Sever’s 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 • Low supination • resistance Trendelenberg with • single knee bend Thomas test negative • Tibial valgum
Anterior pelvic tilt • Core weakness • Tight hip flexors • Proximal weakness is driving functional pronation moments. Reduced calf/ Achilles length is ^ traction at calcaneal apophysis.
Assessment & Differential Diagnosis Clinical symptoms & gait pattern Xray films to rule out other conditions Calcaneal apophysitis- ‘severs’
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
Other treatment modalities Ice Tuli Heel Cups Stretching & Strengthening Exercises- calf complex
Results 80% improved Some soreness with rugby only, which settles quickly
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