A 12 month randomised comparative efficacy trial into the treatment of calcaneal apophysitis

Method This is the world’s largest randomised comparative efficacy trial with one, two, six and 12-month follow-up. Children with clinically diagnosed calcaneal apophysitis (n = 124) were recruited. There were two treatment factors within the study. Factor 1 was two different types of in-shoe orthoses: a heel raise or prefabricated orthoses. Treatment factor 2 was footwear replacement. The alternate condition in this factor was no footwear replacement. These interventions were also representative for different hypothesized causative mechanism of calcaneal apophysitis. The primary outcome was pain/disability measured using the Oxford ankle foot questionnaire. The secondary outcomes were pain measured using the Faces pain scale and ankle range of motion measured using the weightbearing lunge test. At the six-month and 12 month follow up point the Oxford ankle foot questionnaire was completed as the single outcome measure. The intervention factors were examined over time on the primary and secondary outcome measures using a generalized estimating equation. Results The children within this study experienced pain for a mean 10.87 (0.61) months prior to intervention. There was no main effect of shoe insert (heel raise v’s prefabricated orthoses), or footwear (usual footwear v’s athletic footwear), nor an insert by footwear interaction effect for three of the four domains of the primary outcome measure. There was a difference in the footwear domain between footwear intervention groups (usual footwear vs. athletic footwear) however the direction of this difference was opposite for children (p=0.02, favouring usual footwear) than for their parent (p=0.017, favouring athletic footwear).