Effects of foot orthoses on Achilles tendon load

NewsBot · Aug 12, 2014

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Effects of foot orthoses on Achilles tendon load in recreational runners
J. Sinclair, J. Isherwood, P.J. Taylor
Clinical Biomechanics; Available online 8 August 2014

Highlights
• First study to investigate the effects of foot orthoses on Achilles tendon loads during running.
• Foot orthoses served to significantly reduce Achilles tendon loads.
• Those susceptible to Achilles tendon pathology may wish to utilize orthotics to attenuate their risk of injury.
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Background
Achilles tendon pathology is a frequently occurring musculoskeletal disorder in runners. Foot orthoses have been shown to reduce the symptoms of pain in runners but their mechanical effects are still not well understood.
Methods
This study aimed to examine differences in Achilles tendon load when running with and without orthotic intervention. Twelve male runners ran at 4.0 m.s- 1. Ankle joint moments and Achilles tendon forces were compared when running with and without orthotics.

Findings
The results indicate that running with foot orthotics was associated with significant reductions in Achilles tendon load compared to without orthotics. Interpretation: In addition to providing insight into the mechanical effects of orthotics in runners, the current investigation suggests that via reductions in Achilles tendon load, foot orthoses may serve to reduce the incidence of chronic Achilles tendon pathologies in runners.
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NewsBot · Aug 12, 2014

Effectiveness of Orthotic Devices in the Treatment of Achilles Tendinopathy: A Systematic Review.
Scott LA, Munteanu SE, Menz HB.
Sports Med. 2014 Aug 10

Orthotic devices such as foot orthoses, splints, taping and bracing are recommended for Achilles tendinopathy (AT). This systematic review was conducted to review the current evidence for the effectiveness of orthotic devices for the treatment of mid-portion or insertional AT. Electronic bibliographic databases (MEDLINE, EMBASE, Current Contents, CINAHL and SPORTDiscus) were searched in May 2014. The methodological quality of included studies was evaluated using the Quality Index. Where possible, effects were determined using standardised mean differences. The strength of evidence for each intervention was determined according to the quality and number of studies. Twelve studies satisfied the inclusion criteria; nine studies investigated mid-portion AT, whilst three studies did not distinguish between mid-portion and insertional pathology. Weak evidence showed that foot orthoses were equivalent to physical therapy, and equivalent to no treatment. Very weak evidence supported the use of adhesive taping alone or when combined with foot orthoses. Moderate evidence showed that the AirHeel™ brace was as effective as a calf muscle eccentric exercise programme, and weak evidence showed that this intervention was not beneficial when added to a calf muscle eccentric exercise programme. Weak evidence showed that an ankle joint dorsiflexion night splint was equally effective to a calf muscle eccentric exercise programme, and strong evidence showed that this intervention was not beneficial when added to a calf muscle eccentric exercise programme. These findings may aid clinical decision making in the context of AT, however further high-quality studies are required.
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NewsBot · Oct 28, 2015

Orthotic Heel Wedges Do Not Alter Hindfoot Kinematics and Achilles Tendon Force During Level and Inclined Walking in Healthy Individuals.
Weinert-Aplin RA, Bull AM, McGregor AH.
J Appl Biomech. 2015 Oct 21

Conservative treatments such as in-shoe orthotic heel wedges to treat musculoskeletal injuries are not new. However, weak evidence supporting their use in the management of Achilles tendonitis suggests the mechanism by which these heel wedges work remains poorly understood. It was the aim of this study to test the underlying hypothesis that heel wedges can reduce Achilles tendon load. A musculoskeletal modelling approach was used to quantify changes in lower limb mechanics when walking due to the introduction of 12mm orthotic heel wedges. 19 healthy volunteers walked on an inclinable walkway while optical motion, forceplate and plantar pressure data were recorded. Walking with heel wedges increased ankle dorsiflexion moments and reduced plantar flexion moments. This resulted in increased peak ankle dorsiflexor muscle forces during early stance and reduced Tibialis Posterior and toe flexor muscles forces during late stance. Heel wedges did not reduce overall Achilles tendon force during any walking condition, but did redistribute load from the medial to lateral triceps surae during inclined walking. These results add to the body of clinical evidence confirming that heel wedges do not reduce Achilles tendon load and our findings provide an explanation as to why this may be the case.
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NewsBot · Jan 12, 2016

The Effect of an In-Shoe Orthotic Heel Lift on Loading of the Achilles Tendon During Shod Walking
Mathias Wulf, Scott C. Wearing, Sue L. Hooper, Simon Bartold, Lloyd Reed, Torsten Brauner
J Orthop Sports Phys Ther, Epub 11 Jan 2016

Study Design
Controlled laboratory study.

Background
Orthotic heel lifts are thought to lower tension in the Achilles tendon but evidence for this effect is equivocal.

Objective
To investigate the effect of a 12–mm in–shoe orthotic heel lift on Achilles tendon loading during shod walking using transmission–mode ultrasonography.

