Fortunately this risk only appears to be associated with the first and second generation fluoroquinolones with the third and fourth generation drugs not being associated with an increased risk of tendinopathy.
This is a common topic I write about often. I wrote here about just how much I learnt about the condition when my own daughter got it and just how much that subsequently influenced my management. We did a PodChatLive on it with Alicia James and I published my unscientific study on it here.
Secondly, as I said in my unscientific study, I not sure we can do much to help it. The big problem with Sever’s disease is that if you take 100 kids with and do nothing, x% will be a lot better next week. If you took another 100 and did something, then x% would be better next week, so did ‘something’ work or was it the natural history that was the reason for the improvement.
I know when you visit Podiatry Facebook groups and other social media and see discussions on Sever’s disease, so many have there views on what should be done. I have to fight myself really hard not to get involved in arguments, but I often want to ask them how do they know the treatment that they are advocating actually works and that the improvement that they are seeing is not just the natural history that you would expect to see. They actually have no way of knowing unless what they are advocating has been tested in a proper well controlled prospective randomized study.
So what do I do for Sever’s disease. Not a lot. Educate them on the nature of the condition and the natural history; discuss how to manage the loads and use a cushioned heel pad.
One big thing I get from running the Clinical Biomechanics Boot Camps is the feedback that I get when clinicians change their clinical practice based on what I teach on the course and its works!
One of these is the treatment of anterior compartment syndrome. My previous clinical experience in dealing with this problem is an almost 100% failure in its treatment. It really was a challenge. Anterior compartment syndrome is when the muscles expands its volume as it normally does on exercise and the fascial compartment that the muscle is in is particularly tight, so it hurts. Nothing really used to seem to help except the surgical outcomes were always pretty good.
In 2013, this study was published and I immediately started doing it in clinical practice and teaching about it in the Clinical Biomechanics Boot Camps. By changing from a heel strike to a more midfoot or forefoot strike with a lower touch down angle meant the activity in the anterior tibial muscle did not have to work so hard (but keep in mind that to do this requires other muscles to work harder and put them at increased injury risk if this is not done carefully).
This means the rationale was there. Even more surprisingly was that the results were often quite dramatic clinically. It worked. I enjoyed the feedback from course participants who went back to their clinics and tried it and contacted me to tell me it worked.
It may be somewhat voyeuristic, but I periodically head over to YouTube to check out if there are any new videos of athletes getting an Achilles tendon rupture. They hurt you to watch them. Here are a few:
For more on the Kevin Durant rupture, see this write up. One thing I do find interesting about Achilles tendon ruptures is that if you follow the literature, the outcomes between surgical outcome versus conservative care outcomes are about the same; so how does clinician make a decision as to which is the best approach? There is this very log thread on Podiatry Arena with all that literature (you can sign up to watch that thread and get notified of new updates). Some research can be followed here.
The mechanism of action in all these videos is similar. There is a simultaneous extension of the knee and flexion of the ankle as they accelerate.