Severs skada – paradigmskifte gällande diagnostik och behandling?

Perhamre et al.
Table 1. Analysis of heel pad thickness during standing bare foot vs in shoe, and without heel cup in shoe vs with heel cup
body weight did not seem to affect the thickness of
the heel pad standing barefoot or in shoes with or
without a heel cup, even though there was a total age
range of 4 years of age and a weight range of 32 kg
(Table 2). There was no difference in heel pad
thickness when comparing studied soccer shoes
with indoor sports shoes. Comparing the heel cup
group with pain with their matched controls without
pain, the heel cup group showed a non-significant
tendency toward thinner heel pads both bare foot
and in shoe, Table 2.
Peak pressure
Maximal peak pressure comparing sports shoe with
and without heel cup was reduced during running
and standing in favor of the sports shoe with heel
cup. In the statistical analysis during running the
effect of heel cup treatment was significant. The
multiplicative effect of heel cup was 0.79 [0.75,
0.83], resulting in a reduction of heel pad peak
pressure with 21% compared with the shoe without
insole. Data from one child was missing, because of
damage to the F-Scan sensor (n 5 9), and the last
trial running including heel cup treatment was deleted
due to sensor errors for one child. In the
corresponding analysis of standing peak pressure,
the effect of the heel cup was significant, with a
multiplicative effect of 0.75 [0.72, 0.78], resulting in
a reduction with 25%. There were no data missing.
50
n Increase in heel pad
thickness, mean (mm)
95 % confidence interval P-value
Bare foot vs Shoe only 45 2.19 1.69–2.69 o0.001
Bare foot vs Shoe with cup* 15 3.57 2.56–4.29 o0.001
Shoe only vs Shoe with cup* 15 1.53 0.63–2.23 5 0.002
*Treatment group only.
Fig. 3. Radiographic assessment of heel pad thickness when standing on heel in shoe without cup (left) and with heel cup
(right). The most painful heel was investigated and the distance from vertex calcanei and the skin reference mark was measured.
Note how the cup restores soft tissue thickness. The difference in heel pad thickness was in this case 1.95 mm.
4
Table 2. Heel pad thickness in different subgroups
Heel pad thickness during standing,
mean (mm)
Bare
foot
Sports
shoe
Shoe with
cup*
Age
9–10 years (n 5 10) 6.86 8.55 10.66
11–12 years (n 5 29) 6.35 8.47 9.77
13–14 years (n 5 2) 8.02 11.52 11.94
Body weight
30–37 kg (n 5 15) 6.30 8.31 9.43
38–47 kg (n 5 15) 6.82 8.88 11.09
48–62 kg (n 5 15) 6.85 9.47 10.4
Type of sports shoe
Soccer shoes (n 5 23) 6.66 8.93 10.12
Indoor shoes (n 5 22) 6.79 8.90 10.18
Cup treated (group I) 6.51 8.83 10.37
No treatment (group II) 7.13 9.22 –
Controls (group III) 7.00 9.42 –
*Treatment group only.
Table 3 shows the mean values in mmHg in running
and standing. Figure 4 shows one typical example of
maximal peak pressure measurement.
Pain relief
Table 4 shows a significant pain reduction in sport
activities in the treated group during the study
period. There was an immediate reduction of pain