Methods
The propagation speed of ultrasound, which is governed by the elastic modulus and density of tendon and is proportional to the tensile load to which it is exposed, was measured in the right Achilles tendon of twelve recreationally–active males during shod treadmill walking at matched speeds (3.4?0.7 km/h), with and without addition of a heel lift. Vertical ground reaction force and spatiotemporal gait parameters were simultaneously recorded. Data were acquired at 100Hz during 10s of steady–state walking. Statistical comparisons were made using paired t–tests (α=.05).

Results
Ultrasound transmission speed in the Achilles tendon was characterized by two maxima (P1, P2) and minima (M1, M2) during walking. Addition of a heel lift to footwear resulted in a 2% increase and 2% decrease in the first vertical ground reaction force peak and the local minimum, respectively (P<.05). Peak ultrasonic velocity in the Achilles tendon (P1, P2, M2) was significantly lower with addition of an orthotic heel lift (P<.05).

Conclusions
Peak ultrasound transmission speed in the Achilles tendon was lower with the addition of a 12–mm orthotic heel lift, indicating the heel lift reduced tensile load in the Achilles tendon, thereby counteracting the effect of footwear. These findings support the addition of orthotic heel lifts to footwear in the rehabilitation of Achilles tendon disorders where management aims to lower tension within the tendon.
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NewsBot · Jul 29, 2017

Effects of medial and lateral orthoses on Achilles tendon kinetics during running
Gareth Shadwell, Jonathan Sinclair
The Foot and Ankle Online Journal 10 (2): 5
https://faoj.org/2017/06/30/effects...s-on-achilles-tendon-kinetics-during-running/

The aim of the current investigation was to determine the effects of medial and lateral foot orthoses on Achilles tendon kinetics. Achilles tendon kinetics were obtained from twelve male runners who ran at 4.0 m/s, in lateral, medial and no-orthotic conditions. Achilles tendon loading parameters in the three orthotic conditions were examined using one-way repeated measures analysis of variance (ANOVA). The results showed that peak Achilles tendon force was significantly reduced in the medial (49.96 N/kg) in relation to the lateral (54.32 N/kg) and no-orthotic (53.90 N/kg) conditions. In addition, it was also shown that Achilles tendon load rate was significantly reduced in the medial (400.25 N/kg/s) in relation to the lateral (444.11 N/kg/s) and no-orthotic (431.30 N/kg/s) conditions. The current investigation therefore indicates that that medial orthoses can significantly attenuate Achilles tendon loading parameters linked to the etiology of Achilles tendon pathologies. Further study is required to determine whether reductions in Achilles tendon load as a function of medial orthoses also serve to reduce the risk of developing Achilles tendon pathology.
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NewsBot · Dec 9, 2017

Effects of footwear and heel elevation on tensile load in the Achilles tendon during treadmill walking
Torsten Brauner, Sue Hooper, Thomas Horstmann & Scott Wearing
Footwear Science: 07 Dec 2017

This study used transmission-mode ultrasound (US) to evaluate the effect of footwear, with differing heel elevation, on Achilles tendon loading and basic gait parameters. Axial transmission velocity of US was measured in the right Achilles tendon of 20 healthy adults (10 male and 10 female; age: 31 ± 9 years; height: 1.72 ± 0.04 m; weight: 67.8 ± 14.2 kg) while walking barefoot (BF) and in four prototype athletic shoes (S1–S4) on an instrumented treadmill. Shoes were constructed from identical materials and differed only in heel elevation (S1: 0.4 mm; S2: 5 mm, S3: 9.9 mm, S4: 14.8 mm), which was achieved by varying the graded thickness of the midsole beneath the rearfoot. Temporospatial gait parameters, sagittal ankle movement, and vertical ground reaction force were simultaneously recorded at rate of 120 Hz. Shod walking conditions were characterized by a significantly lower cadence, longer stance duration, greater ankle dorsiflexion, larger peak vertical ground reaction force, and higher US transmission velocity in the Achilles tendon than BF walking (P < .05). Incremental heel elevation in footwear resulted in a progressive increase in peak vertical force, a reduction in peak external loading rate, and a small but progressive reduction in US transmission velocity in the Achilles tendon (P < .05). Simple regression modelling predicted that a shoe with 58 mm of heel elevation would effectively replicate values observed during BF walking. Peak US transmission velocity, and hence tensile load, in the Achilles tendon was higher during shod than BF walking and was partially countered by increasing the heel elevation of the shoe. These findings have important clinical implications for the use of footwear in performance applications and in the prevention and rehabilitation of Achilles tendon disorders.
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NewsBot · Jul 2, 2019

This clinical trial was just registered:
Orthotics and Achilles Load in Runners

Compare Customized arch support orthoses (CASO) and orthotic heel lift (HL) on the effect of ATL in recreational runners with pronated feet.
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NewsBot · Nov 17, 2019

Controlled trial to compare the Achilles tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift.
Lee KKW et al
BMC Musculoskelet Disord. 2019 Nov 13;20

BACKGROUND:
Achilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet.

METHODS:
Twelve participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions.

RESULTS:
Participants who ran with CASO (p = 0.001, d = 0.43) or HL (p = 0.001, d = 0.48) associated with a significant reduction in ATL when compared to without orthotics while there was no significant difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO (p = 0.003, d = 0.93) and HL (p = 0.004, d = 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL.

CONCLUSIONS:
Both CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies.
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