Definition

Achilles tendinitis is often a misnomer, as most problems associated with the Achilles tendon are not strictly an inflammatory response. A more appropriate term, which most experts now use, is Achilles tendinopathy which includes:
Tendinosis – microtears in the tissues in and around the tendon
Tendinitis – inflammation of the tendon
Most cases of Achilles tendon pain is the result of tendinosis. Tendon inflammation (tendinitis) is rarely the cause of tendon pain.

Overview

Achilles tendinopathy is a common condition that occurs particularly in athletes and can be difficult to treat due to the limited vascular supply of the tendon and the stress within the Achilles tendon with every step. Evidence indicates that treatment incorporating custom foot orthoses can improve this condition by making the foot a more effective lever in gait. A 2008 study reported between 50 and 100% relief (average 92%) from Achilles tendinopathy symptoms with the use of custom foot orthoses¹.

Clinical Goal for Orthotic Treatment

The orthosis for the patient with Achilles tendinopathy should limit heel eversion and subsequent internal rotation of the tibia to prevent an internal twist of the Achilles tendon, reduce tension on the tendon by encouraging early heel lift, and stabilize midtarsal joint motion to provide a more efficient lever for heel lift.

Prescription

To prescribe this device check “Achilles Tendinitis” under the Pathology Specific Orthoses section (Part A) of the prescription form.

Prescription Recommendations

• Polypropylene Shell – semirigid
• Standard Heel Cup
  • If the resting calcaneal stance position (RCSP) is everted, the practitioner should consider changing this to a deep heel cup
• Wide Width
• Standard Cast Fill
  • Closer contact with the arch of the foot limits subtalar joint pronation and heel eversion by preventing midtarsal joint collapse
• Medial Heel Skive – 4mm
  • A medial heel skive helps control heel eversion
• 0/0 Rearfoot Post with no Lateral Bevel
  • The slightly broader rearfoot post stabilizes the orthosis inside the shoe. The post is flat (0/0) to facilitate application of a heel lift
• EVA Cover to Toes
• Heel Lift – 3mm
  • Adding a heel lift to the rearfoot post decreases tension on the Achilles tendon and assists the tendon in heel lift

Summary

The orthosis designed to treat Achilles tendinopathy should limit heel eversion to minimize internal rotation of the tendon, and should decrease tension on the tendon. If you have further questions about this challenging condition, ProLab clients can contact a Medical Consultant.

References

1. Donoghue OA, Harrison AJ, Laxton P, et al. Orthotic control of rear foot and lower limb motion during running in participants with chronic Achilles tendon injury. Sports Biomech. May;7(2):194-205, 2008
2. Williams DS, Zambardino JA, Banning VA . Transverse-plane mechanics at the knee and tibia in runners with and without a history of achilles tendonopathy. J Orthop Sports Phys Ther 38(12):761-7, 2008
3. Brooker S, Vicenzino B, McPoil T, et al. Use of anti-pronation taping to assess suitability of orthotic prescription: case report. Aust J Physiother 50(2):111-3, 2004
4. Larsen K, Weidich F, Leboeuf-Yde C. Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts. J Manipulative Physiol Ther. 25(5):326-31, 2002
5. Subotnick SI, Sisney P. Treatment of Achilles tendinopathy in the athlete. J Am Podiatr Med Assoc. 76(10):552-7, 1986
6. Reinschmidt C, Nigg BM. Influence of heel height on ankle joint moments in running. Med Sci Sports Exerc. 27(3):410-6, 1995
7. Kirby K: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast 23-24, 1997
8. Smith M, Brooker S, Vicenzino B, McPoil, T. Use of anti pronating taping to access suitability of orthotic prescription: Case report. Australian Journal of Physical Therapy 50(2)111, 2004
9. Larsen K, Weidich F, Le Boeuf-Yde C. Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts. Journal of Manipulative Physical Therapy June 25(5) 326, 2002
10. Riddle DL, Freeman DB. Management of a patient with a diagnosis of bilateral plantar fasciitis and Achilles tendinitis. A case report. Physical Therapy Dec: 68(12) 1913, 1988
11. Subotnick SI, Sisney P. Treatment of Achilles tendinopathy in the athlete. JAPMA Oct: 76 (10) 552, 1986