A heel cup improves the function of the heel pad in Sever's injury: effects on heel pad thickness, peak pressure and pain.

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. Treating Sever's injury with insoles is often proposed as a part of a traditional mix of recommendations. Using a custom-molded rigid heel cup with a brim enclosing the heel pad resulted in effective pain relief without reducing the physical activity level in our previous two studies. The purpose of this study was to assess the effect of the heel cup on heel pad thickness and heel peak pressure (n=50). The difference in heel pad thickness and in heel peak pressure using a sports shoe without and with a heel cup was compared. With the heel cup the heel pad thickness improved significantly and the heel peak pressure was significantly reduced. These effects correlated with a significant reduction in pain when using the heel cup in a sports shoe, compared with using a sports shoe without the heel cup. A heel cup, providing an effective heel pad support in the sports shoe, improved the heel pad thickness and reduced heel peak pressure in Sever's injury with corresponding pain relief.

Sever's injury: treatment with insoles provides effective pain relief.

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. The traditional advice is to reduce and modify the level of physical activity. Recommended treatment in general is the same as for adults with Achilles tendon pain. The purpose of the study was to find out if insoles, of two different types, were effective in relieving heel pain in a group of boys (n=38) attending a Sports Medicine Clinic for heel pain diagnosed as Sever's injury. The type of insole was randomized, and self-assessed pain during physical activity in the treatment phase with insoles was compared with pain in the corresponding pre- and post-treatment phases without insoles. There were no other treatments added and the recommendations were to stay on the same activity level. All patients maintained their high level of physical activity throughout the study period. Significant pain reduction during physical activity when using insoles was found. Application of two different types of insoles without any immobilization, other treatment, or modification of sport activities results in significant pain relief in boys with Sever's injury.

Sever's injury; treat it with a heel cup: a randomized, crossover study with two insole alternatives.

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children. Common advice is to reduce physical activity. However, our previous study showed that application of insoles reduced pain in Sever's injury without having to reduce physical activity. The purpose of this study was to test which of the two insoles, the heel wedge or the heel cup, provided best pain relief during sport activity in boys with Sever's injury (n=51). There was a crossover design in the first randomized part of the study. In the second part, the boys, 9-14 years, chose which insole they preferred. There was a reduction in odds score for pain to a fifth (a reduction of 80%) for the cup compared with the wedge (P<0.001). When an active choice was made, the heel cup was preferred by >75% of the boys. All boys maintained their high level of physical activity throughout. At 1-year follow-up, 22 boys still used an insole and 19 of them reported its effect on pain as excellent or good (n=41).

WOMAC osteoarthritis index. Reliability, validity, and responsiveness in patients with arthroscopically assessed osteoarthritis. Western Ontario and MacMaster Universities.

OBJECTIVE: To validate the WOMAC Osteoarthritis Index for use in Sweden. METHODS: Test-retest reliability, internal consistency, validity, and responsiveness was determined in 52 patients (mean age 48 (20-69)) with arthroscopically assessed cartilage damage of the tibio-femoral knee joint. RESULTS: All WOMAC scales were internally consistent with Cronbach's alpha coefficients of 0.83, 0.87, and 0.96 pre-operatively. Test-retest reliability was satisfactory with intraclass correlation coefficients of 0.74, 0.58, and 0.92. As hypothesized worse post-operative but not pre-operative outcomes were associated with radiographic OA. In comparison with the SF-36 the expected correlations were found when comparing items measuring similar and dissimilar constructs, supporting the concepts of convergent and divergent construct validity. Three months after arthroscopy significant mean improvement was seen in all WOMAC scales (p<0.0004). CONCLUSION: The Swedish version of WOMAC is a reliable, valid, and responsive instrument with metric properties in agreement with the original widely used version.