Alicia M. James

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

BackgroundCalcaneal 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.MethodsA 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.ResultsNine 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.ConclusionThere 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.

Heel raises versus prefabricated orthoses in the treatment of posterior heel pain associated with calcaneal apophysitis (Sever's Disease): study protocol for a randomised controlled trial

Background Posterior Heel pain can present in children of 8 to 14 years, associated with or clinically diagnosed as Severs disease, or calcaneal apophysitis. Presently, there are no comparative randomised studies evaluating treatment options for posterior heel pain in children with the clinical diagnosis of calcaneal apophysitis or Severs disease. This study seeks to compare the clinical efficacy of some currently employed treatment options for the relief of disability and pain associated with posterior heel pain in children. Method Design: Factorial 2 × 2 randomised controlled trial with monthly follow-up for 3 months. Participants: Children with clinically diagnosed posterior heel pain possibly associated with calcaneal apophysitis/Severs disease (n = 124). Interventions: Treatment factor 1 will be two types of shoe orthoses: a heel raise or prefabricated orthoses. Both of these interventions are widely available, mutually exclusive treatment approaches that are relatively low in cost. Treatment factor 2 will be a footwear prescription/replacement intervention involving a shoe with a firm heel counter, dual density EVA midsole and rear foot control. The alternate condition in this factor is no footwear prescription/replacement, with the participant wearing their current footwear. Outcomes: Oxford Foot and Ankle Questionnaire and the Faces pain scale. Discussion This will be a randomised trial to compare the efficacy of various treatment options for posterior heel pain in children that may be associated with calcaneal apophysitis also known as Severs disease. Trial Registration Trial Number: ACTRN12609000696291 Ethics Approval Southern Health: HREC Ref: 09271B

Factors Associated with Pain Severity in Children with Calcaneal Apophysitis (Sever Disease).

OBJECTIVE To identify any association between the pain experienced as a result of calcaneal apophysitis, anthropometric data, and lower limb measurements. STUDY DESIGN This study was a cross-sectional study, nested within a wider randomized, comparative efficacy trial. One hundred twenty-four children between the ages of 8 and 14 years with a clinical diagnosis of calcaneal apophysitis were recruited for this study. Of the participating children, 72 were male. The measures recorded were height, weight, waist circumference, body mass index, foot posture, and ankle joint range of motion; comparison with normative values was also completed. Univariate and multivariable regression analyses were undertaken to identify factors associated with the severity of pain experienced (visual analog scale). RESULTS The children within this study had a higher mean body mass index (P < .001), increased weight (P < .001), and were taller (P < .001) compared with normative values. The children also demonstrated differences in foot posture and ankle joint range of motion. Multivariable regression analyses identified that older participants (P = .046) and those who had experienced pain for longer (P = .043) reported higher pain severity. CONCLUSIONS Children presenting with calcaneal apophysitis were anthropometrically different from their peers and had experienced a lengthy period of pain. Therefore, early management focussing on the anthropometric differences may minimize the intensity and duration of pain experienced. TRIAL REGISTRATION Registered with Australian New Zealand Clinical Trials Registry: ACTRN12609000696291.

Metatarsus adductus: Development of a non‐surgical treatment pathway

Metatarsus adductus (MA) occurs in one to two cases per 1000 births and is the most common congenital foot deformity in newborns. The appearance is that of a curved or adducted forefoot with a normal hindfoot. A systematic literature review was conducted to answer the following question: For a child who presents with MA, what is the most evidence‐based conservative treatment option? Thirteen articles were reviewed using the National Health and Medical Research Council levels of evidence and guidelines for clinical practice. Conservative treatment options reported on included the following: no treatment, stretching, splinting, serial casting, sitting and sleeping positions and footwear/orthotics. There was strong evidence supporting no treatment in the case of flexible MA. Some limited evidence was found for the treatment of semi‐rigid MA. Clinicians should use these recommendations together with clinical experience when advising parents on treatment of MA.

Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial

Objective Calcaneal apophysitis, is a relatively common cause of heel pain in children. Very few randomised studies have evaluated treatment options. This trial compared the effectiveness of currently employed treatment options for the relief of pain and disability associated with calcaneal apophysitis. Design Factorial 2×2 randomised comparative effectiveness trial with 1, 2, 6 and 12-month follow-up. Setting Participants were recruited from the caseload of podiatrists at Monash health and Peninsula Health. Participants Children aged 8–14 years with clinically diagnosed calcaneal apophysitis. Interventions Treatment factor 1: two different types of in-shoe orthoses: a heel raise or prefabricated orthoses. Treatment factor 2: footwear replacement or no footwear replacement. Outcomes Our primary outcome was functional disability, the secondary outcomes were pain and ankle dorsiflexion range. Results A total of 133 children and their parents responded to the recruitment advertisement, 124 participated in the trial. At the 1 and 2-month follow-up points, there was a main effect of the shoe insert (heel raise) in only the physical domain for the Oxford ankle foot questionnaire (p=0.04). At the 6 and 12-month follow-up points, there was no main effect or interaction effect for any outcome measure. Conclusion This trial indicates at the 2-month time point there is a relative advantage in the use of heel raises over prefabricated orthoses for the treatment for calcaneal apophysitis. At 12 months there was no relative advantage to any one of the investigated treatment choices over another. Therefore, if a physical impact is experienced for greater than 2 months, the selection of treatment choice may defer to clinical judgement, cost-minimisation and or patient preference. Trial registration number ACTRN12609000696291.

