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Bilateral calcaneal pain
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Bilateral calcaneal pain - July 28, 2008 7:56:12 AM
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JSPT
Posts: 284
Joined: April 19, 2005
From: Michigan
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I have a 10 y/o male who has had bilateral achille's tendinosis and calcaneal apophysitis (Sever's Disease) for about 2 years. X-rays and MRI's were negative for fracture.
We've done orthotics for subtalar pronation with a medial wedge, calf stretching, rest, iontophoresis, and kinetic chain strengthening for the past 2 weeks, with some improvement.
Has anyone had good experience with any other treatments for this condition?
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RE: Bilateral calcaneal pain - July 28, 2008 8:10:46 AM
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Tom Reeves DPT ATC
Posts: 448
Joined: March 14, 2006
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Try a home Microcurrent unit. Could also be done in the clinic if you have one. I have had Excellent results with Sever's and Osgood Schlatters. Could also try taping his heel. I use Leukotape and basically put a horseshoe around the heel then cover the bottom with 2 or 3 more strips. Rationale is that he might have a fat pad irritation as well and if he is bottoming out through the fat pad, the tape will add sort of hydraulic lift and prevent that.
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RE: Bilateral calcaneal pain - July 29, 2008 1:46:38 AM
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bonez
Posts: 232
Joined: August 29, 2007
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Tom are you able to post some of your settings for micro use?
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RE: Bilateral calcaneal pain - July 29, 2008 9:23:11 AM
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Tom Reeves DPT ATC
Posts: 448
Joined: March 14, 2006
Status: offline
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Sure,
Two settings High and Low High for the majority of the treatment and low for the last 5 minutes.
High = 100 micro amps, 30 Hz, and if you have this adjustment, a waveslope of 10
Low = 20 micro amps, 0.3 Hz, and a waveslope of 1
The current is three dimensional so run the current through the target anatomy.
These settings are from Lynn Wallace The rationale for the low setting is unknown. He was doing a pilot study with a small sample and found that the group that ended their sessions on a lower setting had better pain relief. The reason was unknown.
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RE: Bilateral calcaneal pain - August 9, 2008 5:48:23 AM
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ginger
Posts: 660
Joined: February 26, 2005
From: Melbourne Victoria
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One or two sessions of CM to L5S1 will eliminate these referred pain problems. Good work with the orthotics ( presumably he is an overpronator ) however the consequence of uncontrolled pronation prior to these will need to be addressed, that is SIJ function . The 'Stork' test will almost certainly reveal a loss of SIJ movements , which need to be restored. ( the most common consequence of overpronation, features in the sequelae leading to L5S1 referred pain by initiating protective behaviour in the low back by a loss of the force reducing effect of normal SIJ function )
In a ten year old you may only need to push on the sacrum with both hands for a while ( mobilise ) in prone to restore normal movements here , manipulation is sometimes necessary, but worth the effort with just mobs at first.
All the best
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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RE: Bilateral calcaneal pain - August 10, 2008 2:33:48 AM
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gomez2
Posts: 51
Joined: May 5, 2005
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I have treated knee and ankle issues both directly and indirectly by addressing and correcting hip alignment and efficency through a series of progressive exercise routines, mostly hips but overall body as well. My goals are to establish bilateral muscular activation throughout the body, establish proper AROM, proper muscular balance and postural re-alignment and then begin re-educating proper muscular coodination through full ROM then add demand to reinforce the new proper biomechanics. Then see if the pain issue is still there.
My demo for my clients to illustrate the importance of hip function to the allignment and function of the knees and ankles: stand and lock the knees tight, rotate the femurs in towards each other then outwards. As the hips are IR the feet pronate creating a "flattening" stress on the arch, as the hips ER the feet supinate decreaseing stress on the arch allowing the interosseous nuscles to re-establish the arch.
I have had clients work themselves out of custom orthotics as they re-establish proper hip then foot alignment, also clients have had to get new shoes as they go from severe supination and pes cavus to proper foot alignment and their feet WB properly and the feet acually get larger.
Look at the client's posture in all 4 directions for alignment as well as gait. I would bet she is IR in 1 or B hips
Lifts and supportive shoes would work but is really not addressing the origin of the problem, it is bracing and bandaging the pain.
www.adapttraining.com
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