Effectiveness of Orthotic Devices in the Treatment of Achilles Tendinopathy: A Systematic Review

Abstract

Orthotic devices such as foot orthoses, splints, taping and bracing are recommended for Achilles tendinopathy (AT). This systematic review was conducted to review the current evidence for the effectiveness of orthotic devices for the treatment of mid-portion or insertional AT. Electronic bibliographic databases (MEDLINE, EMBASE, Current Contents, CINAHL and SPORTDiscus) were searched in May 2014. The methodological quality of included studies was evaluated using the Quality Index. Where possible, effects were determined using standardised mean differences. The strength of evidence for each intervention was determined according to the quality and number of studies. Twelve studies satisfied the inclusion criteria; nine studies investigated mid-portion AT, whilst three studies did not distinguish between mid-portion and insertional pathology. Weak evidence showed that foot orthoses were equivalent to physical therapy, and equivalent to no treatment. Very weak evidence supported the use of adhesive taping alone or when combined with foot orthoses. Moderate evidence showed that the AirHeel™ brace was as effective as a calf muscle eccentric exercise programme, and weak evidence showed that this intervention was not beneficial when added to a calf muscle eccentric exercise programme. Weak evidence showed that an ankle joint dorsiflexion night splint was equally effective to a calf muscle eccentric exercise programme, and strong evidence showed that this intervention was not beneficial when added to a calf muscle eccentric exercise programme. These findings may aid clinical decision making in the context of AT, however further high-quality studies are required.

Exercise, orthoses and splinting for treating Achilles tendinopathy: a systematic review with meta-analysis

“…Since the review by Sussmilch-Leitch et al 50 was published in 2012, seven more studies have been published that met the eligibility of this current review. A review by Scott et al 51 concluded that there is ‘weak evidence’ to support the use of foot orthoses, splinting or bracing in managing Achilles tendinopathy. This was in agreement with our review.…”

Ultrasound strain mapping of Achilles tendon compressive strain patterns during dorsiflexion

“…Additionally, heel lifts decrease plantar flexor muscle activity during walking (Akizuki, Gartman, Nisonson, Ben-Avi, & McHugh, 2001; Johanson, Allen, Matsumoto, Ueda, & Wilcher, 2010; Lee, Shieh, Matteliano, & Smiehorowski, 1990), which reduces force on the tendon. Although there is limited evidence supporting its therapeutic use (Carcia, Martin, Houck, Wukich, & Orthopaedic Section of the American Physical Therapy, 2010; Scott, Munteanu, & Menz, 2015), heel lifts are considered a component of standard care for Achilles tendinopathy.…”

Conservative Treatment of Chronic Achilles Tendinopathy: A Systematic Review

“…GCS injections are another adjunct that are used in clinics. These injections around the Achilles tendon are controversial because the exact location of the inflammation is rarely found [47]. Moreover, in some cases it is not recommended because of the risk of tendon rupture [48].…”