"Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever's disease): a systematic review".

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.

Conclusion: 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.