Do the presence, size, and shape of plantar calcaneal spurs have any significance in terms of pain and treatment outcomes in patients with plantar fasciitis?

BACKGROUND: : The purpose of this study was to determine the effect of the presence, size, or type of calcaneal spurs on pain or the outcomes of extracorporeal shock wave therapy (ESWT) therapy in patients with plantar fasciitis. METHODS: Seventy-four patients with unilateral plantar fasciitis who had no pain in the contralateral foot, either currently or in the past, were included in the study. The length, base width, type, and presence of plantar calcaneal spurs in both heels of the patients were determined using radiography. A total of five sessions of ESWT (3 bar, 2000 shocks/session, 12 Hz frequency) with an interval of 3 days were performed on the painful sides of the patients. Symptom duration and numerical rating scale (NRS) scores were recorded pretreatment and 1 week and 12 weeks after treatment. RESULTS: : Spurs were detected in 85.1% of painful feet and 71.6% of painless feet, this difference was statistically significant (p = 0.046). There was no significant correlation between the type of the spurs and whether the foot was painful. Patients with spur sizes of >5 mm or with horizontal and hooked spurs had a higher NRS decrease than patients with spur sizes of ≤5 mm or with a vertical spur. Symptom duration, spur length, and base width were found to be correlated with pretreatment NRS scores. DISCUSSION: The presence and size of calcaneal spurs are associated with pain. However, it should be kept in mind that a high rate of spurs can also be found in painless feet, so spur is not the only factor that causes pain. Patients with a spur size of ≤5 mm or a vertical spur have less pain relief with ESWT.

Comparison between radial and focused types of extracorporeal shock-wave therapy in plantar calcaneal spur: A randomized sham-controlled trial.

OBJECTIVES: Both radial and focused types of extracorporeal shock wave therapy (ESWT) have been used in patients with plantar calcaneal spur (PCS). However, no study has yet addressed the comparative effects of these treatments on the condition. Considering radial and focused waves are different from each other, their effectiveness may also be different in clinical practice. The aim of this study was to compare the effects of radial and focused types of ESWT on PCS. METHODS: Ninety-nine patients with plantar calcaneal spur were randomised into three groups according to ESWT types: focused, radial, and sham. ESWT was applied as three sessions, with 2-4 days intervals (excluding weekends). All patients were evaluated at baseline (week 0) and weeks 1, 5, and 13. The Foot Function Index (FFI) scores were used as outcome measures. RESULTS: Compared with baseline (week 0), at the end of treatment (week 1) and at the follow-up periods (weeks 5, and 13) the FFI scores were significantly reduced in both focused and radial ESWT groups (for all, p < 0.001). When considering the change in data from baseline to follow-up periods (weeks 5, and 13), both focused and radial ESWT groups were significantly superior to the sham group in the all outcome measures (for all, p < 0.05). Importantly, the radial group was significantly superior to focused group based on the changes in the FFI scores (for all, p < 0.05). CONCLUSION: Both focused ESWT and radial ESWT are effective in plantar calcaneal spur. When considering the degree and continuity of the positive effects, radial ESWT is superior to focused ESWT in plantar calcaneal spur.

Efficacy of Extracorporeal Shock Wave and Pulse Electromagnetic Field Therapies in Calcaneal Spurs.

BACKGROUND: Various treatment methods are available for calcaneal spur, which can cause disability. Objective: To evaluate the efficacy of pulsed electromagnetic field therapy (PEMFT) added to extracorporeal shock wave therapy (ESWT) on pain and functional capacity in treating calcaneal spurs. METHODS: Patients with calcaneal spurs who were recommended ESWT or ESWT+PEMFT and whose Foot Function Index (FFI) and visual analogue scale (VAS) values were available in their records were retrospectively analyzed. The two groups were ESWT (n=35) and ESWT+PEMFT (n=40). FFI and VAS scores were obtained from their records before treatment, after treatment, and in the third month after treatment. RESULTS: The two groups were similar regarding their pre-treatment FFI and VAS scores. In intra-group evaluation, statistically significant decreases were found in terms of the FFI pain, disability, and activity limitation and VAS scores in both groups after treatment and in the third month after treatment compared to the pre-treatment period. In the comparison between the groups, the post-treatment and post-treatment third-month FFI pain, disability, and activity limitation and VAS scores were significantly lower in the PEMFT+ESWT group than the ESWT group (P<0.001). CONCLUSION: A calcaneal spur is a condition that can cause pain and functional limitation in patients. Various studies have demonstrated the efficacy of ESWT in the treatment of calcaneal spurs. In our study, we observed that PEMFT added to ESWT significantly improved the pain and functionality of the patients. Further studies are needed to evaluate the efficacy of PEMFT in calcaneal spurs.

