title: "Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review".
abstract: BACKGROUND
  Calcaneal apophysitis, also commonly known as sever's disease, is a condition seen in children usually aged between 8-15 years. Conservative therapies, such as taping, heel lifts and orthotic intervention are accepted management practices for calcaneal apophysitis, though there is very little high quality research examining the efficacy of such treatment modalities. Previous narrative literature reviews and opinion pieces provide some evidence for the use of heel raises or orthoses. The aim of this manuscript was to complete a systemic review on the treatment options for calcaneal apophysitis as measured by pain reduction and maintenance of physical activity.
  
  
  METHODS
  A search strategy completed by two reviewers examined nine databases from inception to May 2012. Search terms included heel pain, children, adolescent, calcaneal apophysitis, sever's disease, treatment, and management (full text publications, human studies). Systematic reviews, randomised control trials, case series, and case studies were included. The reference lists of the selected articles were also examined. The methodology, quality and risk of bias was examined and assessed using the PEDro scale.
  
  
  RESULTS
  Nine articles were retrieved including three clinical trials involving randomisation, two case series, two retrospective case reviews, and two case reports. Effect size calculations and a meta analysis were unable to be completed due to the limited data reported within the literature. Numerous treatment options were reported throughout the literature, though few were examined against a control or alternate treatment option in well-designed trials. The limited evidence indicated that orthoses provided greater short-term pain relief than heel raises. Health practitioners should view these results with caution, as there were apparent methodological problems with the employed study design and limited follow-up of participants.
  
  
  CONCLUSIONS
  There is limited evidence to support the use of heel raises and orthoses for children who have heel pain related to calcaneal apophysitis. Further research is needed to generate higher quality evidence with larger sample sizes, and validated measures of pain and function to establish effective treatment approaches for children with calcaneal apophysitis.
authors: Podiatry, Peninsula Health Service, Melbourne, Australia. AliciaJames@phcn.vic.gov.au.
authors: Alicia M
authors: AM
authors: James
authors: Cylie M
authors: CM
authors: Williams
authors: Terry P
authors: TP
authors: Haines
references: Scand J Med Sci Sports. 2011 Dec;21(6):819-23
references: 20492591
references: Pediatr Clin North Am. 1996 Oct;43(5):1013-33
references: 8858071
references: Clin Podiatr Med Surg. 2005 Jan;22(1):55-62, vi
references: 15555843
references: Lancet. 2002 Feb 16;359(9306):614-8
references: 11867132
references: Orthop Clin North Am. 1987 Oct;18(4):649-66
references: 3313167
references: Foot Ankle Clin. 2007 Jun;12(2):363-79, viii
references: 17561207
references: JAMA. 2001 Apr 18;285(15):1992-5
references: 11308436
references: Phys Ther. 2003 Aug;83(8):713-21
references: 12882612
references: Phys Ther. 2006 Mar;86(3):424-33
references: 16506878
references: J Pediatr Orthop. 1984 Nov;4(6):711-4
references: 6511899
references: Clin Sports Med. 1988 Jul;7(3):563-89
references: 2900075
references: Arch Phys Med Rehabil. 1987 May;68(5 Pt 1):298-301
references: 3579537
references: J Orthop Sports Phys Ther. 1990;11(9):410-3
references: 18787273
references: Clin Sports Med. 1992 Oct;11(4):713-26
references: 1423694
references: J Am Podiatr Med Assoc. 2011 Jan-Feb;101(1):17-24
references: 21242466
references: J Foot Ankle Res. 2010 Mar 02;3:3
references: 20196866
references: Phys Sportsmed. 1993 Apr;21(4):89-91
references: 27447771
references: J Pediatr Orthop. 2004 Sep-Oct;24(5):488-92
references: 15308897
references: Am Fam Physician. 1996 Nov 1;54(6):1995-2000
references: 8900359
references: Br J Sports Med. 1982 Sep;16(3):161-8
references: 7139227
references: AMIA Annu Symp Proc. 2006;:359-63
references: 17238363
references: Br J Sports Med. 1978 Mar;12(1):4-10
references: 24489
references: J Athl Train. 2004 Jan;39(1):77-82
references: 16558682
references: Am Fam Physician. 1995 Jun;51(8):1891-5, 1897-8
references: 7762480
references: J Pediatr Orthop. 1987 Jan-Feb;7(1):34-8
references: 3793908
references: Foot (Edinb). 2009 Mar;19(1):36-43
references: 20307447
references: Aust J Physiother. 2009;55(2):77-8
references: 19463077
references: Open Access J Sports Med. 2010 Dec 06;1:223-32
references: 24198561
references: J Bone Joint Surg Am. 1966 Jan;48(1):66-71
references: 5902799
references: Pediatrics. 1998 Dec;102(6):E63
references: 9832591
references: Can J Appl Sport Sci. 1981 Sep;6(3):123-5
references: 7296746
references: Scand J Med Sci Sports. 2012 Aug;22(4):516-22
references: 21410537
references: J Chiropr Med. 2004 Spring;3(2):66-8
references: 19674626
references: Orthop Clin North Am. 2003 Jul;34(3):405-15
references: 12974490
references: Scand J Med Sci Sports. 2011 Dec;21(6):e42-7
references: 20673253
references: J Am Podiatr Med Assoc. 2008 May-Jun;98(3):212-23
references: 18487595
references: Foot Ankle Int. 2010 Aug;31(8):725-8
references: 20727323
references: J Appl Biomech. 2009 Feb;25(1):54-63
references: 19299830
references: Arch Intern Med. 2006 Jun 26;166(12):1305-10
references: 16801514
references: Curr Opin Pediatr. 2004 Feb;16(1):47-50
references: 14758113
references: Clin Sports Med. 1985 Oct;4(4):641-55
references: 4053193
references: Arch Orthop Trauma Surg. 2002 Jul;122(6):338-41
references: 12136298