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I an hoping you can help me!

I have a patient with chronic Achilles tendon pain who has been searching on the internet for information about treatment. She has only seen me twice but has had lots of physio and pain for about 2 years which has changed very little over that time. I am commencing orthotic therapy but so far she has had only a minimal response to a tempoary device. She has asked me today if an Achilles tendon strap would be helpful. Unfortunately this is not something I have come across before and have never used. For anyone else who has not seen these it works on the same principle as a strap for tennis elbow, it loops under the heel and around the anlke and has a firmer strap across the Achilles tendon providing tension and restricting stretch (I googled 'Achilles tendon strap' and there are lots of companies selling them and therefore I saw some pictures). I can see the principle of the strap but couldn't really advise the patient if this would be helpful. I don't know if they are commonly used but they have certainly passed me by!

I would appreciate any information as to the use of the strap either positive or negative.

Thanks for your help,

Louise

This is a new one to me. Perhaps just tell her that. You had not heard of them and either have many others. Leave it up to her to try. Dont advise her to try it, don't advise her not to - leave it to her to decide. Expalin its not mentioned in the scientific literature anywere as a treatment modality.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

LoiuseB,

I have never heard of this device, but agree with Craig's response

Some questions -
in your opinion why has she got the pain?
where is the problem?
why has it been going on for 2 years?

Regards
Mark

Has your patient tried the correct (ie Alfredson) protocol for eccentric loading exercises? This is the gold standard treatment for Achilles tendinosis. It has a success rate of approximately 80%. Other tretament options for pain not responding to eccentric loading exercises include prolotherapy, polidocinol injections, GTN patches and aprotinin injections. In my experience, most patients who have chronic tendinosis haven't done the correct protocol for eccentric loading exercises and can make a significant improvement once they begin this treatment.

I have seen these straps being used by a few of my patients and some of them even think they work. However, I don't know how they work or how well they work, but I have seen them.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Thanks for the info. I told the patient I had not heard of the strap but would ask around in case it could be of value.

To be honest I don't really know why she has had the pain so long!! She has come to me from physio where I believe she has had stretches and done eccentric loading exercises but I confess I did not check her technique on the exercises only the stretches. She has quite sound foot mechanics but remains tight in the TA so my orthotic prescription has centred around heel raise and first ray facilitation. She does kick boxing and thai chi both of which she stopped for a while on the advice of the physio but has started again as it has been so long and she didn't feel the symptoms were worse with the activity. She has no palpable oedema or thickeneing in the tendon but is painful on palpation especially close to the insertion. I don't think she had any direct therepy to the tendon (massage, frictions, soft tissue mobs) and wondered if this would be beneficial but means a referral back to physio and another wait for the patient (don't you just love the nhs!).

I will pass on the info regarding the strap as she is keen to try anything that might help.

Thanks,

Louise

I haven't seen the achilles strap, but, as suggested, it 'should' work in a similar way that the tennis elbow strap does. Whether this 'working' is long-term or not is another issue.


The typical tennis elbow (aka lateral epicondylitis/epicondylalgia etc etc.) will have a reduced grip strength (15 lbs compared with 45 for example) and a reproduction of symptoms.

Simply applying a compressive influence on the affected musculo-tendinous structure (taping or tennis elbow strap) will invariably double the pre-intervention strength test.

Why does the compressive influence have an effect? The anecdotal consensus suggests that the compressed region becomes the new pulling point, replacing the old pathologically affected tissue. In other words, tension is somehow reduced at the pathological site.


So, if appropriate assessments have been tried and most conventional treatments (heel raises; anti-dorsi-flexion strapping; orthotic therapy; shockwave blah blah etc etc) attempted...then why not?

IMO, understanding why a tennis elbow brace can instantly improve objective assessment should give us a better understanding of the potential of an achilles tendon strap.

The only potential downside may be neuro-vascular compromise; similar to a tennis elbow brace.



How hard is this caper? Get them hopping. If sore, then strap with an elastic non-rigid material that compresses the achilles tendon. Re-assess the hop. If the results are significant, and unattainable with other methods, then one is obliged to look at it.


Ron