Extracorporeal Shockwave Therapy for Foot and Ankle Disorders: A Systematic Review and Meta-Analysis.

BACKGROUND: Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of numerous orthopaedic pathologies. However, clinical evidence of the use of ESWT for various foot and ankle disorders has been limited with a consensus on its efficacy yet available. Therefore, the purpose of this study is to systematically review the literature, to provide a critical evaluation and meta-analysis for the use of ESWT in foot and ankle disorders. METHODS: The PubMed and Embase databases were systematically reviewed and clinical studies that reported ESWT use for various foot and ankle disorders included. RESULTS: A total of 24 clinical studies that included 12 randomized controlled trials and 12 case series were identified. Analysis of the evidence has indicated that ESWT can help manage plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton's neuroma. Meta-analysis of the change in pre- to post-VAS overall scores for plantar fasciitis significantly favored ESWT compared to placebo/conservative treatment with a MD -3.10 (95% CI, -4.36 to -1.83; I2 = 68%; P < 0.00001). CONCLUSIONS: The current evidence has suggested that ESWT can provide symptomatic benefit to plantar fasciitis treatment, with minimal and unremarkable side effects. Overall, ESWT has been demonstrated to be a safe treatment option with a favorable complication profile. Further well-designed studies of ESWT for the treatment of calcaneal spurs, Achilles tendinopathy and Morton's neuroma are warranted to more soundly and safely support its current use. Future studies are suggested to investigate the optimization of ESWT treatment protocols.

A comparative study of operative and conservative treatment of intraarticular displaced calcaneal fractures.

The treatment of intra-articular displaced calcaneal fracture is debatable. We conducted a prospective study to compare operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and nonoperative) and were regularly followed for a period of 1 year. The outcome measures were assessed by Modified Rowe's Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient's job was noted after one year and compared with pre-injury status. Fifty five patients with 61 calcaneal fractures were studied. Thirty of them were operated and 31 were treated conservatively. Out of 30 operated cases, Bohler's angle was restored in 25 cases and these had good results with all three outcome scores at 1 year follow up and remaining 5 cases showed fair results (Mean MRS: 74.783, VAS: 3.348, AOFAS: 78.783). Thirty one cases treated with cast also showed fair results (Mean MRS: 57.368, VAS: 4.944, AOFAS: 71.211). The overall outcome of operated cases were better than non-operated cases (unpaired T test MRS: 5.807 p < 0.001, VAS: 4.387 p < 0.001, AOFAS: 2.728 p = 0.008) . Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler's angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative treatment.

Ground reaction force analysis for assessing the efficacy of focused and radial shockwaves in the treatment of symptomatic plantar heel spur.

BACKGROUND: Extracorporeal shock wave therapy is among the conservative treatments for symptomatic heel spur. OBJECTIVE: The purpose of this trial is to evaluate and compare the therapeutic effects of radial shock wave (RSWT) and focused shock wave (FSWT) applied in the treatment of symptomatic heel spur. METHODS: Fifty-five participants were randomly divided into two comparative groups that were administered FSWT and RSWT, respectively. The severity of dysfunction (Foot Function Index, FFI), ground reaction forces (GRF) and walking temporal parameters were measured in all patients at baseline and at weeks 1, 3, 6, 12 and 24 after treatment. RESULTS: In both groups, a gradual decrease in the FFI values occurred after treatment. The percentage reduction in the FFI was comparable for both groups. Statistically significant changes were only noted between some measurements of GRF and walking temporal parameters. The percentage changes in the values of the force and temporal parameters were similar between the groups. CONCLUSIONS: Both FSWT and RSWT are efficacious in the treatment of symptomatic heel spur and their therapeutic effects are comparable. Objective data registered by force platforms during walking are not useful for tracing the progress of treatment applied to patients with symptomatic heel spur between consecutive procedures.

A Rare Cause of Heel Pain: A Calcaneal Spur Fracture.

