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Treatment of Calcaneal Apophysitis: Wait and See Versus Orthotic Device Versus Physical Therapy: A Pragmatic Therapeutic Randomized Clinical Trial

Wiegerinck, Johannes I. MD, PhD; Zwiers, Ruben MSc; Sierevelt, Inger N. MSc; van Weert, Henk C. P. M. MD, PhD; van Dijk, C. Niek MD, PhD; Struijs, Peter A. A. MD, PhD

Journal of Pediatric Orthopaedics: March 2016 - Volume 36 - Issue 2 - p 152–157
doi: 10.1097/BPO.0000000000000417
Foot & Ankle

Background: Calcaneal apophysitis is a frequent cause of heel pain in children and is known to have a significant negative effect on the quality of life in affected children. The most effective treatment is currently unknown. The purpose of this study is to evaluate 3 frequently used conventional treatment modalities for calcaneal apophysitis.

Methods: Three treatment modalities were evaluated and compared in a prospective randomized single-blind setting: a pragmatic wait and see protocol versus a heel raise inlay (ViscoHeel; Bauerfeind) versus an eccentric exercise regime under physiotherapeutic supervision. Treatment duration was 10 weeks. Inclusion criteria: age between 8 and 15 years old, at least 4 weeks of heel pain complaints due to calcaneal apophysitis based, with a minimal Faces Pain Scale-Revised of 3 points. Primary exclusion criteria included other causes of heel pain and previous similar treatment. Primary outcome was Faces Pain Scale-Revised at 3 months. Secondary outcomes included patient satisfaction and Oxford Ankle and Foot Questionnaire (OAFQ). Points of measure were at baseline, 6 weeks, and 3 months. Analysis was performed according to the intention-to-treat principles.

Results: A total of 101 subjects were included. Three subjects were lost to follow-up. At 6 weeks, the heel raise subjects were more satisfied compared with both other groups (P<0.01); the heel raise group improved significantly compared with the wait and see group for OAFQ Children (P<0.01); the physical therapy group showed significant improvement compared with the wait and see group for OAFQ Parents (P<0.01). Each treatment modality showed significant improvement of all outcome measures during follow-up (P<0.005). No clinical relevant differences were found between the respective treatment modalities at final follow-up.

Conclusions: Treatment with wait and see, a heel raise inlay, or physical therapy each resulted in a clinical relevant and statistical significant reduction of heel pain due to calcaneal apophysitis. No significant difference in heel pain reduction was found between individual treatment regimes. Calcaneal apophysitis is effectively treated by the evaluated regimes. Physicians should deliberate with patients and parents regarding the preferred treatment.

Level of Evidence: Level 1—therapeutic randomized controlled trial.

*Department of General Surgery, Onze Lieve Vrouwe Gasthuis

Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam

§Department of Health and General Medicine, Academic Medical Center, Amsterdam

Department of Orthopaedic Surgery Spaarne Ziekenhuis, Hoofddorp, The Netherlands

None of the authors received financial support for this study.

The authors declare no conflicts of interest.

Reprints: Johannes I. Wiegerinck, MD, Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, P.O. Box 22700, Amsterdam 1100 DE, The Netherlands. E-mail: j.i.wiegerinck@amc.uva.nl.

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