Statin use and peripheral sensory perception: A pilot study

Abstract Objectives. Peripheral sensory neuropathy is a neurological deficit resulting in decreased detection of sensation through the peripheral nervous system. Peripheral sensory neuropathy is commonly diagnosed with the use of a monofilament and either a tuning fork or neurothesiometer. Statins are a widely used medication and there has been some debate of association with their use and peripheral sensory neuropathy. This pilot study aimed to test the sensory perception of participants with long-term statin use and compare these results to their peers who were not taking statins. Methods. Thirty participants were recruited and equally divided into a statin and non-statin group. Healthy participants were screened by their medical and medication history, Australian Type 2 Diabetes Risk assessment, and random blood glucose level. An assessor who was blinded to the participant group conducted sensory assessments using a 10 g monofilament and neurothesiometer. Results. There was no difference in monofilament testing results between the groups. The statin group was less sensate at the styloid process (p = 0.031) and medial malleolus (p = 0.003) than the control group. Results at the hallux were not statistically significant (p = 0.183). Conclusion. This result is suggestive of a potential association between long-term statin use and a decrease in peripheral sensory perception. This may be because of peripheral sensory neuropathy. Limitations such as consideration of participant height, participant numbers, and inability to analyze results against statin groups are reported. As statins are a life-saving medication, careful consideration should be applied to these results and further research be conducted to determine if these results are applicable to larger populations.

Statin use and peripheral sensory neuropathy: a pilot study

Background Peripheral sensory neuropathy is a neurological deficit resulting in decreased detection of sensation through the peripheral nervous system. Statins are a widely used medication and there has been some debate of association with their use and the presence of peripheral sensory neuropathy. This pilot study aimed to test the sensory perception of participants with long term statin use and compare these results to their peers who were not taking statins.

Comparative effectiveness research for the clinician researcher: a framework for making a methodological design choice

Comparative effectiveness research compares two active forms of treatment or usual care in comparison with usual care with an additional intervention element. These types of study are commonly conducted following a placebo or no active treatment trial. Research designs with a placebo or non-active treatment arm can be challenging for the clinician researcher when conducted within the healthcare environment with patients attending for treatment.A framework for conducting comparative effectiveness research is needed, particularly for interventions for which there are no strong regulatory requirements that must be met prior to their introduction into usual care. We argue for a broader use of comparative effectiveness research to achieve translatable real-world clinical research. These types of research design also affect the rapid uptake of evidence-based clinical practice within the healthcare setting.This framework includes questions to guide the clinician researcher into the most appropriate trial design to measure treatment effect. These questions include consideration given to current treatment provision during usual care, known treatment effectiveness, side effects of treatments, economic impact, and the setting in which the research is being undertaken.

3D printing in clinical podiatry: a pilot study and review

Background Advanced and new technologies within the health sector are aimed to increase efficacy and reduce cost. As a profession, podiatry has seen exponential growth in the use of 3D (three-dimensional) scanning in the clinical domain. It has been used within orthotic manufacture to improve timely responses in both production and rapid dispensing. It has also been used within research to better understand foot structure and function. 3D printing is the next technological step, which will impact the podiatric management of common disorders. This presentation explores its potential uses and describes a new method of prosthetic construction based on 3D printing methodology.

Implementing a podiatry prescribing mentoring program in a public health service: a cost-description study

BackgroundIn the management of diabetes and high-risk patients, timely treatment with scheduled medicines is critical to prevent severe infections and reduce the risk of lower extremity amputation. However, in Australia, few podiatrists have attained endorsement to prescribe. The aims of this study were to identify the costs associated with developing and implementing a podiatry prescribing mentoring program; and to compare the cost of this program against potential healthcare savings produced.MethodsThis was a cost-description analysis, involving the calculation of costs associated with the development and implementation of a mentoring program to train podiatrists to become endorsed prescribers. Costs were calculated using the Ingredients Method and examined from the perspective of a public health service provider, and the individual learner podiatrist. Breakeven analysis compared the cost of training a podiatry prescriber for endorsement against the potential benefit (savings) made by averting complications of an infected foot ulcer. A sensitivity analysis was conducted to allow for uncertainty in the results of an economic evaluation.ResultsTotal start-up cost for the podiatry prescriber mentoring program was