treatments!)

My experience

I got the patient into a good pair of cross training shoes with good cushioned soles i then used off the shelf orthotics with a 4mm heel lift with much success.

i recently reviewed her and she is pain free.

to be honest my idea or thinking was that i was reducing excessive pronation and decreasing tension on the achillies tendon. however, i have recently seen posts on this site claiming that heel lifts do not decrease tension on the achillies tendon and may actually increase the load.

Sharon J. Dixon; David G. Kerwin: The Influence of Heel Lift Manipulation on Achilles Tendon Loading in Running. JAB, 14(4), November 1998

i guess the heel raise in increasing cushioning/shock attenuation.

In this case i believe footwear played a major role in relieving her symptoms.
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  #4  
Old 8th February 2008, 12:58 PM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Robertisaacs View Post
Her Podiatrist has (i am told) put her in a night splint to dorsiflex the foot to 90 degrees (which is the full available dorsiflexion).
I have never heard of that before, nor do I necessarily see a need for it. I can not understand the rationale for it.
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Old 9th February 2008, 03:16 AM
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Default Re: Severs disease treatment

Hi Robert,

The biggest challenge I face in pts with severs disease is compliance. Often, the children I treat with this condition want to run around in thongs/barefoot on hard surfaces which makes it difficult to treat. Despite this though, stretching, ice, activity modification, orthotics in conjunction with heel raises and the correct footwear help wonderfully if adhered to properly.

I don't understand the logic behind the use of a night splint. The only reason I can think of is that the podiatrist who prescribed the night splint must believe that the condition is more to do with a tight gastrocnemius-soleus-achilles tendon complex which is certainly not the case. I've tried searching the literature to see if their is any evidence but have found nothing thus far.

In addition, making sure that both the child and parent are educated is important too. I've had some blank looks before when trying to explain what's happening. I routinely use previous x-ray examples to demonstrate the actual problem. I have found this to be very helpful.

Regards,

Daniel
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Old 9th February 2008, 09:24 AM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Robertisaacs View Post
I wish to tap the infinite wisdom of the community.

I have recently become aware of the case of a young lady of 8 yo who presents with a severe case of severs. She cannot "go out" at playtime much less do PE and her quality of life is being severely affected.

Her Podiatrist has (i am told) put her in a night splint to dorsiflex the foot to 90 degrees (which is the full available dorsiflexion).

This is not a treatment i have come across before and i am a little confused by it. I would have imagined dorsiflexing the foot will apply more tensile stress on the growth plate and impeed healing.

1. Is there anyone who can explain this technique to me?

2. If you use any AFO type devices for severs what have you found to be most effective?

3. What treatments have you found to be most effective.

Regards
Robert

Robert:

Contrary to the others, using a plantar fasciitis night splint to treat Sever's disease does make sense to me, but using a night splint would not be my preferred method of treatment for this disease entity.

I treat many cases of Sever's disease. Most cases of Sever's disease respond well to reducing the tensile force on the Achilles tendon so that the shearing stress is reduced on the calcaneal apophysis. I first of all give them 1/4" (6 mm) heel lifts to wear at all times, have them do gastrocnemius and soleus stretches 2-3 times per day, have them ice the posterior heel 20 minutes twice a day, avoid barefoot activities and reduce their running activities initially. If they do not respond to this protocol, then I will try an over-the-counter foot orthosis or custom foot orthosis and may have them totally cut out all running activities for at least 2 weeks. In more extreme cases, I will put them into a below-knee fiberglass cast for 3-6 weeks which works quite well for the more severe cases of Sever's disease.

I have frequently used plantar fasciitis night splints in treating athletes with chronic Achilles tendinitis which does work, in some cases, quite well. The theory is that a low level ankle joint dorsiflexion moment over time will place enough tensile force on the gastrocnemius-soleus-Achilles tendon (GSAT) complex to prevent accommodative shortening of the GSAT at night while the patient sleeps so that there will be less tensile force acting within the Achilles tendon during athletic activities during the day. The same mechanics should hold true for using a night splint in Sever's disease, but I have never used night splints in treating Sever's disease. Using a night splint certainly can't hurt the patient. Maybe I'll give a night splint a try on the next patient I have with Sever's disease.

