Namn: Testnummer: Hur fysiskt aktiv är du? (v 0 ) Bilaga 3 Vilken person stämmer bäst in på dig? Person A: Rör sig ganska lite. Person B: Rör sig en hel del men aldrig så att han/hon blir andfådd <strong>och</strong> svettig. Person C: Rör sig en hel del <strong>och</strong> blir svettig <strong>och</strong> andfådd någon gång ibland. Person D: Rör sig så att han/hon blir svettig <strong>och</strong> andfådd flera gånger i veckan. Person E: Rör sig så att han/hon blir svettig <strong>och</strong> andfådd varje dag eller nästan varje dag. Hur länge har besvären funnits? Hur lång tid har du haft ont i hälen/hälarna i sådan omfattning att det begränsat dig fysiskt? I ...................veckor 30 35
Bilaga 4 Scand J Med Sci Sports 2011: 21: 819<strong>–</strong>823 doi: 10.1111/j.1600-0838.2010.01051.x Sever’s injury: treatment with insoles provides effective pain relief S. Perhamre 1 , S. Janson 2,3 , R. Norlin 4 , M. Kla¨ ssbo 5 1 Centre of Sports Medicine in Va¨rmland, Va¨rmland County Council, Karlstad, Sweden, 2 Department of Paediatrics, Va¨rmland County Council, Karlstad, Sweden, 3 Department of Public Health, Karlstad University, Karlstad, Sweden, 4 Department of Orthopaedics, University Hospital, O¨rebro University, O¨rebro, Sweden, 5 Centre for Clinical Research, Va¨rmland County Council, Karlstad, Sweden Corresponding author: Stefan Perhamre, Idrottsha¨lsan i Va¨rmland, Kolvgatan 1 B, S-653 41 Karlstad, Sweden. Tel: 146 54 15 34 12, Fax: 146 54 15 58 98, E-mail: stefan.perhamre@liv.se Accepted for publication 7 October 2009 Sever’s injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. The traditional advice is to reduce and modify the level of physical activity. Recommended treatment in general is the same as for adults with Achilles tendon pain. The purpose of the study was to find out if insoles, of two different types, were effective in relieving heel pain in a group of boys (n 5 38) attending a Sports Medicine Clinic for heel pain diagnosed as Sever’s injury. The type of insole was randomized, and self-assessed pain during physical activity in the treatment phase with insoles was compared Sever’s injury (apophysitis calcanei, Sever’s disease) is considered to be the dominant cause of heel pain among growing children between 8 and 15 years of age, but epidemiologic data on its incidence are still lacking (McKenzie et al., 1981; Orava & Virtanen, 1982; Staheli, 1998; Ogden et al., 2004; Hendrix, 2005). The complaint is benign, and disappears without exception after puberty when the apophyseal growth plate is closed. The natural course is poorly studied, but the condition appears to settle within 6<strong>–</strong> 12 months. Occasionally, symptoms will persist for 2 years (Cyriax, 1982; Brukner & Khan, 2007). The condition includes a spectrum of pain from recurrent light pain to strong pain. Boys constitute two-thirds of the patients, probably due to different physical activity preferences compared with girls of the same age (Lutter, 1992). The physical activity that appears to produce the highest levels of pain includes frequent running and jumping, and the sport that tends to dominate is soccer (Micheli et al., 1987; Madden & Mellion, 1996). Winter sports are only represented in low frequencies (Orava & Virtanen, 1982; Micheli et al., 1987). The average age at onset is 11<strong>–</strong>12 years (Micheli et al., 1987; Lutter, 1992). Modern literature describes Sever’s injury in terms of mechanical overuse with repetitive microtrauma 36 & 2010 John Wiley & Sons A/S with pain in the corresponding pre- and post-treatment phases without insoles. There were no other treatments added and the recommendations were to stay on the same activity level. All patients maintained their high level of physical activity throughout the study period. Significant pain reduction during physical activity when using insoles was found. Application of two different types of insoles without any immobilization, other treatment, or modification of sport activities results in significant pain relief in boys with Sever’s injury. to the calcaneal apophysis and its growth plate. Some authors relate the injury to forces from the Achilles tendon and the calf muscle complex, causing shear stress that compromises the apophysis (Adams & Hamblen, 1990; Volpon & de Carvalho Filho, 2002; Hendrix, 2005). Others suggest the repetitive impact force at heel strike as an alternative or complementary explanation (McKenzie et al., 1981; Orava & Virtanen, 1982; Ogden et al., 2004). The clinical findings are tenderness over the calcaneal tubercle and a positive calcaneus compression test (Micheli et al., 1987; Adams & Hamblen, 1990; Madden & Mellion, 1996; Kasser, 2006). In 40% of the cases, only one heel is affected (Micheli et al., 1987). The traditional advice is to diminish or eliminate provoking activities for a period of time. This is similar to the recommendations for treating Mb Osgood Schlatter (Hendrix, 2005). In addition, patients are recommended treatment similar to that for adults with Achilles tendon pain, most frequently including stretching, strengthening exercises for calf and extensor muscles and also NSAID treatment (Micheli et al., 1987; Lutter, 1992; Ishikawa, 2005; Kasser, 2006). The importance of correcting malalignment, dominated by pronation, is stressed by some authors (Szames et al., 1990; Madden & 819
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