Achilles Tendinopathy
Description
Achilles tendinopathy is a diffuse term encompassing multiple different pathologies surrounding the Achilles’ tendon. Insertional achilles tendinopathy/enthesopathy, retrocalcaneal bursitis and mid-portion achilles tendinopathy have a strong link towards tendon overload and compression. Whereas the superficial bursa on the posterior heel is mainly linked towards friction and irritation.
In cases where tendon overload is suspected, orthotic therapy may play a role in soft tissue offloading – improving patients comfort and ability to perform daily tasks. However, in order to be comprehensive, exercise rehabilitation is key to restoring the full capabilities of the tendon and ensuring long term resolution is achieved.
Keys to effective Achilles tendinopathy orthotic management:
Posterior chain tightness (calves) and rearfoot pronation are both correlated with patients experiencing achilles tendinopathy. Controlling movement through rearfoot posting and MLA contour can be an effective way to reduce the tensile load being placed through the achilles tendon during mid stance. Further, adding a heel raise onto the orthotic may reduce tensile load, however more importantly speed up the gait cycle – reducing how much time the achilles tendon is under load.
The Extrinsic Heel Lift will be tapered from the proximal heel to no thickness in-line with the sulcus. The specified thickness will be measured from the heel centre as indicated by the pink line in the image below.This may also be provided intrinsically.