Heel pain is a complaint frequently encountered in orthopedic clinics that has peculiar symptoms and may have various etiologic causes. Calcaneal spur fracture is an extremely rare cause of heel pain, and only four cases had previously been reported in the English language literature. We present a 45-year-old woman who had heel pain on her right foot after falling from a height onto the heel. Radiographic examination of her right foot showed a fractured calcaneal spur, which was successfully treated with conservative methods. Calcaneal heel pain is a complaint that may be attributable to many different etiologic causes, which often have specific symptoms, and we frequently encounter them in the orthopedic clinic. Calcaneal spur fracture after trauma should be remembered in the differential diagnosis of heel pain as a rare cause. Our case is the fifth reported case in the English language literature of this extremely rare condition.

Farmacopuntura: nueva estrategia de tratamiento para espolón calcáneo / Pharmacopuncture: new treatment strategy for calcaneal spur

Se realizó un estudio prospectivo, longitudinal descriptivo en pacientes remitidos al Servicio de Medicina Natural y Tradicional del Hospital General Docente Dr Agostinho Neto de las diferentes áreas de salud, en el período de enero - diciembre 2016 con el diagnóstico clínico radiológico de espolón calcáneo con el objetivo de evaluar los resultados del tratamiento con farmacopuntura utilizando medicamento esteroideo (triamcinolona). Se operacionalizaron las siguientes variables: edad, sexo, ocupación, alivio del dolor según sesiones tratamiento aplicado, resultados al finalizar el tratamiento y recurrencias del dolor. A todos se les midió el grado de intensidad del dolor según escala visual analógica al inicio, durante y al final del tratamiento, encontrándose alivio del dolor a partir de la tercera sesión de tratamiento y el (64.4 por ciento de los pacientes curaron, se emitieron recomendaciones(AU)

A prospective, longitudinal descriptive study was carried out in patients referred to the Natural and Traditional Medicine Service of the General Teaching Hospital Dr Agostinho Neto from the different health areas, in the period January - December 2016 with the radiological clinical diagnosis of calcaneal spur with the objective of evaluating the results of the treatment with pharmacopuncture using steroid medication (triamcinolone). The following variables were used: age, sex, occupation, pain relief according to treatment sessions, results at the end of treatment and recurrence of pain. The degree of pain and intensity was measured according to the visual analogue scale at the beginning, during and at the end of the treatment, and pain relief was found from the third treatment session and (64.4 percent) patients were cured, recommendations(AU)

Golpe del espolón calcáneo complementado con electroacupuntura / Calcaneal spur shockwave complemented with electroacupuncture

El síntoma más importante del espolón calcáneo es el dolor, que se agrava con la carga estando el paciente parado o caminando; localizado en la zona del talón y de rara irra­diación. Se hace presentación de caso: mujer de 47 años de edad, sobrepeso, larga estancia de pie laborando en una cafetería, con espolón calcáneo y la descripción técnica de un único golpe en región plantar, complementado con electroacupuntura por su efecto analgésico y antiinflamatorio. La técnica se aplica por personal calificado y especializado de salud pública(AU)

The most important symptom of the calcaneal spur is pain, which worsening with the weight charge as the patients is standing up or walking; located in the heel area and of rare irradiation. Case presentation: women of 47 years of age, overweight, long time standing up as she works in a cafeteria, with a calcaneal spur and the technical description of an only plantar region shockwave, complemented with electroacupuncture for its analgesic and anti-inflammatory effect. The technique was applied by the qualified and specialized public health personal(AU)

Golpe del espolón calcáneo complementado con electroacupuntura / Calcaneal spur shockwave complemented with electroacupuncture

El síntoma más importante del espolón calcáneo es el dolor, que se agrava con la carga estando el paciente parado o caminando; localizado en la zona del talón y de rara irra­diación. Se hace presentación de caso: mujer de 47 años de edad, sobrepeso, larga estancia de pie laborando en una cafetería, con espolón calcáneo y la descripción técnica de un único golpe en región plantar, complementado con electroacupuntura por su efecto analgésico y antiinflamatorio. La técnica se aplica por personal calificado y especializado de salud pública(AU)

The most important symptom of the calcaneal spur is pain, which worsening with the weight charge as the patients is standing up or walking; located in the heel area and of rare irradiation. Case presentation: women of 47 years of age, overweight, long time standing up as she works in a cafeteria, with a calcaneal spur and the technical description of an only plantar region shockwave, complemented with electroacupuncture for its analgesic and anti-inflammatory effect. The technique was applied by the qualified and specialized public health personal(AU)

An attempt at objective and subjective evaluation of the therapeutic efficacy of focused and radial shockwave applied to symptomatic heel spur.

