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- Author or Editor: Rolf Scharfbillig x
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Sever’s Disease
A Prospective Study of Risk Factors
Background: Sever’s disease, also known as calcaneal apophysitis, is thought to be an inflammation of the apophysis of the heel, which is open in childhood. This condition has been commented on and looked at in a retrospective manner but has not been examined systematically. We assembled the most commonly cited theoretical causative models identified from the literature and tested them to determine whether any were risk factors.
Methods: Children with Sever’s disease were compared with a similarly aged nonsymptomatic population to determine whether identifiable risk factors exist for the onset of Sever’s disease. Areas raised in the literature and, hence, compared were biomechanical foot malalignment, as measured by Root et al–type foot measurements and the Foot Posture Index; ankle joint dorsiflexion, measured with a modified apparatus; body mass index; and total activity and types of sport played.
Results: Statistically significant but small odds ratios were found in forefoot to rearfoot determination and left ankle joint dorsiflexion.
Conclusions: This study suggests that there is no evidence to support that weight and activity levels are risk factors for Sever’s disease. The statistically significant but clinically negligible odds ratio (0.93) on the left side for decreased ankle joint dorsiflexion and statistically significant and clinically stronger odds ratio bilaterally for forefoot to rearfoot malalignment suggest that biomechanical malalignment is an area for further investigation. (J Am Podiatr Med Assoc 101(2): 133–145, 2011)
Background
The neutral calcaneal stance position (NCSP), despite its known issues, is currently used as an “ideal” measure compared with the resting stance position in clinical podiatric medicine. The nonweightbearing (NWB) foot position, as used in the foot mobility magnitude (FMM), can provide an alternative comparative position, which is partially validated, if a significant correlation between the NCSP and the NWB position exists. This study aimed to establish the correlation between the component measures of the FMM in the NCSP and the NWB foot position of the FMM.
Methods
Eighty participants were recruited. Measures of dorsal arch height (DAH) and midfoot width (MFW) were obtained at the 50% total foot length mark in the NCSP and the NWB position by two examiners using the apparatus described by McPoil et al.
Results
Reliability analysis with intraclass correlation coefficients (ICCs) indicated intrarater results of 0.90 to 0.99 for DAH and 0.96 to 0.99 for MFW and interrater results of 0.90 for DAH and 0.96 for MFW in the NWB position. Using a Pearson product moment correlation coefficient analysis, there was a significant correlation between the NCSP and the NWB position for DAH (r = 0.82) and MFW (r = 0.86).
Conclusions
A significant correlation between the NCSP and the NWB position was evident when the measures of DAH and MFW were conducted. Therefore, clinically, the NWB position can potentially replace the NCSP as the ideal position for clinical treatment.
Measurement of Foot Dorsiflexion
A Modified Lidcombe Template
The Lidcombe template was introduced in 1991 for the nonweightbearing assessment of ankle joint dorsiflexion, and it has shown excellent reliability in impaired and unimpaired adult populations. We discuss limitations of the original template and test the reliability of a modified apparatus in an adolescent population. Intrarater and interrater reliability were assessed for 14 children (28 limbs) aged 7 to 14 years, returning intraclass correlation coefficient (1,1) results of greater than 0.99 for both aspects of reliability. (J Am Podiatr Med Assoc 94(6): 573–577, 2004)
Effectiveness of Two Moisturizers in the Treatment of Foot Xerosis
A Randomized Clinical Trial
Background:
Xerosis (dryness) of the foot is commonly encountered in clinical care and can lead to discomfort, pain, and predisposition to infection. Many moisturizing products are available, with little definitive research to recommend any particular formulation.
Methods:
We compared two commonly prescribed moisturizing products from different ends of the price spectrum (sorbolene and 25% urea cream) for their effectiveness in reducing xerosis signs using the Specified Symptom Sum Score. A randomized clinical trial of parallel design was conducted over 28 days (February–May 2015) on 41 participants with simple xerosis. Participants, therapists, assessors, and data entry personnel were blinded to treatment, and allocation was determined via a randomization table.
Results:
Thirty-four participants completed the study (19 urea and 15 sorbolene), with one reporting minor adverse effects. There were statistically significant improvements in both groups after 28 days. Mean differences between pre and post scores were 3.50 (95% confidence interval [CI], 2.80 to 4.20) for the urea group and 2.90 (95% CI, 2.00 to 3.80) for the sorbolene group. There was a slightly lower mean posttreatment score in the urea group (1.16; 95% CI, 0.67 to 1.64) than in the sorbolene group (1.80; 95% CI, 1.25 to 2.35), but this difference was not significant (P ≤ .09). Effect size of difference was –0.48 (95% CI, –1.16 to 0.22).
Conclusions:
In this study, there was no difference between using sorbolene or 25% urea cream to treat symptoms of foot xerosis. A recommendation, therefore, cannot be made based on efficacy alone; however, sorbolene treatments are invariably cheaper than urea-based ones.
Background: Sever’s disease is typical of many musculoskeletal conditions where observational annotations have slowly been accepted as fact with the passing of years. Acceptance of these nontested observations means that health professionals seeking information on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series.
Methods: A comprehensive review of the literature was undertaken gathering available articles and book references relating to Sever’s disease. This information was then reviewed to present what is actually known about this condition.
Results: Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition.
Conclusion: The level of evidence for most of what we purport to know about Sever’s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment. (J Am Podiatr Med Assoc 98(3): 212–223, 2008)
Repeatable measures are essential for clinicians and researchers alike. Both need baseline measures that are reliable, as intervention effects cannot be accurately identified without consistent measures. The intrarater and interrater reliability of the new Foot Posture Index and current podiatric measures of foot position were assessed using a same-subject, repeated-measures study design across three age groups. The Foot Posture Index total score showed moderate reliability overall, demonstrating better reliability than most other current measures, although navicular height (normalized for foot length) was the single most reliable measure in adults. None of the tested measures exhibited adequate reliability in young children, and, with less-than-desirable reliability being demonstrated, most measures need to be interpreted accordingly when repeated measures are involved. (J Am Podiatr Med Assoc 93(3): 203-213, 2003)
The Foot Posture Index is a new multidimensional and multiplanar tool aimed at quantifying the degree of pronation to supination of the foot, comprising eight criteria that sum to produce a final “score” of foot posture. In an initial study involving 31 subjects, angulations measured from dorsoplantar and lateral radiographs were compared with the corresponding Foot Posture Index criteria using Spearman’s rho and the generalized linear model of analysis of variance. Eleven of the participants from Study 1 completed a second study in which wedges were used to alter foot position to determine whether changes to foot position were sensitively reflected in Foot Posture Index criterion scores and associated radiographic images. Study 1 demonstrated a significant correlation for only one criterion (talar head palpation), while Study 2 demonstrated intrasubject sensitivity to overall changes from supinated to pronated and supinated to resting positions but insensitivity to changes from resting to pronated positions. The results suggest that although the Foot Posture Index could be a useful tool to broadly classify foot postures, it is not sensitive to all small movements when assessed by this method. (J Am Podiatr Med Assoc 94(1): 31-38, 2004)
