Practice: Resonance Podiatry and Gait Labs
Patient: 12 year old male rugby player
Sever’s disease (also known as a calcaneal apophysitis) is one of the most common causes of heel pain in growing children, usually occurring between the ages of 8-15 years. It is an inflammation of the growth plate in the calcaneus (heel) caused by repetitive stress to the heel usually during a growth spurt. It is more likely to be seen in children who are active in sports such as football (soccer).
Current Situation
12 year old male, Rugby player. Extremely hard playing surfaces due to drought. Pain in the posterio-plantar aspect of calcaneus. The patient also presented with:
Tibial valgum
Negative Lunge test
Low supination resistance
Trendelenberg with single knee bend
Thomas test negative
Anterior pelvic tilt
Core weakness
Tight hip flexors
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Proximal weakness is driving functional pronation moments.
Reduced calf/ Achilles length is traction at calcaneal apophysis.
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Assessment
Clinical symptoms & gait pattern
X-ray films to rule out other conditions
Calcaneal apophysitis - ‘Severs’
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Treatment
Formthotics
Formthotics dual density were selected to increase shock absorption, maintain fatty pad of heel under calcaneus. Increase weight bearing surface of foot, control excessive pronation and to increase cushioning.
A lateral forefoot post from styloid was also added to the Formthotics.
Other treatment modalities
Ice
Tuli Heel Cups
Stretching & Strengthening Exercises - calf complex
Results
80% improved
Some soreness with rugby only, which settles quickly
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