Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial

Abstract

Objective(s)To compare the efficacy of in-shoe heel lifts to calf muscle eccentric exercise in reducing pain and improving function in mid-portion Achilles tendinopathy.MethodsThis was a parallel-group randomised superiority trial at a single centre (La Trobe University Health Sciences Clinic, Discipline of Podiatry, Melbourne, Victoria, Australia). One hundred participants (52 women and 48 men, mean age 45.9, SD 9.4 years) with clinically diagnosed and ultrasonographically confirmed mid-portion Achilles tendinopathy were randomly allocated to either a (1) heel lifts (n=50) or (2) eccentric exercise (n=50) group. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 12 weeks. Differences between groups were analysed using intention to treat with analysis of covariance.ResultsThere was 80% follow-up of participants (n=40 per group) at 12 weeks. The mean VISA-A score improved by 26.0 points (95% CI 19.6 to 32.4) in the heel lifts group and by 17.4 points (95% CI 9.5 to 25.3) in the eccentric exercise group. On average, there was a between-group difference in favour of the heel lifts for the VISA-A (adjusted mean difference 9.6, 95% CI 1.8 to 17.4, p=0.016), which approximated, but did not meet our predetermined minimum important difference of 10 points.ConclusionIn adults with mid-portion Achilles tendinopathy, heel lifts were more effective than calf muscle eccentric exercise in reducing pain and improving function at 12 weeks. However, there is uncertainty in the estimate of effect for this outcome and patients may not experience a clinically worthwhile difference between interventions.Trial registration numberACTRN12617001225303.

Are Plantarflexor Muscle Impairments Present Among Individuals with Achilles Tendinopathy and Do They Change with Exercise? A Systematic Review with Meta-analysis

“…torque) because the resistance training prescribed should lead to strength and hypertrophy gains [28]. This finding is less surprising when considered in the context of conflicting plantarflexor function impairments across [23,39,46,48,49], Pain Disability Index [50], visual analog scale (VAS) [24][25][26]41] or proportion that had pain with activity [51]; b strength, i.e. peak concentric torque [24,26,41,48,50], isometric torque [45] or repetition maximum [23]; c endurance, i.e.…”

“…peak concentric torque [24,26,41,48,50], isometric torque [45] or repetition maximum [23]; c endurance, i.e. work done during isotonic contractions [26,39,49], heel raise repetitions [23,46,51] or mean concentric torque over repeated repetitions; d power, i.e. isotonic heel raise power studies in our review and may reflect the participants having adequate strength when they commenced rehabilitation.…”

“…4) [39,49]. Similarly, there was limited evidence (four studies, 105 mid-portional AT participants) that plantarflexion heel raise test repetitions increased significantly after 12 weeks of resistance training (Silbernagel programme [25,51] a resistance training and hopping intervention [23] and Alfredson programme [46] (Fig. 4).…”

“…Two studies [11,37] measured the plantarflexion explosive strength. Endurance was measured as isotonic total work or average work in ten studies [8,25,26,36,39,40,43,44,47,49] or heel raise test (repetitions to fatigue) in six studies [23,25,39,46,49,51]. Three studies did not provide sufficient detail on the outcomes of management [33,47,50].…”

Evaluating lower limb tendinopathy with Victorian Institute of Sport Assessment (VISA) questionnaires: a systematic review shows very-low-quality evidence for their content and structural validity—part I

“…The VISA-A, VISA-H, and VISA-P were primarily designed for sporting populations; however, tendinopathy also occurs in non-sporting or sedentary individuals [14]. Item 8 ("sports") of the VISAs is irrelevant to nonsporting/inactive individuals (e.g., greater trochanteric pain syndrome patients, sedentary individuals) [20,67,70]. This results in sedentary individuals scoring 0 in both items 7 and 8 and an underestimation of the total score irrespective of their symptoms.…”