Considering the known time-dependent viscoelastic properties of ligaments and tendons such as stress-relaxation, where tendons and ligaments experience a decrease in tensile force over time when stretched to a given length, and creep, were tendons and ligaments stretch further over time when subjected to a given tensile loading force, why wouldn't a night splint reduce the tensile force on the Achilles tendon also? If these splints work for plantar fasciitis, they should work for Sever's disease, since there is a direct relationship between Achilles tendon tensile force and plantar fascial tensile force during weightbearing activities (Carlson RE, Fleming LL, Hutton WC: The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle. Foot Ankle Intl., 21:18-25, 2000; Erdimir A, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA: Dynamic loading of the plantar aponeurosis in walking. JBJS, 86A:546-552, 2004).

Here is some additional reading for those of you who want to learn more about the time-dependent viscoelastic properties of ligaments and tendons.

http://www.asbweb.org/conferences/2001/pdf/179.pdf

http://www.engin.umich.edu/class/bme...ten/ligten.htm

http://jeb.biologists.org/cgi/reprint/201/1/135.pdf

http://www3.interscience.wiley.com/c...29117/ABSTRACT

http://ttb.eng.wayne.edu/~grimm/BME5370/Lect5Out.html

http://www.chiroweb.com/archives/11/04/27.html

http://www.medscape.com/viewarticle/440810_5

http://repositoryaut.lconz.ac.nz/con...e/viewcontent/

http://www.ingentaconnect.com/conten...format=pri nt

http://books.google.com/books?id=nIN...KKXg#PPA379,M1

http://www.ncbi.nlm.nih.gov/sites/en... ndexed=google

http://proceedings.jbjs.org.uk/cgi/c...SUPP_III/236-c
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Last edited by Kevin Kirby : 9th February 2008 at 10:17 AM.
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  #7  
Old 1st May 2008, 02:09 AM
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Default Re: Severs disease treatment

Has anyone heard or used OSCON tablets ?? yvonnespod
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Old 1st May 2008, 04:36 PM
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Default Re: Severs disease treatment

Quote:
Originally Posted by yvonnespod View Post
Has anyone heard or used OSCON tablets ??
It a vitamin e derivative. How will something like that come close to helping Severs - a mechanical problem? Put it in the snake oil category.
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Old 1st May 2008, 06:37 PM
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Default Re: Severs disease treatment

I treat Sever’s disease by first making a pair of orthoses, and if there is equinus, I will treat that also.
The whole idea is to decrease compression forces at the metaphysis. The tension from the plantar fascia is a distal directed vector, and the tension from the Achilles is a vertical vector. The combined vector is angled upwards and distally, so as to cause a compression of the metaphysis.
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Old 4th May 2008, 03:47 AM
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Default Re: Severs disease treatment

I have found with the drought here in Australia that there has been an increase in sever's issues is this something that others are finding as well.

For football players i.e. soccer and rugby I also advise them to stop wearing the boots for training and only wear them for games.

Also any thoughts on the latest offering from ASICS football boots with 10mm heel gradient ?
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Old 4th May 2008, 09:12 AM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Mark Egan View Post
I have found with the drought here in Australia that there has been an increase in sever's issues is this something that others are finding as well.

For football players i.e. soccer and rugby I also advise them to stop wearing the boots for training and only wear them for games.

Also any thoughts on the latest offering from ASICS football boots with 10mm heel gradient ?
Mark,

It would seem that because of the drought the ground is harder, so the spikes do not penetrate the gound as well. That means that the heel and forefoot are being raised.
Put the shoe on a hard level surface and push down on the shank from the inside of the boot. If the shank is not rigid, then this is your problem. You can place some material in the arch area to mimic the shape of the deformation, or under the orthosis if the patient already has one
The real answer would be if Asics were to put another spike in the middle of the arch.

Regards,

Stanley
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Old 4th May 2008, 09:19 PM
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Default Re: Severs disease treatment

G'day all,

Interesting idea using a night splint for the management of Sever's. I can undertand the rationalle, given the relationship between equinus and traction on the growth plate (1). I always make a point of my Sever's management to include a stretching program to reduce the constant traction on the growth plate by lengthening the achillies, and can see how one could reason that night splinting can assist with stretching. However... we must remember that Sever's is an acute apopsitis injury due to trauma and traction, with inflammation, that may lead to avascular necrosis to the growth plate(2). It is important to attempt to lengthen the achillies to reduce the pull on the growth plate, but my fear with a constant protracted stretch for several hours each night will just contribute to the problem, especially in cases when there is signifant avascular necrosis, and thus a reduction in the overall tensile strength of what is already a stretched growth plate. I also tend to use 9mm PPT poron heel cushions in the absence of other mechanical abnormalities with good success. Failure to respond to these usually sees my patients in orthoses, but as this is often a developmental disorder, they will generally outgrow the Sever's in time.

