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Running shoes and achilles tendon loads

Discussion in 'Biomechanics, Sports and Foot orthoses' started by NewsBot, Feb 6, 2014.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Running Shoes Increase Achilles Tendon Load in Walking: an Acoustic Propagation Study
    Wearing, Scott C.; Reed, Lloyd; Hooper, Sue L.; Bartold, Simon; Smeathers, James E.; Brauner, Torsten
    Medicine & Science in Sports & Exercise: 4 February 2014
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    It would be interesting to see how the new internal spring lever orthotics would perform in this testing to reduce achilles loads and pathology. www.kingetics.com.

    Just a thought.

    If anyone is interested at looking into something new and advanced...

    A Hui Hou,
    Steve
     
  4. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    I am surprised by the lack of discussion here on Podiatry Arena about the results of this study.

    How can we justify our orthotic treatment for achilles tendonitis if the underlying foam based shoe we place our orthotics on increases the achilles load ?? " we cannot have it both ways

    "Conclusions
    -This study is the first to show that standard running shoes increase Achilles tendon loading, as
    defined by an increase in acoustic velocity, during treadmill walking. These findings question
    the potential role of standard running shoes in the prevention and therapeutic management of
    Achilles tendinopathy and suggest that footwear with a 10–mm heel offset may increase
    loading in the Achilles tendon during gait."


    I was impressed with the discriptor of the footwear used. They took some time to quantify the characteristics of the shoes. It would have been nice if they took the time to define "standard shoes". Perhaps we should start testing Non-starndard shoes with this technique?

    "A standard running shoe (Oregon, Adidas, Herzogenaurach, Germany) ranging in size between
    US 9.5–11.5 (length 29.4 – 30.9 cm) and mass between 359 – 396 gm, with identical, flexible
    mesh uppers and incorporating a single density EVA midsole and rubber outsole were used for
    the shod condition. The midsole and outsole hardness of the shoes was 60 ± 1 and 88 ± 1, respectively,
    as determined by a Shore A Durometer, which measures resistance to indentation on a
    dimensionless scale ranging from 0 to 100. All shoes were made by the same manufacturer and
    had a heel offset (elevation) of 10 mm (forefoot height, 17.0–19.5 mm; heel height, 27.0 – 29.5mm)"

    Lastly this technology to use ultra sound to measure realtime tendon loads is bodacious.

    A Hui Hou,
    Steve

    advanced composite spring lever runner
     
  5. Deka08

    Deka08 Active Member

    This has bugged me for a few days, and I have been trying to think of reasons why. I have an idea or 2 that may at least satisfy me, if no one else.
    The hand has better grip strength when the wrist operates at a slightly dorsiflexed position. It could be that the ankle has a similar position closer to its neutral.
    I noted that they only measured barefoot and 10mm. It would be interesting to see a progression of measures 5mm, 10, 15, to see if there is any continuing trend. For Achilles treatments we (i) often add a raise to an already pitched shoe.
    The other thing, and I am not sure if this does really make a difference, were the tendons in these individuals healthy? There are differences between healthy tendon and a tendon with pathology, could this change load characteristics.
    I too am keen to hear other opinions about this.
     
  6. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    Goood points,

    It looks as though they used a good healthy sample group.

    "Twelve healthy adult males were recruited from university faculty to participate in the study.
    The mean (± SD) age, height, body mass and foot length of participants was 31 ± 9 years
    (range, 20 – 47 years), 1.78 ± 0.06 m, 81.0 ± 16.9 kg, and 26.4 ± 0.9 cm, respectively.
    Participants were non–smokers, non–medicated and recreationally active based on self–report.
    No participant reported a medical history of diabetes, inflammatory joint disease, familial
    hypercholesterolemia or Achilles tendon pain or pathology. No participants reported a history
    of Achilles tendon surgery."


    Perhaps collapsing foam based shoes do not allow ample enough stability to reduce the need for the achilles to work?

    ie When i run the beach my achilles works harder to stabilize the foot during heel contact and has to work more to get out of the sand at toe off. Foam soleing material collapses and deforms in a simular way so why would it not act in a simular way?

    Here may be a significant way to reduce achilles loads.
    Previously posted by Newbot
    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=54503
    "RESULTS: High-top shoes significantly reduced peak Achilles tendon tension by an average of 9.9% when compared with low-top shoes. "
    This seems a no brainer because we already have successful results at treating achilles injuries with dynamic AFO's and cam boots.

    Take a peak at the new Kobe 9's by Nike.

    Notice anything different with his footwear after Kobe's achilles injury??

    Should have he been wearing hightops in the first place to prevent the injury???

    http://espn.go.com/nba/story/_/id/10080275/nike-kobe-bryant-unveil-new-high-top-kobe-9-sneakers

    Now how can we get the ultasound probes inside this hightop shoe to test the validity of the high top to reduce achilles loads.

