The Effects of Heel Lifts on Dynamic Measures of Gait and Static Posture in Individuals with Parkinson’s disease

This study expands upon the Hastings et al (2018) study on the use of heel lifts to change static postural alignment in persons with Parkinson's Disease (PD) and further explores whether the use of heel lifts provide improvements in dynamic gait parameters, Timed Up and Go (TUG) scores, and balance confidence. Outcome measures were taken with and without the heel lifts in place, at two data collection dates. Photographs were analyzed for postural alignment measures using ImageJ software and video was analyzed for gait and turning parameters utilizing the Dite and Temple scale. The Activities-specific Balance Confidence (ABC) scale was collected at baseline and after two weeks of heel lift use, otherwise outcome measures were performed in the reverse order on the first and second session to account for ordering, practice, and fatigue effects. Statistical analysis included paired t-tests for outcome measures and Pearson product correlation between the degree of plantarflexion contracture and ABC scale and overall balance confidence and fall history. We found that head tilt angle and turn time significantly improved (p = .037) (p = .002) with use of heel lifts. Turn time correlated to overall balance confidence (r = -.802, p = .000) and overall balance confidence correlated to fall history (r = -.501, p = .041). This study showed that accommodating a lack of ankle dorsiflexion range of motion with heel lifts significantly improves head tilt angle and decreases turn time as compared to without heel lifts, but has no significant effect on step length, gait speed, or overall TUG score in individuals with PD. Because our work shows that limited range of motion at the ankle contributes to real and perceived balance difficulties healthcare providers working with any population of patients exhibiting balance problems should include this measurement in their assessment and consider intervention with a heel lift when limitations are found.

Influence of Arch-Support Orthoses with Heel Lift Manipulation on Joint Moments and Forefoot Mechanics in Running

While foot orthosis is suggested to improve rearfoot motion in running, little information is known about forefoot biomechanics. The objective of this study was to examine the effects of arch-support orthoses with various heel lift manipulation on the loading rate, spatiotemporal, and forefoot joint mechanics using a skin marker set model. Fifteen male habitual rearfoot strikers ran at their selected speeds on an instrumented treadmill in four foot orthoses conditions: flat-control, D2 (2 mm heel lift, arch-support), D6 (6 mm heel lift, arch-support), and D10 (10 mm heel lift, arch-support). A repeated measures ANOVA was performed to examine any significant difference in each of the tested variables, with α = 0.05. Wearing D10 led to smaller maximum loading rate than D2 (p < 0.001) and control (p = 0.002). For sagittal plane, D10 had larger rearfoot touchdown dorsiflexion than D2 (p = 0.027) and control (p = 0.007) and larger in D6 than control (p = 0.025). For frontal plane, wearing D10 demonstrated larger rearfoot frontal RoM than D2 (p = 0.018) and peak forefoot eversion than D6 (p = 0.047) and control (p = 0.048). Furthermore, the forefoot frontal range of motion was lowest when wearing D6. For joint moment, wearing control orthosis exhibited larger peak rearfoot eversion moment than D6 (p = 0.035), but smaller peak knee extension moment than D2 (p = 0.025) and D10 (p = 0.010). These findings indicate that the use of arch-support orthoses would alter the running mechanics that are related to injury potential. Lower heel lift orthoses led to alternations to most of the biomechanical variables than higher heel lift orthoses. Further longitudinal study seems necessary to optimize arch-support orthoses design in running.

Partial Achilles Tendon Rupture—A Neglected Entity: A Narrative Literature Review on Diagnostics and Treatment Options