Cheers!



(1) Szames S et.al. 1990 "Sever's disease and its relationship to equinus: a statistical analysis" Clin Podiatr Med Surg Apr 7:(2) pp 377-84
(2)Hendrix C. 2005 "Calcaneal Apopysitis" Clin Podiatr Med Surg Jan 22: (1) pp. 55-62
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  #13  
Old 5th May 2008, 02:53 PM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Robertisaacs View Post
I have recently become aware of the case of a young lady of 8 yo who presents with a severe case of severs. She cannot "go out" at playtime much less do PE and her quality of life is being severely affected.
Robert,

I see quite a bit of Severs. With "severe" cases where the child comes in limping with the aforementioned quality of life issues, I recommend a short leg cast for 3-4 weeks. In uber-compliant kids and fracture boot may suffice- but most will remove this frequently. After casting, proceed with what has been mentioned- stretching, heel lifts, ice, and perhaps physio referral.

Nick
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Old 5th May 2008, 08:13 PM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Kevin Kirby View Post
The theory is that a low level ankle joint dorsiflexion moment over time will place enough tensile force on the gastrocnemius-soleus-Achilles tendon (GSAT) complex to prevent accommodative shortening of the GSAT at night while the patient sleeps so that there will be less tensile force acting within the Achilles tendon during athletic activities during the day. The same mechanics should hold true for using a night splint in Sever's disease, but I have never used night splints in treating Sever's disease. Using a night splint certainly can't hurt the patient. Maybe I'll give a night splint a try on the next patient I have with Sever's disease.

Considering the known time-dependent viscoelastic properties of ligaments and tendons such as stress-relaxation, where tendons and ligaments experience a decrease in tensile force over time when stretched to a given length, and creep, were tendons and ligaments stretch further over time when subjected to a given tensile loading force, why wouldn't a night splint reduce the tensile force on the Achilles tendon also? If these splints work for plantar fasciitis, they should work for Sever's disease, since there is a direct relationship between Achilles tendon tensile force and plantar fascial tensile force during weightbearing activities (Carlson RE, Fleming LL, Hutton WC: The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle. Foot Ankle Intl., 21:18-25, 2000; Erdimir A, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA: Dynamic loading of the plantar aponeurosis in walking. JBJS, 86A:546-552, 2004).
Kevin,

How does a night splint cause stetching of the gastroc, if the patent bends their knee when sleeping?

Stanley
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Old 5th May 2008, 09:04 PM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Stanley View Post
Kevin,

How does a night splint cause stetching of the gastroc, if the patent bends their knee when sleeping?

Stanley

If the patient keeps their knees flexed all night, then the night splint would mostly stretch the soleus and Achilles tendon. However, if they keep their knees extended, the night splint would mostly stretch the gastrocnemius and Achilles tendon. That is why I very cleary stated in my posting the following: "The theory is that a low level ankle joint dorsiflexion moment over time will place enough tensile force on the gastrocnemius-soleus-Achilles tendon (GSAT) complex to prevent accommodative shortening of the GSAT at night while the patient sleeps so that there will be less tensile force acting within the Achilles tendon during athletic activities during the day."
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Old 6th May 2008, 08:15 PM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Kevin Kirby View Post
If the patient keeps their knees flexed all night, then the night splint would mostly stretch the soleus and Achilles tendon. However, if they keep their knees extended, the night splint would mostly stretch the gastrocnemius and Achilles tendon. That is why I very cleary stated in my posting the following: "The theory is that a low level ankle joint dorsiflexion moment over time will place enough tensile force on the gastrocnemius-soleus-Achilles tendon (GSAT) complex to prevent accommodative shortening of the GSAT at night while the patient sleeps so that there will be less tensile force acting within the Achilles tendon during athletic activities during the day."
Kevin,

The muscle we are concerned with is the tightest structure of the gastrocnemius-soleus-Achilles tendon. I find that this is the gastrocnemius, as dorsiflexion increases in the ankle with the knee flexed, not with the knee extended.
As far as people sleeping with the knee extended, unless they sleep on their back this will not happen. It is recommende that people sleeping on their back put a pillow under their knees to reduce the stress on their back (this also flexes the knee). http://www.romow.com/health-blog/dif...ition-for-you/
Furthermore, my patients do not tolerate night splints that are tight enough to cause stetching.
You obviously get different results. How exactly do you have the patients apply their night splints?
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Old 7th May 2008, 08:44 AM
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Default Re: Severs disease treatment