    Interesting,

    A hui hou,
    Steve

    Advanced Composite Spring Lever Orthotic and High Top Shoe/Boot Runner
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Influence of running shoes and cross-trainers on Achilles tendon forces during running compared with military boots
    Jonathan Sinclair, P J Taylor and S Atkins
    J R Army Med Corps doi:10.1136/jramc-2014-000308
     
  8. efuller

    efuller MVP

    They were walking faster with longer strides. That could be the reason there was more acoustic velocity in the Achilles tendon. Hopefully, there is some earlier work that correlates tendon velocity with tension. Anybody have a copy of the article?

    Another factor is that many running shoes have a rocker tip that could shorten the lever arm of ground reaction force. This would reduce the tension needed, but could allow a faster velocity, but lower tension.

    Eric
    fullerpod@lmi.net
     
  9. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of estimates of Achilles tendon loading from inverse dynamics and inverse dynamics-based static optimisation during running
    Thomas Kernozek, Naghmeh Gheidi & Robert Ragan
    Journal of Sports Sciences 18 Nov 2016
     
  10. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,
    Is there a good explanation for these results?

    Please will all research scientists in the field of studying impacts use a more robust descriptor of the impact midigator-mechanism tested.
    "Standard running shoes incorporating a 10-mm heel offset were used."

    What was the durometer of foam used and at what temperature?
    Was it EVA or PU or dual density, where they new or the subject own shoes???

    How can we repeat this work?

    What does standard mean?

    Time to start studying the non-standard advanced composite spring levered running shoes instead.

    I think we have beaten foam to death.

    Mahalo,
    Steve

    Dr. Steven King
    Prior Army Officer and Podiatrist
    Managing Member Kingetics LLC

    Subject Matter Expert and voting member for ASTM American Society of Testing Materials committees;
    -E54.4 Homeland Security Applications and Personal Protective Equipment, Tactical Body Armor
    -F13 Pedestrian and Walkway Safety Footwear Testing and Standards
    Co-Principle Investigator SBIR A11-109 “Advanced Composite Insoles for the Reduction of Stress Fractures.” US Department of Defense and Army Medical Research and Materials Command
    Co-Author US Pat.# 8,353,968 "Spring Lever Orthotic Device"
     
  11. terigreen

    terigreen Active Member

    Great info here, thanks. I find that a small heel lift such as a 6 mm (1/4") heel lift can decrease the load on the Achilles tendon, especially if there is Achilles tendonitis. The load on the Achilles is diminished.

    Thanks,

    Teri
    Atlas Biomechanics
     
  12. efuller

    efuller MVP

    I've always been impressed by the study below. They decided to look at whether the conventional wisdom was really true. If you think about it makes some sense. People will use their calf muscles whether or not they are on a heel lift. That would be the explanation of why Achilles tendon tension would be unchanged with and without a heel lift while running. On the other hand, if the ankle stiffness increases because of Achilles tension when the bottom surface of the foot is plantarflexed relative to perpendicular to the leg, A heel lift would decrease tension in the tendon in static stance. However, to maintain fore aft balance, there will be intermittent contraction of the gastroc and soleus.


    Influence of heel height on ankle joint moments in running.

    Reinschmidt C1, Nigg BM.
    Author information

    Abstract

    Clinically, heel lifting or heel wedging in running shoes has been proposed as a prevention and treatment of Achilles tendinitis. It has been speculated that heel lifting decreases the Achilles tendon forces. The purpose of this study was to determine the effect of heel height on resultant ankle flexion moments during running. It was assumed that plantarflexion moments at the ankle joint would indicate Achilles tendon loading. Each of the five subjects performed five running trials (4.6 m.s-1) for each of the five shoes, differing only in heel height (2.1-3.3 cm). Resultant plantar-/dorsiflexion moments were calculated using a standard three-dimensional inverse dynamics analysis. The results showed that, typically, a small initial dorsiflexion moment took place changing into a larger plantarflexion moment before 20% of stance phase. The magnitude and time of occurrence of the initial dorsiflexion moment were significantly affected by heel height changes, but the maximum plantarflexion moment and its time of occurrence were not significantly affected. The results did not support the speculation that a heel lift generally decreases the Achilles tendon loading during running. However, single subject analyses indicated that for two subjects the plantarflexion moments decreased with increasing heel height.
     
