Comparison of Braces for Treatment of Sever's Disease in Barefoot Athletes: A Randomized Clinical Trial

Abstract

Abstract Context: Sever's is a common condition in youth athletes, including those who participate in barefoot sports. Health care professionals often recommend that young athletes with Sever's should wear heel cups in their shoes while active, but barefoot athletes are unable use heel cups. Objective: We wanted to compare the efficacy of two braces used by barefoot athletes with Sever's disease. Design: Randomized controlled clinical trial. Setting: Pediatric sports medicine clinic. Participants: Barefoot athletes 7–14 years old with Sever's disease completed self-reported assessments after diagnosis (baseline), and again 1-month, 2-months, and 3-months later. Interventions: Participants were randomized to Cheetah heel cup™ or X-brace™ groups for use during barefoot sports over the 3-month study period. Main Outcome Measures: Primary outcome: Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical score (3-months post-enrollment). Secondary outcomes: OxAFQ-C school/play and emotional scores, and Visual Analog Scale (VAS) pain scores. Results: We enrolled 43 participants and 32 completed the study (n=16/group; age=13.3±1.6 years; 91% female). The Cheetah heel cup™ and X-brace ™ groups spent a non-significantly different percentage of time wearing the brace during barefoot sport (81% vs 64% of time in-sports, p=0.08). At 3-months, there were no significant differences for OxAFQ-C physical, (0.79 vs 0.71, p=0.80: Hedge's g=0.06), school/play (0.94 vs 1.00, p=0.58, Hege's g=0.26) or emotional (1.00 vs 1.00, p=0.85, Hedge's g=0.21) scores. VAS pain scores during ADLs and sports were significantly lower (better) at 2- and 3-month time points as compared to baseline (p<0.001). Conclusions: Both groups demonstrated improvements in ankle/foot function across time, however, no between-group differences were observed at 3 months. Given these results, barefoot athletes with Sever's disease may consider using either brace with barefoot activity to help improve pain and functional status.