Stanley,

I use night AFO's to help adults and children who present with tight Gastrocs secondary to a variety of underlying neurological problems. Although the AFO's are primarily designed to be worn at night time I advise patients to wear them for an hour or 2 during the day and encourage both walking and long leg sitting (while watching TV). Using a dorsiflexion assist "Tamarack" ankle joint can be useful and will provide a continuous dorsiflexion stretch.

A leg gaiter can also be used at night time to resist knee flexion and ensure that the Gastroc remains stretched.

With suitable wearing guidlines compliance and tolerance with these devices never seems to be an issue,

Regards

Declan
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Old 7th May 2008, 08:07 PM
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Quote:
Originally Posted by deco View Post

A leg gaiter can also be used at night time to resist knee flexion and ensure that the Gastroc remains stretched.
Declan,

What you say makes sense. However, most podiatrists do not use leg gaiters, and they still get good results. It would make one think that possibly there is another mechanism.

Regards,

Stanley
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Old 16th May 2008, 04:04 PM
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Default Re: Severs disease treatment

Sever’s Disease: What Does the Literature Really Tell Us?
Rolf W. Scharfbillig, Sara Jones and Sheila D. Scutter
Journal of the American Podiatric Medical Association; Volume 98 Number 3 212-223 2008
Quote:
Background: Sever’s disease is typical of many musculoskeletal conditions where observational annotations have slowly been accepted as fact with the passing of years. Acceptance of these nontested observations means that health professionals seeking information on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series.

Methods: A comprehensive review of the literature was undertaken gathering available articles and book references relating to Sever’s disease. This information was then reviewed to present what is actually known about this condition.

Results: Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition.

Conclusion: The level of evidence for most of what we purport to know about Sever’s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment
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Old 8th June 2008, 02:36 PM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Craig Payne View Post
It a vitamin e derivative. How will something like that come close to helping Severs - a mechanical problem? Put it in the snake oil category.
I noticed your "snake oil" comment about Oscon from a couple of years ago. It told me two things:

1. You have never utilized it.

2. You have no problem passing judgement and issuing opinions on techniques that you know little or nothing about!

I'm sorry if that seems harsh, but I have employed Oscon in many thousands of cases of Severs and Osgood-Schlatter and Severs disease SUCESSFULLY!

If you are willing to learn what it is, as well as how and why it works just email me with any questions. I can also give you users in your area.

Gary Nelson
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Pediatric Sports Therapy
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Old 8th June 2008, 03:10 PM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Gary Nelson View Post
I noticed your "snake oil" comment about Oscon from a couple of years ago. It told me two things:

1. You have never utilized it.

2. You have no problem passing judgement and issuing opinions on techniques that you know little or nothing about!

I'm sorry if that seems harsh, but I have employed Oscon in many thousands of cases of Severs and Osgood-Schlatter and Severs disease SUCESSFULLY!

If you are willing to learn what it is, as well as how and why it works just email me with any questions. I can also give you users in your area.

Gary Nelson
Biochemist
Pediatric Sports Therapy

Gary:

You wouldn't happen to sell Oscon for a profit, would you?? If you are coming onto this site for the first time to tell how great a product is, and don't have any financial interest in the product, then that is one thing. However, we already have enough individuals who sell a certain product, then come onto this website to tell us how great it is, and then offer us a website we can purchase it....and help line their wallets for them.

Which one is it Gary? Do you sell Oscon or not?? My snake oil sensor alarm is starting to go off...

By the way, Gary, you may not be harsh...but I am.
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Old 8th June 2008, 03:16 PM
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Craig Payne Craig Payne is offline
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Default Re: Severs disease treatment

Quote:
Originally Posted by Gary Nelson View Post
I noticed your "snake oil" comment about Oscon from a couple of years ago. It told me two things:

1. You have never utilized it.
You right I have not used it and at this stage have no plans to start sing it (or buying it from your website).
Quote:
2. You have no problem passing judgement and issuing opinions on techniques that you know little or nothing about!
Please provide the references to randomised controlled clinical trials that it it better than placebo for Severs. Please provide references to credible pathophysiological mechanism by which a vitamin can affect the mechanical nature of Severs.
Quote:
I'm sorry if that seems harsh, but I have employed Oscon in many thousands of cases of Severs and Osgood-Schlatter and Severs disease SUCESSFULLY!
You do realise that by making such a claim without the references, you are just confirming the snake oil nature of this product (there are planty of tutorials on the web on how to recgnise snake oil, eg Spotting Quackery Online; Peddlers, Scammers, and Snake Oil... oh my!; Snake Oil Tutorial). You also help confirm the snake oil perception by posting here with the sorts of comments that you did and not declaring your vested finanical interest in selling the product.