PURPOSE: The experiment was designed to evaluate and compare the efficacy of focused shockwave and radial shockwave in symptomatic heel spur treatment. Postural balance tests were used to ensure the objectivity of evaluations. METHODS: Forty three patients with symptomatic heel spur were divided into two comparative groups that received respectively focused shockwave therapy (the FSWT group; 2000 impulses, 4 Hz, 0.4 mJ/mm2) and radial shockwave therapy (the RSWT group; 2000 impulses, 8 Hz, 5 bars + 2000 impulses, 8 Hz, 2.5 bars). Each patient received 5 treatments at weekly intervals. Before therapy started and 1, 3, 6 and 12 weeks after it ended, the intensity of pain experienced by the patients was assessed and static balance tests were performed on a force platform. RESULTS: Successive measurements showed that the intensity of all kinds of pain under consideration was decreasing gradually and statistically significantly in both groups. The percentage reduction in pain intensity was similar between the groups. The standard deviation of the COP in the anterior-posterior and medial-lateral directions, 95% confidence ellipse area and COP velocity kept varying throughout the experiment, but in none of the groups changes were statistically significant. CONCLUSIONS: Focused shockwave therapy and radial shockwave therapy improve the well-being of patients with symptomatic heel spur significantly and comparably. Posturography cannot deliver unambiguous data for tracking changes that the two therapies induce in these patients.

Efectividad de la terapia Su-Jok en pacientes con dolor por espolón calcáneo / Effectiveness of the Su-Jok therapy in patients with pain due to heel spur

Se realizó una intervención terapéutica en 128 pacientes con dolor por espolón calcáneo, seleccionados aleatoriamente, quienes fueron tratados en el Departamento de Rehabilitación del Hospital General Docente Orlando Pantoja Tamayo en el municipio de Contramaestre, de la provincia de Santiago de Cuba, de enero del 2014 a abril del 2015, con vistas a evaluar la efectividad de la terapia Su-Jok. Se conformaron 2 grupos: uno de control, que recibió tratamiento convencional, y otro de estudio, en el cual se aplicó la terapia Su-Jok. Luego de efectuado el análisis estadístico mediante las pruebas de hipótesis de homogeneidad de la Χ2 y de diferencias de medias (ambas técnicas con un error permisible de 5 %), pudo concluirse que la terapia Su Jok es efectiva para aliviar el dolor por espolón calcáneo, por lo que se recomendó promoverla para ello debido a su fácil empleo y bajo costo(AU)

A therapeutic intervention was carried out in 128 randomly selected patients with pain due to heel spur, who were treated in the Rehabilitation Department of Orlando Pantoja Tamayo Teaching General Hospital in Contramaestre municipality, Santiago de Cuba province, from January, 2014 to April, 2015, with the aim of evaluating the effectiveness of the Su-Jok therapy. Two groups were formed: a control group which received conventional treatment, and a study group, in which the Su-Jok therapy was applied. After the statistical analysis was carried out by means of the homogeneity and hypothesis tests of homogeneity of Χ2 and the means differences (both techniques with a permissible error of 5%), it could be concluded that the Su-Jok therapy is effective to mitigate the pain due to heel spur, so it was recommended to promote it taking into account its easy use and low cost(AU)

[Physiotherapeutic proceeding in symptomatic calcaneal spur treatment].

Calcaneal spur is one of the most common disorders associated with foot pain. According to appearance of pain in each step during the day, it is important to find the most effective method of treatment. This article is a review of medical reports about non-operative treatment method. It shows that ultrasound therapy was the most common physical intervetion used so far, and mostly occurs to be effective. However one of the comparative studies improves higher efficiency of phonopheresis. Another comparative study, shows higher efficiency of combined ultrasound and laser therapy, than exclusive laser therapy. There haven't been found any articles that would evaluate efficacy of electrotherapy and short wave diathermy (electric field) in the treatment of mentioned disorder. Studies that describe the effect of ESWT treatment were also analyzed in this article, and all of them confirm its effectiveness in heel spur therapy, showing no side-effects. Cryotherapy also causes positive effect in treatment of this disorder. However Cryoultrasound therapy that uses the energy of two interconnected terapeutic techniques which is cryotherapy and ultrasounds, proved to be more effective.

