Original Article
Factors Associated with Pain Severity in Children with Calcaneal Apophysitis (Sever Disease)

https://doi.org/10.1016/j.jpeds.2015.04.053Get rights and content

Objective

To identify any association between the pain experienced as a result of calcaneal apophysitis, anthropometric data, and lower limb measurements.

Study design

This study was a cross-sectional study, nested within a wider randomized, comparative efficacy trial. One hundred twenty-four children between the ages of 8 and 14 years with a clinical diagnosis of calcaneal apophysitis were recruited for this study. Of the participating children, 72 were male. The measures recorded were height, weight, waist circumference, body mass index, foot posture, and ankle joint range of motion; comparison with normative values was also completed. Univariate and multivariable regression analyses were undertaken to identify factors associated with the severity of pain experienced (visual analog scale).

Results

The children within this study had a higher mean body mass index (P < .001), increased weight (P < .001), and were taller (P < .001) compared with normative values. The children also demonstrated differences in foot posture and ankle joint range of motion. Multivariable regression analyses identified that older participants (P = .046) and those who had experienced pain for longer (P = .043) reported higher pain severity.

Conclusions

Children presenting with calcaneal apophysitis were anthropometrically different from their peers and had experienced a lengthy period of pain. Therefore, early management focussing on the anthropometric differences may minimize the intensity and duration of pain experienced.

Trial Registration

Registered with Australian New Zealand Clinical Trials Registry: ACTRN12609000696291.

Section snippets

Methods

This study was designed as a cross-sectional study, nested within a wider randomized comparative efficacy trial.10 The randomized trial had a 4-group design and focused on pain reduction and activity maintenance with footwear, orthoses, or heel lifts in children experiencing pain associated with calcaneal apophysitis.10 The present study utilized observational data collected from participants at their first appointment (prior to randomization). The utilized observational data collected from

Results

A total of 133 participants responded to the recruitment advertisement between March 2010 and December 2013. Nine participants were excluded because of FPI-6 score <−1 (n = 4), a suspected diagnosis of juvenile idiopathic arthritis (n = 1), resolved pain prior to initial assessment (n = 3), and a participant making up pain to avoid school activity (n = 1). All remaining 124 participants (52 [42%] girls, 72 [58%] boys) consented to participate in the study.

Among the 124 participants, the mean

Discussion

We identified that children with calcaneal apophysitis were more likely to have a greater BMI, increased weight, greater waist circumference, and increased height than the general population data. Although an association with BMI has previously been reported in symptomatic children,8 this study found that symptomatic children also were taller.

We also report the impact of greater height with pain experienced in calcaneal apophysitis. This was a weak correlation and may support the passive

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    Funded by Monash Health (Emerging Researcher Grant [to A.J.]). The authors declare no conflicts of interest.

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