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Achilles Tendonitis

Achilles Tendonitis, also known as “Achilles Tendinopathy” is a common condition, Studies have found more than half of runners studied with Achilles Tendonitis showed excessive pronation and it is estimated that Achilles Tendonitis accounts for around 11% of all running injuries.   Angiographic studies have found that an area of hypovascularity exists proximal to the tendon insertion into the calcaneus.  “Excessive internal rotation of the tibia during pronation draws the achilles tendon medially, creating a whipping action along the tendon; this action wrings out the hypovascular area of the tendon, resulting in microtears and inflammation

 

 

 

What does the evidence say? Study: 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; in which they reported: 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.

Symptoms

 

1. The most common sign of Achilles tendinitis is pain that develops gradually and worsens over time.
2. Mild ache or pain at the back of the leg and above the heel after running or other sports activity
3. Episodes of more severe pain associated with prolonged running, stair climbing or intense exercise, such as sprinting
4. Tenderness or stiffness, especially in the morning, that usually improves with mild activities
5. Mild swelling or a “bump” on the Achilles tendon
6. A crackling or creaking sound when you touch or move your Achilles tendon
7. Weakness or sluggishness in your lower leg

 

Orthotic Treatment

1. Full width orthotic device
2. Min fill in medial longitudinal arch and calcaneal inclination angle
3. 4mm medial heel skive
4. 4* rearfoot post to control overpronation
5. 3mm heel raise
6. Stretching routine for Gastrocnemius and Soleus

References

  • Robert A. Donatelli: Biomechanics of the Foot and Ankle
  • Mayo Clinic: Mayo Foundation for Medical Education and Research
  • Donoghue OA, Harrison AJ, Laxton P, Jones R: : Orthotic control of rear foot and lower limb motion during running in participants with chronic Achilles tendon injury


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