  13. Petcu Daniel

    Petcu Daniel Active Member


    The Effect of an In-shoe Orthotic Heel Lift on Loading of the Achilles Tendon During Shod Walking

    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 proportional to the tensile load to which it is exposed, was measured in the right Achilles tendon of 12 recreationally active men 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 100 Hz during 10 seconds 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 2 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). Ultrasonic velocity in the Achilles tendon (P1, P2, M2) was significantly lower with the addition of an orthotic heel lift (P<.05).
    Conclusion
    Peak ultrasound transmission speed in the Achilles tendon was lower with the addition of a 12-mm orthotic heel lift, indicating that the heel lift reduced tensile load in the Achilles tendon, thereby counteracting the effect of footwear observed in previous studies. 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.

    http://www.jospt.org/doi/abs/10.2519/jospt.2016.6030?code=jospt-site

    and a discussion on PA on this subject: https://podiatryarena.com/index.php?threads/reduced-at-load-with-use-of-heel-lifts-yes-no.106013/

    Daniel
     
  14. Colleagues:

    Regardless of what the research shows, 31 years of clinical practice and the placing of probably over a thousand heel lifts into the shoes of patient for the treatment of Achilles tendinopathy has clearly shown that heel lifts consistently reduce the pain from Achilles tendinopathy. This leads to the logical conclusion that heel lifts probably provide their therapeutic effect by reducing either the peak magnitude of Achilles tendon tension or reduce the strain rate of elongation (i.e. decrease the slope of the stress-strain curve) on the Achilles tendon during walking and/or running. My guess is that heel lifts reduce both the peak tension force within the Achilles tendon in most individuals and also, possibly more importantly, reduce the strain rate, or reduce the slope of the stress-strain curve of the Achilles tendon. It is therefore likely one or both of these factors that produce the consistent clinical effects seen with heel lifts in the treatment of Achilles tendinopathy.
     
  15. efuller

    efuller MVP

    Another possible explanation is the reduction of the impulse (Force x time) in the tendon. If passive stretch of the Achilles is one factor in producing tension in the tendon, then the passive stretch will occur later in stance when there is a heel lift. If this were true, then the duration of time where the forces are high would be reduced with a heel lift. Also, the passive stretch may cause the CNS to initiate or increase muscle contraction.

    I don't see how a heel lift could reduce the magnitude of the force in the tendon. Especially, if active contraction of the gastorc and soleus muscles are what produces the peak forces that are needed for walking.

    Eric
     
  16. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Comparison of estimates of Achilles tendon loading from inverse dynamics and inverse dynamics-based static optimisation during running
    Thomas Kernozek, Naghmeh Gheidi & Robert Ragan
    Journal of Sports Sciences Pages 1-7 Nov 2016
    .
     
  17. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    Craig, please I call on you to examine this statement in detail, as a scientist, and ask if it was anybody else but our esteemed "elderly statesman of podiatry" Dr. Kirby would this be allowed?

    "Regardless of what the research shows, 31 years of clinical practice and the placing of probably over a thousand heel lifts into the shoes of patient for the treatment of Achilles tendinopathy has clearly shown that heel lifts consistently reduce the pain from Achilles tendinopathy."

    I could as easily say,
    "Regardless of what the research shows drinking fresh pond water daily has clearly shown that it will reduce the smell of my farts."
    Scientifically this could be true because my bad breath may over power my powerful flatulence... Only true scientific research and analytical data can tell.

    BTW we are looking for olfactory volunteers and funding for this important research study.

    Mahalo,
    Steve

    Levers Do Work...:)
    Foam Do Not...:(
     
  18. The point of my post, Dr. King, is to clearly state that regardless of what research shows (which, by the way, is contradictory in this case) heel lifts do work clinically, work very well in many cases, and are still a standard treatment of Achilles tendinopathy, as it has been for over a half century. Just because a study showed that heel lifts did not cause a decrease in ankle joint plantarflexion moment does not mean that the strain rate of the Achilles tendon or the magnitude of Achilles tendon tension force is not decreased with a heel lift. Researchers may have not have studied the correct mechanical factor that positively correlates to Achilles tendon loads in the design of their study and this is certainly a reasonable explanation for the different conclusions from the different studies. Invasive strain gauge implantation into the Achilles tendon of subjects would be the gold standard for testing the mechanical effects of heel lifts on the human bipedal locomotor apparatus. That study has yet to be done.

    Also, thank you, Dr. King for the first time in a few years, for not self-advertising your expensive shoe/orthosis products in one of your posts. Maybe there is hope for you after all! I doubt, however, from your history of continual self-promotion of your products at every chance you get here on Podiatry Arena, that you will be able to actually have a discussion where composites, and their apparent benefits, are not mentioned within the post, or at the end of the post (Levers Do Work...:) Foam Do Not...:().

    Please surprise us, Dr. King. Let's see if you can not advertise your product somehow over the next ten posts you make here on Podiatry Arena. I personally think you are incapable of commenting here without self-promoting your products for any length of time.

    Merry Christmas!
     
  19. I can see how a heel lift could modify the Achilles tendon tension force vs time curve during walking and running which may be best reflected in a change in the strain rate of the Achilles tendon. However, I would tend to agree that the CNS will tend to keep the peak Achilles tendon tension load relatively constant with or without a heel lift added to the shoe.
     
