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Achilles Tendinopathy Improved by Foot Orthotics: Proving the Concept

Custom-made, semi-rigid foot orthotics have been shown to relieve Achilles tendinosis symptoms up to 92% within one month. The exact mechanism by which this relief is achieved has been largely theoretical. The first-ever investigation of foot orthotics and Achilles tendon loading finds that orthotics significantly reduce the load on the tendon, the duration of maximum load, and the rate at which that load is applied.

Achilles tendinopathy is a common source of discomfort and an impediment to active lifestyles. While overuse related to the active lifestyles of athletes and recreational athletes appears to provoke symptoms, even relatively inactive patients may present with Achilles tendinopathy, and the extent of histopathology appears to occur regardless of the level of physical activity. Despite the more traditional term Achilles Tendonitis, histological evaluation and contemporary molecular biology techniques demonstrate this condition is not primarily an inflammatory condition. Achilles tendinopathy is primarily a failed healing response characterised by collagen disarray and neovascularisation.


Surgery is generally considered effective in most cases, but conservative approaches are recommended as the first-line of treatment. In particular, custom-made, semi-rigid foot orthotics have been shown to reduce Achilles tendonitis symptoms up to 92% within one month. The consensus opinion has been that arch supports accomplish their clinical effects by reducing rear foot eversion and aligning the calcaneus in the vertical direction, thereby reducing the shear stress experienced by the Achilles tendon. However, this opinion has been challenged, and there has been a paucity of evidence demonstrating why and how foot orthotics achieve their known benefits in Achilles tendinopathy. 


This is why Jonathan Sinclair, PhD, and colleagues published last year the first-ever investigation of the effects foot orthotics have on the Achilles tendon in running. Using extensive analysis of 12 adult male runners with and without shock-absorbing arch supports, the researchers were able to demonstrate with statistical significance that foot orthotics do moderate forces on the Achilles tendon. While ground reaction force remained the same between with-orthotic and without-orthotic tests, the Achilles tendon loads were reduced significantly with orthotics. Additionally, the time spent in higher loads was reduced and the rate at which load increased was reduced. 


Reduction of forces through the Achilles tendon is likely a mechanism by which foot orthotics can quickly achieve symptom relief in patients with Achilles tendinopathy. Furthermore, this normalization of biomechanical forces is likely to provide long-term protection for the tendon and the remainder of the lower extremities involved in the attenuation of ground reaction forces - for as long as the foot orthotics remain fully functional. 

At Advanced Physiotherapy & Injury Prevention, we provide custom orthotics using dynamic, pressure-mapping technology. Our orthotics are built from a unique memory plastic which is guaranteed for life against breakage and will never flatten. Various design options allow us to find the right balance between comfort, control, and sports performance for each client. Our capacity for state-of-the art foot orthotics gives us an advantage in the conservative treatment of many symptoms related to weight-bearing biomechanics. Please keep Advanced Physiotherapy in mind for referrals for:


·        Plantar fasciosis

·        Shin pain

·        Ankle sprains

·        Achilles tendinosis



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