Southern Medical Journal, 2020/12, 113(12):771, type of study: ,cr,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

Full text    (https://sma.org/abstracts/utilizing-osteopathic-manipulative-treatment/)

Keywords:

achilles tendon [8]
adolescent [83]
calcaneal apophysitis [1]
case report [736]
conference abstract [127]
female [655]
OMT [3925]
osteopathic manipulative treatment [3946]
pediatrics [573]
women [608]

Abstract:

Introduction Sever's disease also known as calcaneal apophysitis is caused by repetitive strain and micro trauma to the secondary ossification center at the Achilles tendon insertion. It often occurs with a pediatric/adolescent rapid growth spurt or sudden increased activity. Treatment consists of rest, pain medications, and orthotics. If conservative measures are not successful, surgery may be considered. This case describes a patient who was successfully treated with osteopathic manipulative treatment (OMT) for bilateral Severs disease. A literature review revealed no prior studies addressing this. Case Presentation A 12-year-old female presented to the outpatient OMT clinic with bilateral calcaneal pain for six months, worse on the left. She plays softball and has a history of obesity. X-rays revealed reactive sclerosis of the calcaneal apophysis bilaterally with no fractures or dislocations. The patient was seen by orthopedics, diagnosed with bilateral Sever's disease, and prescribed conservative measures. She had minimal improvement with two months of wearing a boot and rest; orthopedics was considering surgery. The physical exam revealed bilaterally taught and thickened Achilles tendons with 5/10 pain when palpated. Osteopathic structural exam was notable for numerous somatic dysfunctions affecting both lower extremities, especially the left. Diagnosis Prior to considering surgery, the patient was treated with OMT. Her structural exam suggested a bio mechanical cause of her pain. Gentle OMT was performed to both lower extremities above and below the ankle with the goal of decreasing muscular hypertonicity and thereby ameliorating traction tension on the calcaneal tendon. The patient was counseled to stretch daily. Outcomes After the third session, the patient reported her pain went from 5/10 to 2/10. She was able to walk pain-free without her boot, return to softball practice, and no longer required surgery. This case study is incomplete as the patient was lost to long term follow up. Learning Objectives 1. Understand the pathophysiology of Severs disease 2. Recognize the biomechanical factors that contribute to Severs disease in growing adolescents 3. Understand how Osteopathic Manipulative Treatment (OMT) can be used to address the bio mechanical components of Severs disease.