Eficacia de las ondas de choque como método de tratamiento en espolón calcáneo / Effectiveness of shock wave as a method of heel spur treatment

Objetivo: Conocer la efectividad clínica de las ondas de choque como tratamiento del espolón calcáneo y analizar la calidad metodológica de los artículos. Búsqueda y selección de estudios: Se identificaron 78 publicaciones mediante búsqueda electrónica en bases de datos MEDLINE, Dialnet, Cochrane Library Plus, PEDro y CSIC. Los criterios de inclusión fueron: artículos en inglés o español publicados desde enero del 2000 hasta enero del 2013, ensayos controlados y clínicos. Como criterio de exclusión se estableció: estudios que aborden el espolón calcáneo desde otro punto de vista y fisioterapia que no sea ondas de choque. Resultados: Se incluyeron 5estudios en la revisión. Dos de ellos con calidad metodológica de 5 y 6 (escala PEDro). Los otros 3 no pudieron ser valorados por carecer de grupo control. Conclusiones: Los resultados de la revisión indican que la utilización de esta técnica mejora el dolor en pacientes con espolón calcáneo. Es necesario un mayor número de estudios para determinar la eficacia de las ondas de choque en el espolón calcáneo

Objective: To know the clinical effectiveness of extracorporeal shock wave treatment as treatment of the heel spur and analyze the methodological quality of the articles. Study search and selection strategy: 78 publications were identified by electronic search in the databases MEDLINE, Dialnet, Cochrane Library Plus and PEDro and CSIC. Inclusion criteria were articles published from January 2000 to January 2013, controlled and clinical trials. Exclusion criteria were articles that studied heel spur from another point of view and in which the physiotherapy used was not shockwave. Results: Five studies were included in the review. Two of them had a methodological quality of 5 and 6 (PEDro scale). The other three could not be evaluated because they lacked a control group. Conclusions: The results of the review suggest that the use of extracorporeal shockwave treatment can improve pain and functional status in patients with heel spur. More studies are needed to determine the effectiveness of the extracorporeal shockwave treatment on the heel spur

Plantar heel pain.

Plantar heel pain is a common complaint encountered by orthopedic surgeons, internists, and family practitioners. Although it is most often caused by plantar fasciitis, this is a diagnosis of exclusion. Other mechanical, rheumatologic, and neurologic causes must be considered first. The history and physical examination are typically all that is needed to make the proper diagnosis, but diagnostic adjuncts are available to assist the clinician. When plantar fasciitis is diagnosed, conservative modalities must be tried first. Corticosteroid injections and extracorporeal shock-wave therapy may also be used. After 6 months of failed conservative treatments, surgical intervention should be considered.

Cryoultrasound therapy in the treatment of chronic plantar fasciitis with heel spurs. A randomized controlled clinical study.

BACKGROUND: Plantar fasciitis is one of the most common causes of pain in the inferior heel and is very frequent in some running sports. It affects up to 10% of general population and accounts for 11% to 15% of all foot pain symptomatology. Several treatments have been suggested, but there is no evidence supporting a specific conservative management strategy. AIM: Evaluation of the efficacy of combined cryoultrasound therapy on chronic plantar fasciitis with heel spurs resistant to pharmacological and instrumental therapies. DESIGN: Single-blind randomized clinical trial. POPULATION: 102 consecutive patients affected by chronic plantar fasciitis with painful symptomatology for at least 6 months, intensity of pain higher than 5 on the VAS score, presence of heel spurs, use of plantar orthoses and ineffectiveness of previous therapies. METHODS: The patients were randomized into two groups: Group A treated with cryoultrasound therapy and Group B with cryotherapy. Our protocol was based on 10 daily treatments, lasting 20 minutes. Each participant was evaluated using VAS score before (T0) the treatment and 3 months (T1), 12 months (T2) and 18 months (T3) after. Effectiveness index was calculated from T1 to T3. RESULTS: Both treatments have been found effective. The difference in pain intensity on the VAS scale between the two groups at T2 was 4.35 points in favor of Group A (IC 95% 3.75; 4.95; P<0.001), reaching the primary end point. The difference in pain intensity on the VAS scale between the two groups at T1, T2 and T3 was 3.00, 4.35 and 4.81 respectively, showing a statistically significant difference between VAS average scores at all follow-ups in favor of Group A. Scores of at least 66% at the effectiveness index were only achieved in Group A (P values <0.001). CONCLUSION: Cryoultrasound therapy could be an efficient treatment option for chronic plantar fasciitis. CLINICAL REHABILITATION IMPACT: Cryoultrasound therapy promises an effective and long-lasting clinical improvement in patients with chronic plantar fasciitis, granted its high therapeutic efficiency, patients' satisfaction, its limited cost and its short and repeatable protocol of use.