  20. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,
    Kevin you cannot have it both ways.

    If you believe that your heel lift technique is so special then do the research on it and publish your results.
    In a way perhaps you are advertising your expertise above everyone else's here on Podiatry Arena when you claim success with unsupported clinical based statements like you did.

    Yes, i am trying to educate-sell you on the ability to reduce achilles tendon load and strain through the use of an advanced composite spring-levered orthotic that we started testing for the US Department of Defense and Army Medical Research and Materials Command for SBIR A11-109.



    Mahalo,
    Steve

    About our Science
    It received the CAMX2015 Most Creative Application Award with Advanced Composite Materials co-sponsored by ACMA and SAMPE.
    http://www.thecamx.org/wp-content/uploads/2015-ACE-Awards-Book.pdf
    The technology was an Innovation Competition finalist at the inaugural Wearable Robotics Conference sponsored by DARPA and Intel at WearRAcon16.
    http://www.wearablerobotics.com/view-submissions/
    http://exoskeletonreport.com/2016/05/wearracon16-innovation-competition/

    Exoskeletons are orthotics, and so are your shoes.
    http://www.oandp.com/articles/2016-01_05.asp

    I could claim that this innovation has helped me and my achilles tendons climb lots of hills better this year of which i have over 236,000 vertical feet thus far.
    Check out my "clinical research" run on Strava.
    https://www.strava.com/activities/796536564

    About Me
    Dr. Steven King DPM
    Prior US Army Officer and Podiatrist
    Maui, Hawaii

    Subject Matter Expert and voting member of the ASTM American Society of Testing Materials committees;
    -E54.4 Homeland Security Applications and Personal Protective Equipment, Tactical Body Armor
    -F13 Pedestrian and Walkway Safety Footwear Testing and Standards
    Co-Principle Investigator SBIR A11-109 “Advanced Composite Insoles for the Reduction of Stress Fractures.” US Department of Defense and Army Medical Research and Materials Command
    Co-Author US Pat.# 8,353,968 "Spring Lever Orthotic Device"
     
  21. Steve:

    As I correctly predicted, you are incapable of not advertising your product in your posts here on Podiatry Arena. As such, you can believe what you want about me. But as far as I'm concerned, you are no better than people like Dennis Shavelson or Ed Glaser who could never come here on Podiatry Arena and just discuss academics without also advertising. It's a shame that we need to continually read your nonsense product endorsements, all so you can continue to use this academic forum to attempt to make more money trying to sell your expensive products.

    Steve, why don't you try selling your product elsewhere? Podiatry Arena is for those who have enough self-control to not continually advertise something they have a financial interest in...obviously not something you ever can seem to do!
     
  22. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha Kevin,
    Being smart and being wise are two paths hard to merge.

    I am sorry for your inability to talk about the use of a lever to lift the rearfoot to decrease the load and work on the achilles tendon and its insertions.
    This is serious business we are in and lives and livelihoods depend on our adherence to scientific methods.

    Your comment that "Regardless of what the research shows…" is the same types of comments that you whamblasted Dennis Shavelson, Ed Glaser and the guy with the water bag inserts for.
    So much that they got themselves banned.

    Hey Craig! How about a New Years "get out of jail free card" for those guys? Since Kevin is now using their techniques to prove his superior science of foam heel lifts to plastic inserts to foam midsoled shoes for the treatment of overloaded achilles tendons?

    As a fellow teacher Kevin, we cannot have our students pursue science that could be construed as pseudoscience and we cannot make claims that have not stood the rigors of objective scrutiny.


    Please help me with the mechanics here.
    The largest shoe maker in the world Nike has had their Chief of Design team describe the Nike Air Jordan's as having the ability to capture and release "Zoom".
    Try to discern just what is the technology they are talking about in this Nike video with Tinker Hatfield and his underling.
    Use your physics education.

    Start video time at 1:10 where Nike’s Chiefs of Design makes the claims, "we capture Zoom Air with a foam carrier that does not let that Zoom to go anywhere, allowing us to unlock that zoom"
    They are describing an air bag bladder.



    Now since many young basketball players and players wear Air Jordans does Zoom affect the load on the achilles?
    Tinker ! Could you please convert your Nike Zoom units to SI units so that we may vet your advanced designs and mechanics, please.

    How many students at our publicly funded schools and universities must be branded with Nike's pagan logo if this is the best science they can supply?

    :):) Hey Craig yippee the wicked hatchet man of death is dead on your new platform, great!

    Mahalo,
    Steve
     
  23. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Towards the Real-time Monitoring of Achilles Tendon Strain
    Bruce, Olivia Leigh
    Thesis; University of Calgary; 2018
     
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