The effect of an in–shoe orthotic heel lift on loading of the Achilles tendon during shod walking

Wulf, Mathias, Wearing, Scott C., Hooper, Sue, Bartold, Simon, Reed, Lloyd, & Brauner, Torsten (2016) The effect of an in–shoe orthotic heel lift on loading of the Achilles tendon during shod walking. Journal of Orthopaedic and Sports Physical Therapy, 46(2), pp. 79-86.

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  • Study Design

Controlled laboratory study

  • Objective

To investigate the effect of a 12–mm in–shoe orthotic heel lift on Achilles tendon loading during shod walking using transmission–mode ultrasonography.

  • Background

Orthotic heel lifts are thought to lower tension in the Achilles tendon but evidence for this effect is equivocal.

  • Methods

The propagation speed of ultrasound, which is governed by the elastic modulus and density of tendon and is proportional to the tensile load to which it is exposed, was measured in the right Achilles tendon of twelve recreationally–active males during shod treadmill walking at matched speeds (3.4±0.7 km/h), with and without addition of a heel lift. Vertical ground reaction force and spatiotemporal gait parameters were simultaneously recorded. Data were acquired at 100Hz during 10s of steady–state walking. Statistical comparisons were made using paired t–tests (α=.05).

  • Results

Ultrasound transmission speed in the Achilles tendon was characterized by two maxima (P1, P2) and minima (M1, M2) during walking. Addition of a heel lift to footwear resulted in a 2% increase and 2% decrease in the first vertical ground reaction force peak and the local minimum, respectively (P<.05). Peak ultrasonic velocity in the Achilles tendon (P1, P2, M2) was significantly lower with addition of an orthotic heel lift (P<.05).

  • Conclusions

Peak ultrasound transmission speed in the Achilles tendon was lower with the addition of a 12–mm orthotic heel lift, indicating the heel lift reduced tensile load in the Achilles tendon, thereby counteracting the effect of footwear. These findings support the addition of orthotic heel lifts to footwear in the rehabilitation of Achilles tendon disorders where management aims to lower tension within the tendon.

  • Level of Evidence

Therapy, level 2a

Impact and interest:

1 citations in Scopus
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ID Code: 90581
Item Type: Journal Article
Refereed: Yes
DOI: 10.2519/jospt.2016.6030
ISSN: 1938-1344
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > CLINICAL SCIENCES (110300)
Divisions: Current > Schools > School of Clinical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2015 Journal of Orthopaedic & Sports Physical Therapy
Deposited On: 23 Nov 2015 03:31
Last Modified: 17 May 2016 13:13

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