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Severs Disease Traction apophysitis at the Achilles Tendon Insertion Presentation 12 year old male Rugby player Extremely hard playing surfaces due to drought Pain - posterio-plantar aspect of calcaneus Negative Lunge test

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  1. Sever’s Disease Traction apophysitis at the Achilles Tendon Insertion

  2. Presentation  12 year old male  Rugby player  Extremely hard playing surfaces due to drought  Pain - posterio-plantar aspect of calcaneus

  3. Negative Lunge test • Low supination • resistance Trendelenberg with • single knee bend Thomas test negative • Tibial valgum

  4. Anterior pelvic tilt • Core weakness • Tight hip flexors • Proximal weakness is driving functional pronation moments. Reduced calf/ Achilles length is ^ traction at calcaneal apophysis.

  5. Assessment & Differential Diagnosis  Clinical symptoms & gait pattern  Xray films to rule out other conditions  Calcaneal apophysitis- ‘severs’

  6. Orthotic Therapy Formthotics  Why were Formthotics used? – Increase shock absorption – Maintain fatty pad of heel under calcaneus – Increase weight bearing surface of foot – Control excessive pronation  What density was used and why? – DUAL – For above reasons and for increased cushioning  What postings were used? – Lateral forefoot post from styloid

  7. Other treatment modalities  Ice  Tuli Heel Cups  Stretching & Strengthening Exercises- calf complex

  8. Results  80% improved  Some soreness with rugby only, which settles quickly

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