I will be one of the first to use any product or method when the clinical research evidence supports it. In the absence of evidence I use methods or products I am comfortable using then when there is a clear pathphysiological or pathomechanical rationale to them, that is theorectical coherent and biologically plausible. I can see neither for this product.
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Old 8th June 2008, 03:27 PM
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Default Re: Severs disease treatment

Quote:
Originally Posted by Kevin Kirby View Post
You wouldn't happen to sell Oscon for a profit, would you?? If you are coming onto this site for the first time to tell how great a product is, and don't have any financial interest in the product, then that is one thing. However, we already have enough individuals who sell a certain product, then come onto this website to tell us how great it is, and then offer us a website we can purchase it....and help line their wallets for them.
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Originally Posted by Craig Payne View Post
Y...(or buying it from your website).
How any times have we been around this track?
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  #24  
Old 8th June 2008, 09:09 PM
Gary Nelson Gary Nelson is offline
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Default Re: Severs disease treatment

Quote:
Originally Posted by Craig Payne View Post
You right I have not used it and at this stage have no plans to start sing it (or buying it from your website) .Please provide the references to randomised controlled clinical trials that it it better than placebo for Severs. Please provide references to credible pathophysiological mechanism by which a vitamin can affect the mechanical nature of Severs.You do realise that by making such a claim without the references, you are just confirming the snake oil nature of this product (there are planty of tutorials on the web on how to recgnise snake oil, eg Spotting Quackery Online; Peddlers, Scammers, and Snake Oil... oh my!; Snake Oil Tutorial). You also help confirm the snake oil perception by posting here with the sorts of comments that you did and not declaring your vested finanical interest in selling the product.

I will be one of the first to use any product or method when the clinical research evidence supports it. In the absence of evidence I use methods or products I am comfortable using then when there is a clear pathphysiological or pathomechanical rationale to them, that is theorectical coherent and biologically plausible. I can see neither for this product.
1. I am not asking you to use it or buy it. I only would like a fair, unbiased opinion based on fact, not on unsubstantiated prejudice. I do distribute the product, but I was not aware that profit was forbidden, or even a valid basis for criticism.

2. I'll try to make it simple for you. Severs is only initiated by trauma at the tendon's insertion point. The reason it does not heal is because of a persistent inflammatory condition at the site. Osgood-Schlatter is a similar situation.
The inflammation is caused by Reactive Oxygen Species and Lipid Peroxyl Radicals, and their subsequent propagation. Remove the inflammatory situation and the injury heals. The University of Southern California's School of Pharmacy published the following explanation of the action of the ingredients in Oscon:

Reaction of antioxidant compounds with oxyradical species
Reactive oxygen species (ROS) are represented by activated forms of oxygen (oxyradicals or monovalent reduction products of oxygen) and organic radicals and peroxides that are produced by reaction with oxyradicals. Figure 9 (33 Kb) shows the stages for monovalent reduction of oxygen, indicating the oxyradicals (O2-., superoxide radical; .OH, hydroxyl radical) and ROS (H2O2). Also shown at the bottom are the various common biological sources for these ROS. These ROS can oxidize cell proteins (particularly sulfhydryl-rich proteins) leading to inactivation. They also readily react with and oxidize unsaturated lipids. This process is facilitated by transition metals such as iron and copper, or by heme proteins where the metal in these heme proteins are oxidized to hypervalent states that readily attack unsaturated lipids.
Figure 10 describes the steps involved in the oxidation of a typical unsaturated fatty acid, linoleic acid. The first product is a lipid peroxyl radical, derived from oxygen addition to the lipid alkyl radical intermediate which arises by reaction of the lipid with the ROS or hypervalent metal. The peroxyl radical rapidly reacts with another lipid to generate a new peroxyl radical and a lipid hydroperoxide. This reaction proceeds at a rate constant of 106 moles/sec and represents the kinetic stages for the propagation of lipid peroxidation. By these reactions lipid hydroperoxides accumulate, leading to the deterioration of the lipid and formation of organic ROS that account for many of the biological effects noted above.

