The Effects of Custom-made Insoles on Foot Pressure Redistribution and Spatio - Temporal Gait Parameters in Sever Disease
Condition: Calcaneal Apophysitis; Gait; Sever's Disease
Study type: Interventional

Summary: 
      The aim of this study was to investigate the effect of specially produced insoles on
      biomechanical and gait parameters in children with Sever's disease.
    

Detailed description: 
      Introduction: Sever's disease or calcaneal apophysitis is common in pediatric and adolescent
      patients and characterized by heel pain. Inflammation of apophysis in children of growing age
      causes microabrasion in bone cartilage joint. At the same time, the disease affects the
      self-limitation and affects the maturation of calcaneus.Sever's disease is an overuse
      syndrome and was described by James Warren Sever in 1912. The prevalence of Sever's disease
      varies between 2% and 16%.Sever's more common in children aged 8 - 15 years, but it was
      reported that heel pain increased during or after activity.This results in a shortening of
      the stance phase to remove the limb to avoid heel strikes during walking. Increased tension
      in the Achilles tendon and plantar fascia is affected by the mobility of the medial
      longitudinal arch of the foot and increases loading on the calcaneal cartilage. Stimulates
      foot alignment to pronation.

      Different treatment have been described in Sever's disease. In the treatment program,
      stretching, strengthening exercises and ice application are recommended especially for
      gastrocnemius muscle and extensor muscle group.The traditional treatment approach is the
      restriction of the child's physical activity and sporting activities and rest until the
      symptoms have passed. In addition, orthoses can be used to treat the heel amplifier,
      anatomical dysregulation dominated by standing pronation. There is no previous study in order
      to investigate the effect of the specially produced insoles on the Sever's disease by
      changing the foot pressure center and the effect of the pronation on the gait parameters.

      Subjects and methods:

      The study is planned to be done with physical examination and radiological imaging of the
      patients who are between 8 and 15 years of age and diagnosed with Sever's disease. After the
      first physical examination evaluation, the foot rotation, step length, stance phase
      percentage, swing phase percentage, cadence and velocity parameters will be recorded with
      Zebris FDM -T (Force Distribution Measurement Treadmill) system. Zebris is a name of company
      in Germany.

      Zebris Medical Limited ) is an innovative company that has been successful for many years in
      the development and production of 3D motion analysis and force measurement technologies for
      biomechanics. When the treadmill is in static and dynamic condition, strong pressure
      distribution measurement will be taken and personalized insole production according to foot
      pressure map will be done by orthosis prosthesis technician with Arch drafters Orthotics
      technology. After physiotherapist,decision, it will be delivered to the patients with the
      condition of being used outside and inside the home. Measurements related to pressure and
      gait parameters will be repeated after 4 weeks of use and home exercise (strengthening,
      stretching and eccentric exercise for the anterior lateral - posterior compartment of the
      foot ).

      The spatio temporal gait parameters of the patients will be evaluated with Zebris (Zebris
      Medical Limited , Germany) FDM (Force Distribution Measurement ) treadmill system and pain
      levels at rest and during activity will be questioned using Visual Analog Scale.

      Sample size: 40 professional athlete who are between 8 and 15 years of age for experimental
      group.
    

Intervention name(s): Study group
Intervention type(s): Device
Intervention description(s): 4 weeks of custom-made insoles in the home and outside the home environment , follow the home exercise program during this process.It is planned to perform gait parameters and pain assessment before and after the treatment.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: gait; sever's