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).

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 (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. Treating Sever's injury with insoles is often proposed as a part of a traditional mix of recommendations. Using a custom-molded rigid heel cup with a brim enclosing the heel pad resulted in effective pain relief without reducing the physical activity level in our previous two studies. The purpose of this study was to assess the effect of the heel cup on heel pad thickness and heel peak pressure (n=50). The difference in heel pad thickness and in heel peak pressure using a sports shoe without and with a heel cup was compared. With the heel cup the heel pad thickness improved significantly and the heel peak pressure was significantly reduced. These effects correlated with a significant reduction in pain when using the heel cup in a sports shoe, compared with using a sports shoe without the heel cup. A heel cup, providing an effective heel pad support in the sports shoe, improved the heel pad thickness and reduced heel peak pressure in Sever's injury with corresponding pain relief.

The diagnosis of Sever's injury is clinical, not radiologic. Radiologic findings of increased density and fragmentation are found also in pain-free controls with high levels of physical activity and may, therefore, represent normal growth and development. We suggest that the diagnosis of Sever's injury should be based on patient history and the results of two specific clinical tests.