Inhibition of lipid peroxidation by specific antioxidants: the special role of vitamin E and selenium

It is at this stage that vitamin E and related antioxidants exert an inhibitory effect. By reacting with the lipid peroxyl radical at a rate constant faster than reactions of lipid peroxyl radical with other lipids (ie. 109 moles/sec) vitamin E has a strong kinetic advantage in suppressing the propagation of lipid peroxidation. Moreover, the limited formation of hydroperoxides by reaction with vitamin E is readily managed by reactions with peroxidases, key among which are the selenium containing glutathione peroxidases which convert the potentially reactive lipid hydroperoxides to nonreactive lipid alcohols.

I myself am more interested in the truth than in any "randomised controlled clinical trials ", but I will make you this offer:

I will provide you with whatever quantity of Oscon that you feel is necessary for you yourself to adequately test it and form your own substantiated opinion of the product. In the process I am sure you will help relieve over 90% of the non-placebo group, as well as gain knowledge that will help many others.
What do you have to lose? You can then form a valid opinion based on the facts, rather than on outside or prejudicial influences. I am aware that there are "snake-oil' salesment on the internet. I am not one of them. I had Severs and Osgood-Schlatter myself some 50+ years ago. I fully understand the frustration and recall the pain that accompanies such conditions.

Here are some responses from Australia:
Hi Gary, My son Tim began to take OSCON about 10 days ago. When I ordered OSCON my husband said "Here we go, you've fallen for another scam!" But I didn't care because Tim, who is a keen runner and footballer, needed something. We are all amazed. The pain is gone, though as your email says the bump is still slightly tender. Thank you, I will be ordering another course to be certain of a good recovery.
Jenny M., Lambton, Australia

Dear Gary
Thanks for your reply. Oscon is nothing short of a miracle. My daughter felt an improvement on day one of taking it. On day 2 she was pain free. My husband can't believe it. In fact, when I had first showed him the Oscon website he suggested that he could sit down and write all those testimonies in an afternoon.
Although I did find one discrepancy in the testimonies, I felt that they had the ring of truth about them and I had no doubt that Oscon would work. I am very glad that you included all those testimonies on your website because I would not have bought the Oscon (and my daughter wouldn't be where she is now) if I hadn't read all the testimonies. When I first saw Oscon, I immediately discounted it as something to try. But as I read through the testimonies, I realised that here was something that could work. It is as amazing as an antibiotic - the patient is immediately better when they take it!! (Note: Recovery times do vary. It usually takes more than one day)
Oscon has saved our family from months of stress and misery. My daughter's Olympic dreams may have ended. There is no way that my daughter could have coped with the workload expected by the High Performance coaches with the amount of pain she was in. She would have been absolutely devastated.
Thank you for your truly amazing, remarkable product.
Judy B., Mudgeeraba, Queensland, Australia

Gary,

I wish to give you some feedback.

My 13 yo daughter had Severs and plays at an elite level of tennis and predominantly on hard courts. She could not train for extended periods without severe pain. She has been taking the Oscon for a month now and the pain is gone. We have also reduced the number of hours on court, ice the heel after play and she has been working regularly with a physio. We are all very pleased with the outcome.
From your notes below, it seems that we could reduce the dosage to 1 per day.
I look forward to your further advice.
Regards,

Philip K., Buderim, Australia


Dear Gary,

My 13 year old boy is extremely talented in track & field, and has been frustrated with not been able to compete this season due to Severs. After three weeks of taking Oscon, and seeing a physiotherapist twice a week, he is almost pain free. He has been able to run sprints and hurdles, with hardly any pain, and has just been selected in the State team, to compete in the Nationals in hurdles. I am so glad I came across your website, and in desperation, decided to give Oscon a go. My son is just about to finish his first bottle, and I have ordered another one, so he will be able to compete in the Nationals without any problems. I just wanted to say thank you very much, and you may use this on your website.
Kind Regards,

Raine Mitchell, (Melbourne, Australia)

I have 90 pages of such testimonials. If you want to see more, I will gladly share them.

By the way, I did not post a website to purchase it did I? It may have been in my profile though.

