Treatment of Sever's Disease:
A Therapeutic Randomized Clinical Trial
Wait and See versus Orthotic device versus Physical Therapy

Sever*s disease (calcaneal apophysitis) is a traction epiphysitis of calcaneus.
Sever*s disease is a common injury. Symptoms present around the age of 7-15
years in boys and 8-13 year in girls. The incidence of Sever*s disease in
musculoskeletal injuries has been reported to be between 2 and 16% and is the
most common cause of heel pain in the growing child. It is known to have a
severe impact on the quality of life of the patients.
Most of the data on effectiveness of treatments are retrospective and based on
clinical notes and describe mainly the incidence, symptoms and sex ratio for
Sever*s disease. As there is currently no scientific evidence for the treatment
of Sever*s disease, the treatment has been described as *a guessing game*.
The current treatment, based on marginal scientific evidence is focused on
conservative treatment: rest, sport cessation and extensor strengthening; heel
lifts; orthoses; stretching and padding of the heel. Most studies report a
large decline of pain symptoms after a treatment period of 4-17 weeks. In our
centre the most often provided treatment is either the prescription of rest and
sports cessation with aditional strengthening of the extensor lower leg
muscles, heel lift inlays, or stretching exercises for the lower leg muscles.

The goal of this trial is to find the best available conservative treatment,
based on subjective pain scores, for children with Sever*s disease. Our primary
objective is to score the possible decrease of pain experienced by the
subjects. This will be measured using two questionnaires:
*VAS Pain score for pressure pain at the insertion of the Achilles tendon
*Oxford Ankle and Foot Score

A therapeutic randomized controlled trial, with an intervention period of 10
weeks will be finished after a follow-up period of 12 months. Three different
treatment methods will be evaluated during the trial: prescribed stretching
exercises, rest and sports cessation for 10 weeks; a continuously worn
customized heel raise inlay; supervised strengthening (10 sessions during 10
weeks).

Subjects allocated to the heel raise group will need to wear a customized heel
raise inlay throughout the whole study period (10 weeks)

The treatment is the current treatment (same as the non-research setting), we
expected subjects to have a decrease of pain complains, regardless of which
treatment they will receive.
Subjects in group 2 (heel raise) may need to grow accustomed to their heel
raised shoe. This may be experienced as a burden for subjects. To subjects
allocated to group 3 (strengthening program), the first exercise sessions may
result in muscle-ache. This should subside as the program continues.