Category Archives: Musculoskeletal

What is the best-selling product on Amazon.com for ‘Sever’s Disease’?

I was doing some digging around Amazon.com to see what sorts of products people are buying for the self-care of their foot problems and this one for Sever’s disease stuck out like a sore thumb. I can’t say I am surprised by this. What I was surprised by was I had never seen or heard of the product before and just how well it is selling.

It was this ‘half sock’ with a gel under the heel:

severs
severs

They are proving to be very popular on Amazon.com and just go to further illustrate what my not-so-scientific study on calcaneal apophysitis found in the most cases they seem to be self-managed and do just fine.

Link to the product on amazon.com.

I can’t attest to their efficacy, but given that we seem to treat most cases with some sort of cushioned heel raise, then there is no reason to assume that these will not be helpful.

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My Not So Scientific Study on Calcaneal Apophysitis (Sever’s Disease)

I have previously written on all my clinical work, research and teaching experiences with calcaneal apophysitis and just how much I realised I did not know and just how much I learnt when my own child got it. As my daughters have just come out of the age bracket where the condition is common, I used that opportunity over the last few years to chat to as many of their friends and their friend’s parents that I could about their experiences with ‘Severs Disease’ whenever I could (an unrepresentative purposively selected sample with recall bias and no ethics approval, but, hey no worries).

Based on my own recall bias, here is what I found:

  • most of the kids either had it or had a friend that had it
  • almost all of them knew of the special type of growing heel pain that occurs in kids
  • of those that got it, only a bit over half of them actually went to a health professional for treatment or advice
  • a wide variety of treatments were used and advice given
  • some of that advise or treatment, in my opinion, was bad and would have made no difference to the natural history of the condition
  • they all got better at an age before the growth plate would have merged with the rest of the calcaneus
  • a bit under two-thirds of them attributed the getting better to taking it easy (eg during school holidays) and not due to any specific treatment given
  • for many it lasted a while, but the symptoms were always there and manageable, but they got better eventually by doing nothing much
  • of those that got foot orthoses, NONE of them thought they actually made any difference (except one)!

Over recent years, I have started to question if there is actually anything we can do for Calcaneal apophysitis (Sever’s disease). I talked about a particularly painful case here with a massive improvement that all I did was say to them on Thursday, that I will see you Monday. Now I know you are not supposed to give much weight to anecdotes, especially if they fit in with your agenda or world view, but if you combine that anecdote with the experiences I had with my daughters, the unscientific study above and what was being published in peer-reviewed journals, then it is time for some self-reflection on one’s beliefs about the condition.

When we get to this stage, we should be relying on high-quality evidence from proper controlled and unbiased studies. There are not many. This one told us that heel raises do a bit better than foot orthoses, but neither really had a big impact (and that is sorta consistent with my unscientific study above). This study showed that doing nothing and just ‘wait and see’ works pretty well (and that is sorta consistent with my unscientific study above).

The use of foot orthoses to treat this is particularly problematic. The study linked in the previous paragraph showed they did not do too well. My cohort thought they were not particularly useful, yet you still see on a lot of podiatry websites claim that “overpronation” is a factor in calcaneal apophysitis (Sever’s disease) and therefore foot orthoses are needed. We know from the evidence that the claims about “overpronation” and this condition are false which removes the rationale as to why foot orthoses would be used.

Does this mean that we should just leave Calcaneal apophysitis (Sever’s disease) alone and not treat it? Of course not. I do now believe that this condition has its own good natural history and it gets better pretty much on its own regardless of any intervention. Yes, I know they grow out of it when the growth plate merges with the rest of the calcaneus, but I am talking about before that stage. Our role is simply one of education about the nature of the condition, managing expectations and managing loads. Terminology and words matter. Combine that with some ice for pain relief if it gets bad and maybe a cushioned heel raise and we good to go.

Any advocacy for any other treatments or interventions for this are going to have to be accompanied by actual evidence that they are better than a placebo or doing nothing due to the nature of the natural history of this condition. In clinical practice, did it get better because the intervention is better than a placebo or doing nothing or did it get better because it was going to anyway (ie natural history). That is why we need the actual evidence rather than unsubstantiated claims.

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Advertisement:

SaleBestseller No. 1
Coding Companion for Podiatry 2021
  • OPTUM360 (Author)
  • English (Publication Language)
Bestseller No. 2
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  • Shi, Eric (Author)
  • English (Publication Language)
Bestseller No. 4
Funny Foot Whisperer Podiatry for Podiatrist T-Shirt
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  • Medical students gift idea for future foot whisperer who love to care feet. A Funny gift for every passionate podiatrist and Chiropodist. A funny food doctor quote for men and women. Every legendary Podiatrist loves Podiatry Humor.
Bestseller No. 5
Ultrasound of the Foot and Ankle
  • Hardcover Book
  • Schwartz, Nathan (Author)
SaleBestseller No. 6
SaleBestseller No. 7
Pocket Foot and Ankle Medicine and Surgery (Pocket Notebook Series)
  • English (Publication Language)
  • 400 Pages - 07/18/2018 (Publication Date) - LWW (Publisher)
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Bestseller No. 9
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  • English (Publication Language)
Bestseller No. 10
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  • HEAVY-DUTY FACIAL BEAUTY BED/CHAIR WITH 400 LBS WEIGHT CAPACITY
  • HIGH GRADE FAUX LEATHER WITH HIGH DENSITY FOAM FOR BOTH COMFORT & DURABILITY

I get commissions for purchases made through links on this website. As an Amazon Associate I earn from qualifying purchases

For more, please check all the threads on this on Podiatry Arena and our PodChatLive with Alicia James.