Partial ruptures in the Achilles tendon are rather uncommon and are often misinterpreted as aggravated Achilles tendinopathy, and not always considered as a differential diagnosis. The aim of this literature review was to characterize typical symptoms, to provide an overview of available diagnosis and treatment options, and to give reference points for future research. There were few studies and sparse knowledge of scientific value, making it difficult to give evidence-based recommendations. Based on the few studies and the authors’ clinical experience, a diagnosis should be based on a patient’s history with a typical sharp onset of pain and inability to fully load the tendon. Previous intratendinous cortisone injections might be present. Clinical findings are a localized tender region in the tendon and often weakness during heel raises. Ultrasound and Doppler examinations show a region with an irregular and bulging superficial tendon line, often together with localized high blood flow. Magnetic resonance Imaging (MRI) shows a hyperintense signal in the tendon on T1 and T2-weighted sequences. First-line therapy should be a conservative approach using a 2 cm heel lift for the first 6 weeks and avoiding tendon stretching (for 12 weeks). This is followed by a reduced heel lift of 1 cm and progressive tendon loading at weeks 7–12. After 12 weeks, the heel lift can be removed if pain-free, and the patient can gradually start eccentric exercises lowering the heel below floor level and gradually returning to previous sport level. If conservative management has a poor effect, surgical exploration and the excision of the partial rupture and suturing is required. Augmentation procedures or anchor applications might be useful for partial ruptures in the Achilles insertion, but this depends on the size and exact location. After surgery, the 12 to 14-week rehabilitation program used in conservative management can be recommended before the patient’s return to full tendon loading activities.

Muscle Activity of the Triceps Surae With Novel Propulsion Heel-Lift Orthotics in Recreational Runners

Background: The triceps surae muscle has been identified with propulsion during running gait, and typical heel-lift orthotics (THOs) have been used to treat some sports injuries of this structural-biomechanical unit. The effects of a novel propulsion heel-lift orthotic (PHO) on surface electromyography (EMG) activity of the gastrocnemius during a full cycle of running have yet to be tested. Purpose/Hypothesis: We aimed to assess EMG changes in gastrocnemius medialis and lateralis muscle activity when wearing THOs, PHOs, or neutral sports shoes only (SO) during running. We hypothesized that EMG activity of the triceps surae muscle would be lower for PHOs than THOs or SO during running. Study Design: Controlled laboratory study. Methods: A total of 26 healthy, regular recreational runners of both sexes (mean age, 33.58 ± 6.02 years) with a neutral Foot Posture Index and rearfoot strike pattern were recruited to run on a treadmill at 9 km/h using aleatory THOs of 6 and 9 mm, PHOs, and SO while EMG activity of the gastrocnemius medialis and lateralis muscles was recorded over a 30-second period. Intraclass correlation coefficients were calculated to assess reliability. Results: The intraclass correlation coefficient values indicated near perfect reliability, ranging from 0.801 for 6-mm THOs to 0.959 for SO in the gastrocnemius lateralis muscle. EMG activity of the gastrocnemius lateralis muscle was greater for PHOs (25.516 ± 4.780 mV) than for SO (23.140 ± 4.150 mV) ( P < .05), but EMG activity of the gastrocnemius medialis muscle did not show any statistically significant difference between conditions (23.130 ± 2.980 mV vs 26.315 ± 2.930 mV, respectively) ( P = .3). Conclusion: A novel PHO may increase muscle activity of the gastrocnemius lateralis during a full cycle of running gait; consequently, its prescription to treat triceps surae muscle injuries is cautioned. Clinical Relevance: The prescription of novel PHOs could increase EMG activity, which has not been previously described.

Controlled trial to compare the Achilles tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift

Background Achilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet. Methods Twelve participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions. Results Participants who ran with CASO (p = 0.001, d = 0.43) or HL (p = 0.001, d = 0.48) associated with a significant reduction in ATL when compared to without orthotics while there was no significant difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO (p = 0.003, d = 0.93) and HL (p = 0.004, d = 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL. Conclusions Both CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies. Trial registration NCT04003870 on clinicaltrials.gov 1 July 2019.

Controlled Trial to compare the Achilles Tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift

Achilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet. Methods: 12 participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions. Results: Participants who ran with CASO (p=0.001, d=0.43) or HL (p=0.001, d=0.48) associated with a significant reduction in ATL when compared to without orthotics. There was no difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO (p=0.003, d= 0.93) and HL (p=0.004, d= 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL. Conclusion: Both CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies.

Controlled Trial to compare the Achilles Tendon load during running in flatfeet participants using a customized arch support orthoses vs an orthotic heel lift

Background: Achilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet. Methods: 12 participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions. Results: Participants who ran with CASO (p=0.001, d=0.43) or HL (p=0.001, d=0.48) associated with a significant reduction in ATL when compared to without orthotics. There was no difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO (p=0.003, d= 0.93) and HL (p=0.004, d= 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL. Conclusions: Both CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies.