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Achilles tendonopathy

Discussion in 'Biomechanics, Sports and Foot orthoses' started by annakostrikki, Mar 4, 2014.

  1. annakostrikki

    annakostrikki Welcome New Poster

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    Do orthotics work when it comes to Achilles tendonopathy? Is there any evidence to support it?
  2. Donoghue OA, Harrison AJ, Laxton P, Jones RK. Orthotic control of rear foot and lower limb motion during running in participants with chronic Achilles tendon injury. Sports Biomech. 2008; 7:194–205.

    Mayer F, Hirschmuller A, Muller S, Schuberth M, Baur H. Effects of short-term treatment strategies over 4 weeks in Achilles tendinopathy. Br J Sports Med. 2007; 41

    Gross M, Davlin L, Evanski P. Effectiveness of orthotic shoe inserts in the long-distance runner. Am J Sports Med. 1991;19:409–412.

    That's about all other than anecdote.
  3. Deka08

    Deka08 Active Member

    Hi Simon (and anyone else),
    Is there anything on foot to leg strapping in Achilles treatment - short term primarily? I have been looking for weeks, and haven't found anything.
  4. annakostrikki

    annakostrikki Welcome New Poster

    Thank you for your prompt response Simon and the publication details.
  5. Admin2

    Admin2 Administrator Staff Member

  6. Deka08

    Deka08 Active Member

    First - thank you, and how do you find this stuff? Honestly, I am very serious in asking this question. I have a bit of an interest in achilles pathologies, I follow the threads here very carefully, I follow links to their ends, I have access to medical library through work, etc. I really do look hard for stuff on this topic, and you come on and casually throw a link (or several) our way.
    Genuinely, to you and to others on this forum, how do i get better at finding what i am looking for??
  7. Try Google Scholar. In the box in Google Scholar type in the words:

    foot orthotics, achilles tendonitis

    Hit the enter button.

    See what you get. Works wonders.:drinks
  8. DaveJames

    DaveJames Active Member

    Thanks for the article details Simon.

    There are a couple more, which may be useful:

    • Smith M, Brooker S, Vicenzino B & McPoil T (2004) Use of anti-pronation taping to assess suitability of orthotic prescription: Case report. Australian Journal of Physiotherapy 50: 111–113.
    • Munteanu, S. E., Landorf, K. B., Menz, H. B., Cook, J. L., Pizzari, T., & Scott, L. a. (2009). Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial. Journal of Foot and Ankle Research of foot and ankle research, 2(27). doi:10.1186/1757-1146-2-27

    The Munteanu et al study above was completed as a study, and reported on at the Sport Medicine Australia 2013 Conference, the abstract details are shown below. I don't believe it has been formally published as yet.

    Effectiveness of customised foot orthoses for the treatment of Achilles tendinopathy: Preliminary findings
    of a randomised controlled trial

    S. Munteanu1,2*  L. Munteanu1,2  K. Landorf1,2  D. Bonanno1,2  T. Pizzari1,3  J. Cook4  H. Menz1
    1Lower Extremity and Gait Studies Program, Faculty of Health Sciences, La Trobe University  2Department of Podiatry, Faculty of Health Sciences, La Trobe University
    3Department of Physiotherapy, Faculty of Health Sciences, La Trobe University  4Faculty of Medicine, Nursing and Health Sciences, Monash University
    Introduction: Foot orthoses are commonly recommended for the management of mid-portion Achilles tendinopathy (AT), but the evidence relating to
    their effectiveness is equivocal. This study aimed to evaluate the effectiveness of customised foot orthoses for chronic AT in people who were also
    undergoing a calf muscle eccentric exercise program.
    Methods: One hundred and forty community-dwelling men and women aged 18 to 55 years with AT (mean [SD] age=43.6 [7.9] years) were randomly
    allocated to either a control group (sham foot orthoses) or an experimental group (customised foot orthoses). Both groups were also prescribed a standard
    12 week calf muscle eccentric exercise program. Participants were blinded to group allocation. The primary outcome measure was the Victorian Institute
    of Sport Assessment – Achilles (VISA-A) questionnaire. Secondary outcome measures included participant perception of treatment effect (dichotomised as
    effective or ineffective change in symptoms), level of physical activity (assessed using the 7-day Physical Activity Recall questionnaire), and health-related
    quality of life (assessed using the Short-Form-36 questionnaire – Version 2). Data were collected at baseline, then at 1, 3, and 6 months.
    Results: There were clinically significant improvements in VISA-A questionnaire scores across time in both groups. However, there were no
    statistically significant differences between groups in scores of the VISA-A questionnaire at 1, 3, or 6 months (VISA-A at 3 months adjusted mean
    difference=2.1 points, 95% CI -4.1 to 8.2, p=0.506). Furthermore, there were no significant differences between groups for the perception of
    treatment effect (risk ratio at 3 months=1.08, 95% CI=0.89 to 1.31), or health-related quality of life at any time point.
    Discussion: Customised foot orthoses are no more effective than sham foot orthoses in reducing symptoms and improving function and activity
    in people with AT undergoing a calf muscle eccentric exercise program.​

    Kind regards,

  9. Take a look at the design of foot orthoses they used in their study, then decide if this is how you would design a foot orthosis for someone with achilles tendonopathy...
  10. DaveJames

    DaveJames Active Member

    I believe they used a Root type device and then tailored it based on the foot posture index. The rationale appears to be that is what is "commonly prescribed" Australia and New Zealand.

    It wouldn't be my first choice of prescription, or treatment, for that matter.

    Kind regards,

  11. Deka08

    Deka08 Active Member

    Thanks Kevin,
    One further Q. Given the volume of results that those searches produce, is it possible to discern which article to read in full?
    Don't mean to sidetrack the thread.
  12. Derek:

    I skim the titles one by one until I find the most promising one. Sure beats going to the library...which is what I did to research papers during all of podiatry school, all of my residency training and during my first 10 years of practice.
  13. Deka08

    Deka08 Active Member

    Thanks Kevin,
    I thought there might be some sage like method that you guys have for sorting hay from chaff. But it seems like I just have to keep going, pouring through article after article. I agree, it does beat the library. I remember at uni when pubmed was the new thing, haha.

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