Please do not hold such a negative opinion without justification, and I hope that you take me up on my offer to run your own trial. Not to make money hand over fist (or should I more aptly say "head over heels"?), but to help the many thousands of young athletes that needlessly suffer for months with apophyseal injuries like Severs.

Oscon is theoretically coherent and biologically plausible. Why not find out for yourself?

Sincerely,
Gary Nelson

Last edited by Gary Nelson : 8th June 2008 at 10:46 PM.
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  #25  
Old 8th June 2008, 09:46 PM
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Default Re: Severs disease treatment

Quote:
Severs is only initiated by trauma at the tendon's insertion point. The reason it does not heal is because of a persistent inflammatory condition at the site. Osgood-Schlatter is a similar situation.
The inflammation is caused by Reactive Oxygen Species and Lipid Peroxyl Radicals, and their subsequent propagation. Remove the inflammatory situation and the injury heals.
Hi Gary,
Do you have a reference for the above statements?
I am keeping an open mind, but I have similarly fantastic results by decreasing the mechanical load on on the tendo-achilles insertion (as I am sure most of the contributors on this forum do- it is not something I regard as a challenging problem...)
Interested that you also claim brilliant results also with Osgood-schlatters. This is regarded by some as an indicator of a high risk of patella tendon pathology later in life... can you fix that too? Then I will be impressed...
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Old 8th June 2008, 10:25 PM
Gary Nelson Gary Nelson is offline
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Default Re: Severs disease treatment

Inflammation is generally regarded as a given. See http://www.footpaininfo.com/seversdisease.html

In my experience Severs is eliminated by Oscon within 2-8 weeks. Without it 6 months is not uncommon. Osgood-Schlatter is controlled in about the same time with Oscon. Without it 18 months seems to be the "average", and I have seen it persist for 4-6 years!!

Most health professionals do not regard either condition as compelling problems, maybe because both are considered to be self limiting. However for the youngster with these conditions they can be a considerable hardship.

Some researchers feel that up to 60% of those who had Osgood-Schlatter as a youth may have some discomfort as adults. See: http://www.intelihealth.com/IH/ihtIH/WS/9339/31201.html (Near bottom of page.)

I myself avoid kneeling on hard surfaces, as I have the "souvenir" osteophytes on both tibial tuberosities! Also there is a genetic component. It does run in families, and a child that has had Severs is more likely to develop OSD that one that did not have it. "Same church, different pew". By the way, Ischial Apophysitis is similar, although rarer, and can be treated the same way.

Here is a sports medicine Podiatrist who can tell you of his own successful experiences with Oscon:

Name: Dr. Todd Flitton, DPM
Address: 507 Anita Dr.
City, St. ZIP: Kaysville, Utah 84037
Country: UnitedStates
Telephone: 8017734840
E-Mail Address: my234pr@aol.com


Need a sample?

Best regards,
Gary Nelson

Last edited by Gary Nelson : 8th June 2008 at 10:41 PM.
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Old 8th June 2008, 10:49 PM
CraigT CraigT is offline
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Default Re: Severs disease treatment

Quote:
The inflammation is caused by Reactive Oxygen Species and Lipid Peroxyl Radicals, and their subsequent propagation
Pardon my ignorance, but is this different from other types of inflammation? Do you have any reference differentiating this from other inflammatory problems in the body?

Quote:
Most health professionals do not regard either condition as compelling problems
Not this little black duck.

Quote:
In my experience Severs is eliminated by Oscon within 2-8 weeks.
In my experience it is 1-2 weeks with control of mechanical overload.

Unfortunately (or fortunately...?) Severs is not a problem I have seen much of in Qatar up to this point so no need for a sample at this stage. This may be due to most of the local population not knowing what a Sports Podiatrist is (yet!) and not seeking treatment. If I find that I am having a lot of these cases, then perhaps I will run a trial for you. Otherwise I would suggest a double blind randomised control trial run in conjunction with a University like La Trobe (which is where Craig Payne is( and me originally))... They did do this a few years back to test claims that wheat grass extract cured plantar fasciitis (it did no better than placebo).
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Old 9th June 2008, 01:05 AM
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Default Re: Severs disease treatment

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Originally Posted by Gary Nelson View Post
1 I'll try to make it simple for you. Severs is only initiated by trauma at the tendon's insertion point. The reason it does not heal is because of a persistent inflammatory condition at the site.
Where are you getting your information from? Severs has nothing to do with the tendon's insertion. Published studies using MRI have shown the pathology to be in the metaphysis - thats a long way from the tendon insertion. Do you have some published research showing otherwise? I did not know Severs was even an inflammatory process. Do you have a published reference to support that claim? (Osgood Schlatters is a different beast and is an inflammatory process)
Quote:
I myself am more interested in the truth than in any "randomised controlled clinical trials ",
You need to follow those links on how to recognise snake oil. You just proved again what I was saying by making all the claims you do.
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Old 9th June 2008, 06:48 AM
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Default Re: Severs disease treatment

Since you are the self-professed "Professor of Life, The Universe and Everything" I expected you to be a "tough sell'. However I stand by my experiences in treating Severs and Osgood-Schlatter.

