Controlled trial to compare the Achilles tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift

Kawin K W Lee, Samuel K K Ling, Patrick S H Yung, Kawin K W Lee, Samuel K K Ling, Patrick S H Yung

Abstract

Background: Achilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet.

Methods: Twelve participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions.

Results: Participants who ran with CASO (p = 0.001, d = 0.43) or HL (p = 0.001, d = 0.48) associated with a significant reduction in ATL when compared to without orthotics while there was no significant difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO (p = 0.003, d = 0.93) and HL (p = 0.004, d = 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL.

Conclusions: Both CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies.

Trial registration: NCT04003870 on clinicaltrials.gov 1 July 2019.

Keywords: Achilles tendon; Arch support; Flatfeet; Heel lift; Insole; Load; Orthoses; Runners; Tendinopathy.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The CASO fabricated from the negative plaster cast
Fig. 2
Fig. 2
The CASO (left) and the CASO with 3 mm multiform added (right)
Fig. 3
Fig. 3
CASO intervention to foot pronation (left in barefoot condtion, right in CASO)
Fig. 4
Fig. 4
The HL with maximum height of 18 mm
Fig. 5
Fig. 5
Retroreflective markers including anterior superior iliac spine, lateral thigh, lateral femoral epicondyle, lateral shank, lateral malleolus
Fig. 6
Fig. 6
The flow of the experimental procedure
Fig. 7
Fig. 7
Ankle kinetics and kinematics in the three conditions during stance phase of running (a = sagittal ankle angle, b = sagittal plantarflexion moment, c = Achilles tendon load)
Fig. 8
Fig. 8
Peak Plantar Flexion moment in the three conditions
Fig. 9
Fig. 9
Peak Achilles tendon load in the three conditions
Fig. 10
Fig. 10
Time to peak Achilles tendon force in the three conditions
Fig. 11
Fig. 11
Achilles tendon loading rate in the three conditions
Fig. 12
Fig. 12
Peak dorsiflexion angle in the three conditions

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