Success with Orthotics for Achilles Tendonitis. Fact or Fiction?
Clinicians will often prescribe orthotics for Achilles Tendonitis. The question remains, will sufferers of Achilles Tendonitis find relief when using an orthotic insole?
Achilles Tendonitis is caused by repetitive strain on the Achilles Tendon. One reason for this, is when the arch of the foot flattens during walking, called pronation.
Orthotics for Achilles Tendonitis are designed to correct this pronation. This is thought to reduce strain on the Achilles Tendon.
Do these insoles actually reduce strain on the tendon? And does reduced strain on the tendon mean reduced pain?
The article below will answer these questions in more detail.
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What is Achilles Tendonitis?
Achilles Tendonitis – now called Tendinopathy is a condition where the Achilles tendon structure slowly breaks down. Repetitive strain is usually the cause of the injury. Some examples of this might be a weekend hike or progressing a running program too quickly.
The tendon first becomes inflamed, but other processes soon occur. Blood vessels begin to grow in the tendon, and the fibres of the Achilles tendon become tangled.
This process may continue without proper treatment. Unfortunately Achilles Tendonitis doesn’t usually get better with rest alone. The best response to Achilles Tendonitis is exercise and load management.
Common symptoms are heel pain in the morning, a lump on the Achilles Tendon and pain in the Achilles tendon when getting up after sitting for a while. Not to be confused with Haglund’s Deformity which is another condition that present with heel pain.
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Achilles Tendonitis can resolve when given the correct treatment. Earlier treatment usually results in quicker changes to the tendon.
For further information on Achilles Tendonitis see our ultimate guide here.
Can Orthotics for Achilles Tendonitis be helpful?
The most supported treatment for Achilles Tendonitis is exercises like calf raises, and load management strategies. These treatments help to retrain your Achilles Tendon to tolerate loads and help to re-align the collagen fibres in the Achilles Tendon.
Most research demonstrates that orthotics on their own are not effective in the treatment of Achilles Tendonitis. Orthotics are not recommended as a stand-alone treatment, although some people do find benefit using them at the same time as other treatments.
Orthotics have been shown to reduce the loading on the Achilles Tendon during running. This study suggested the use of heel lifts alone helped to reduce the load on the Achilles Tendon during running.
Orthotic insoles have been more effective when combined with an appropriate pair of shoes for Achilles Tendonitis.
We have found during clinical treatment that certain patient groups are more likely to respond favourably to insoles. These patients tend to role their feet inwards more during walking – this is called pronation of the foot.
An excellent way to test if orthotics will help your Achilles Tendonitis is to try a low-dye taping technique. If this is effective in relieving your pain, there is a greater chance that you will benefit from orthotics for Achilles Tendonitis.
Alternatively you could see whether heel lifts are enough to give you some reprieve from pain.
Prefabricated or custom orthotics for Achilles Tendonitis?
Evidence suggests there is no difference to outcomes when patients used custom insoles over off-the-shelf orthotics. This is huge especially considering the price difference between the two.
Custom orthotics will cost anywhere from $600 upwards, and then you may have to pay for return visits to get them adjusted.
Off the shelf orthotics like the ones below may only set you back up to $50. This investment is much cheaper for something that may or may not help.
There are some important things to look out for in choosing an off the shelf orthotic.
Firstly they must be comfortable. There is always a period where orthotics will be uncomfortable, but some are just more comfortable than others. This is extremely important as you need to wear these most of the time.
Secondly, they need to be a good fit. Most orthotics will come in different sizes. Make sure you have a size that fits your shoe well, so there is minimal slippage as you walk. This means your heel wont move around as much in the orthotic.
When these two things are satisfied you will have a better result, regardless of the orthotics being prefabricated or custom made.
What orthotics should you buy for Achilles Tendonitis?
There are always huge amounts of variability in the quality of orthotics on the market, and in price point. But remember, the important part is that these orthotics should be comfortable. This will increase any chance they have at successfully reducing pain.
We have recommended some brands below that have worked for some of our clients who have suffered with Achilles Tendonitis.
First is the Powerstep Pinnacle Max arch support.
These have amazing customer reviews and are a good balance between offering a level of support, whilst still being comfortable. They are also incredibly affordable which is important considering this may not work for your Achilles Tendonitis.
Next is the Spenco Total Support Max insole.
The spenco arch support is another reliable brand that offers a good prefabricated orthotic. Customers have found these to be comfortable and breathable. They are another great choice for those wanting to experiment with insoles for Achilles Tendonitis.
Should I buy different running insoles for Achilles Tendonitis?
The orthotics mentioned above should work for running with Achilles Tendonitis. Remember that insoles are only part of the treatment for Achilles Tendonitis and for runners, it’s very important to load the tendon appropriately.
If you are a runner you should consider integrating a return to running plan as part of the treatment of Achilles Tendonitis. Most runners will be able to return to running without the need for orthotics if they follow a progression-based loading program for their Achilles Tendon.
When do I wear my Orthotics?
Orthotics for Achilles Tendonitis are made to be worn most of the time. If you are trialling whether orthotics will help with your pain it is even worthwhile to wear them around your home.
When you first get orthotics it is important to gradually use them in your shoes. You should trial them for the first couple of days for a few hours only. After a few hours, take the orthotics out and don’t use them until the next day. This is important as your feet need time to adjust to the new orthotics.
It can take around a week for any orthotic to feel normal for you. After two days you can then move up to four hours a day, and then to a full day of wearing your orthotics.
If you aren’t noticing any benefits within the first two weeks, the chances are they probably won’t help with your pain longer term.
Insoles are not recommended as a stand-alone treatment for Achilles Tendonitis. There may be some patients who will still find benefits in using orthotics for Achilles Tendonitis. The most recommended treatment is exercise therapy which is progressed appropriately for the patient.
Frequently Asked Questions
Can orthotics help with Achilles Tendonitis
Orthotics aren't usually recommended for the treatment of Achilles Tendonitis as they don't work for most people. Some people do find good effects, so it can be something to look into.
What brand of orthotics work best?
There is no one brand of orthotics that are better than others. We would recommend off-the-shelf orthotics compared to custom made, as there is no difference between the two for Achilles Tendonitis.
Jill L. Cook, Dimitrios Stasinopoulos & Jean-Michel Brismée (2018) Insertional and mid-substance Achilles tendinopathies: eccentric training is not for everyone – updated evidence of non-surgical management. Journal of Manual & Manipulative Therapy, 26:3, 119-122, DOI: 10.1080/10669817.2018.1470302
Lee, K.K.W., Ling, S.K.K. & Yung, P.S.H. Controlled trial to compare the Achilles tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift. BMC Musculoskelet Disord 20, 535 (2019). https://doi.org/10.1186/s12891-019-2898-0
Munteanu SE, Scott LA, Bonanno DR, et al. Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. British Journal of Sports Medicine 2015;49:989-994.
Wilson F, Walshe M, O’Dwyer T, et al. Exercise, orthoses and splinting for treating Achilles tendinopathy: a systematic review with meta-analysis. British Journal of Sports Medicine 2018;52:1564-1574.
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