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Orthotic control of rear foot and lower limb motion during running in participants with chronic Achilles tendon injury.
Donoghue OA, Harrison AJ, Laxton P, Jones RK. Sports Biomech. 2008 May;7(2):194-205
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This study examined the kinematic effects of orthoses in participants with a history of chronic Achilles tendon injury. Twelve participants ran at self-selected speeds on a treadmill with and without customized orthoses. Joint and segment angles including leg abduction, calcaneal, eversion, ankle dorsiflexion, and knee flexion angles were calculated from three-dimensional data throughout stance. Five footfalls were obtained for each participant and condition. Statistical tests revealed an increase in maximum eversion with orthoses (P < 0.001, eta(p)2 = 0.642). In the individual participant analysis, this was evident in 9 of 12 participants. Trends towards increased eversion range of motion and decreased ankle dorsiflexion maximum and range of motion angles were also observed. Increased eversion was unexpected as all devices were designed to provide pronation control as deemed necessary by the podiatrist. Despite this, participants reported between 50 and 100% (average 92%) relief from symptoms with the use of orthoses. Further analysis of the angle-time curves and coordination between angular measures is recommended.
Re: Orthotic control of rear foot in chronic Achilles tendon injury
I just love this stuff:
Quote:
Originally Posted by NewsBot
Trends towards increased eversion range of motion
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Despite this, participants reported between 50 and 100% (average 92%) relief from symptoms with the use of orthoses.
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
Re: Orthotic control of rear foot in chronic Achilles tendon injury
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Originally Posted by Secret Squirrel
How did the orthotics help if they pronated the foot more?
You need to come to one of the Boot Camps!
Think about it intuitivly ... what is the function of the muscles that pull on the achilles tendon? .... supinate and plantarflex the foot .... so if an orthotic is going to help, then it has to reduce the force in the tissues; ... ie it has to reduce the pronatory moments and the dorsiflexion moments .... it does not matter what it does to the motion ....its matters what it does to the forces
Quote:
Originally Posted by Kent
But really, 92% relief of symptoms with orthotics?????
I'd like to see a high quality RCT before I stop prescribing eccentric loading exercises and start giving all my Achilles patients orthotics.
The 92% reduction in symptoms was not compared to a control group without orthotics, so any conclusion has to be tempered with that.
__________________ Craig Payne
__________________________________________________ ___________________________________ Follow me on Twitter | Run Junkie God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
Re: Orthotic control of rear foot in chronic Achilles tendon injury
Quote:
Originally Posted by NewsBot
Increased eversion was unexpected as all devices were designed to provide pronation control as deemed necessary by the podiatrist. Despite this, participants reported between 50 and 100% (average 92%) relief from symptoms with the use of orthoses.
These had to be special orthoses equipped with pronation boosters.
Pronation allows more dorsiflexion to occur in the midtarsal joint, so it would seem that we shouldn't make good orthoses for Achilles tendontitis.
Despite anecdotal evidence linking overpronation to the onset of
Achilles tendinopathy (AT), there is little conclusive evidence of a
particular movement pattern of the lower extremity associated with this
injury. Therefore, the objective of the present study was to observe
differences in the kinematic profiles of healthy runners (CON) and
runners with mid-portion Achilles tendinopathy (ATG). Materials and
Methods: In this cross-sectional analysis, 48 male height and weight
matched subjects were invited to participate: 27 with mid-portion
Achilles tendon pain and 21 asymptomatic controls. Subjects underwent
lower extremity clinical examination, then ran barefoot for 10-trials
at a self-selected pace. A 3D motion capture system analysed tri-plane
kinematic data for the lower extremity. Results: The ATG displayed
significantly greater sub-talar joint eversion displacement during
mid-stance of the running gait (13 ± 3 degrees vs. 11 ± 3 degrees; p =
0.04). Trends were observed such that the ATG showed lower peak
dorsiflexion velocity (300 ± 39 degrees/s vs. 330 ± 59 degrees/s; p =
0.08) and greater overall frontal plane ankle joint range of motion (45
degrees ± 7 vs. 41 degrees ± 7; p = 0.09). Conclusion: We found an
increase in eversion displacement of the sub-talar joint in runners
with Achilles mid-portion tendinopathy. Based on the findings from this
study, there is evidence that devices used to control sub-talar
eversion may be warranted in patients with Achilles mid-portion
tendinopathy who demonstrate over-pronation during mid-stance of the
running gait.
Re: Orthotic control of rear foot in chronic Achilles tendon injury
Anecdotally, those runners with pronated feet and Achilles tendinitis/tendinosis who don't initially respond to heel lifts, stretching and icing seem to respond quite well to anti-pronation foot orthoses. My assumption has always been that the orthosis must decrease the tensile stress on the injured/torn area of the Achilles tendon and therefore allows the pain to gradually resolve or the Achilles tendon to heal. However, we still have no research yet, to my knowledge, that confirms this idea.
__________________
Sincerely,
Kevin
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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College
Orthotic control of rear foot in chronic Achilles tendon injury
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