Evaluation of the effectiveness of vibroacoustic therapy treatment of patients with so-called "heel spur". A preliminary report.

BACKGROUND: The so-called "heel spur" is a radiological term referring to adaptive bone growth as a result of chronic overload enthesopathy of the proximal attachment of the plantar fascia. The main cause of the pain is continued localised pressure on the surrounding soft tissues. Vibroacoustic wave therapy is a relatively new method gaining popularity among doctors, physiotherapists and patients. The aim of this study was to confirm the clinical efficacy of vibroacoustic therapy compared to laser and ultrasound therapy. MATERIAL AND METHODS: The study enrolled 60 patients treated for plantar heel spurs who were divided into a study group of 40 patients who underwent vibroacoustic therapy and a control group of 20 patients treated with ultrasound and laser therapy. The outcome measure for evaluating the effectiveness of physiotherapy was a subjective assessment of pain intensity by VAS and the modified short-form McGill Pain Questionnaire. RESULTS: The mean pain intensity score in patients undergoing vibroacoustic therapy decreased by about 2.6 points according to the VAS scale and 17 points according to the McGill questionnaire, compared to reductions of 0.6 and 6 points, respectively, in the ultrasound and laser therapy group. The correlation between subjective assessment of pain according to the VAS scale and palpation-based assessment of pain was significantly positive between the two groups, demonstrating similarity of the two scales, with a slight dominance of the group undergoing laser and ultrasound therapy. CONCLUSIONS: These results represent a tentative confirmation of analgesic effectiveness of the vibro-acoustic method in musculoskeletal overload conditions. 2. In order to confirm its effectiveness, it is necessary to conduct further prospective randomized studies with blinding and evaluate the long-term results.

Effects of extracorporal shock wave therapy on symptomatic heel spurs: a correlation between clinical outcome and radiologic changes.

Plantar heel pain, a chronic and disabling foot alignment, occurs in the adult population. Extracorporal shock wave therapy (ESWT) offers a nonsurgical option in addition to stretching exercises, heel cups, NSAI, and corticosteroid injections. This study aimed to investigate the effects of ESWT on calcaneal bone spurs and the correlation between clinical outcomes and radiologic changes. The study involved 108 patients with heel pain and radiologically diagnosed heel spurs. All patients underwent ESWT once a week for 5 weeks at the clinic. Each patient received 2,000 impulses of shock waves, starting with 0.05 mJ/mm2 (1.8 bar) and increasing to 0.4 mJ/mm2 (4.0 bar). Standard radiographies of the affected heels were obtained before and after the therapy. Clinical results demonstrated excellent (no pain) in 66.7% of the cases, good (50% of pain reduced) in 15.7% of the cases, and unsatisfactory (no reduction in pain) in 17.6%. After five ESWT treatments, no patients who received shock wave applications had significant spur reductions, but 19 patients (17.6%) had a decrease in the angle of the spur, 23 patients (21.3%) had a decrease in the dimensions of the spur, and one patient had a broken spur. Therefore, results showed no correlation between clinical outcome and radiologic changes. The present study supports the finding that even with no radiologic change after ESWT therapy, the therapy produces significant effects in reducing patients' complaints about heel spurs.

Sever's injury: treatment with insoles provides effective pain relief.

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=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 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.

Sever's injury; treat it with a heel cup: a randomized, crossover study with two insole alternatives.

Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children. Common advice is to reduce physical activity. However, our previous study showed that application of insoles reduced pain in Sever's injury without having to reduce physical activity. The purpose of this study was to test which of the two insoles, the heel wedge or the heel cup, provided best pain relief during sport activity in boys with Sever's injury (n=51). There was a crossover design in the first randomized part of the study. In the second part, the boys, 9-14 years, chose which insole they preferred. There was a reduction in odds score for pain to a fifth (a reduction of 80%) for the cup compared with the wedge (P<0.001). When an active choice was made, the heel cup was preferred by >75% of the boys. All boys maintained their high level of physical activity throughout. At 1-year follow-up, 22 boys still used an insole and 19 of them reported its effect on pain as excellent or good (n=41).