Severs is initiated by an injury, followed by inflammation and subsequent edema.

Quote:
Q. Where are you getting your information from? A. Since I have researched this problem for over 20 years, I have dozens, if not hundreds of sources.
One is: http://www.med.umich.edu/1libr/sma/sma_calcapop_sma.htm

Q. Severs has nothing to do with the tendon's insertion. Published studies using MRI have shown the pathology to be in the metaphysis - thats a long way from the tendon insertion. Do you have some published research showing otherwise?
A. See: http://www.hawaii.edu/medicine/pedia...ray/v1c20.html

I did not know Severs was even an inflammatory process. Do you have a published reference to support that claim? (Osgood Schlatters is a different beast and is an inflammatory process)

Severs and Osgood-Schlatter are almost identical conditions.
From the US National Institutes of Health: http://www.ncbi.nlm.nih.gov/pubmed/8900359
Question: Why are anti-inflammatories suggested?
Answer: To treat the inflammation.
Also see: http://www.fpnotebook.com/Ortho/Ankle/SvrsDs.htm

An inflammatory process inhibits rapid healing in both conditions.

More information: http://www.ncbi.nlm.nih.gov/pubmed/7762480

In some ways you remind me of my father. Two of his favorite statements were:

"My mind is made up, don't confuse me with the facts."
and "Even if it was good, I wouldn't like it."

But let's not get caught up in the minutiae. Either Oscon works or it does not. I know it works, are you willing to test it?

You are a DPM, and I am a biochemist. It is natural that we would follow different paths to different destinations. I do not reject your methods because they are different than mine, and would hope that you would be a little more open to other modalities. If I were trying to "steal" someone's hard earned money I would likely be trying to sell something that made them skinnier, richer, sexier or enlarged certain parts of their anatomy. I am a lot more altruistic than that, and I had hoped that you would be as tolerant of my efforts as I am of yours.

Gary Nelson
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Old 9th June 2008, 07:15 AM
Gary Nelson Gary Nelson is offline
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Default Re: Severs disease treatment

Quote:
Originally Posted by CraigT View Post
Pardon my ignorance, but is this different from other types of inflammation? Do you have any reference differentiating this from other inflammatory problems in the body?


Unfortunately (or fortunately...?) Severs is not a problem I have seen much of in Qatar up to this point so no need for a sample at this stage. This may be due to most of the local population not knowing what a Sports Podiatrist is (yet!) and not seeking treatment. If I find that I am having a lot of these cases, then perhaps I will run a trial for you. Otherwise I would suggest a double blind randomised control trial run in conjunction with a University like La Trobe (which is where Craig Payne is( and me originally))... They did do this a few years back to test claims that wheat grass extract cured plantar fasciitis (it did no better than placebo).
Inflammation is inflammation. The exact chemistry may vary, but the basics are the same. So does Oscon work in other types of inflammation? I would be the first to say that it is not a panacea. But I have received reports from people with various problems such as shin splints, rib fractures, knee replacement and others who are convinced that it made a huge difference in their cases. I do not however feel comfortable recommending it for conditions where I do not have hundreds of valid reports to rely upon.

I agree that there is more "sizzle than steak" in wheatgrass.

Now if someone would consent to a double blind randomised control trial I would be ecstatic. However it seems that almost all current trials are being done by drug companies who pay huge sums to their researchers. True?
I have yet to find anyone who does such work for the sake of science. I hope to someday soon. Maybe someone in this arena could point me in the proper direction?
Keep in mind that I am just one small company that has the objective of helping young athletes overcome their conditions as rapidly and economically as possible. I have been lucky enough to have enough good DNA (MENSA qualified), and persistent (stubborn swede) enough to come up with an honestly valid tool to help in cases of apophyseal injury.

Best regards,
Gary Nelson
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