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.

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Acknowledgments

This study was funded by the Prescription Foot Orthotic Laboratory Association (PFOLA). Professor Hylton B. Menz is currently a National Health and Medical Research Council Senior Research Fellow (ID 1020925). The funders played no role in the study design, collection, analysis, interpretation of data, writing of the report, or in the decision to submit the manuscript for publication.

Shannon E. Munteanu and Hylton B. Menz conceived the idea and obtained funding for the study. Lisa A. Scott and Shannon E. Munteanu equally designed the study, acquired the data, performed the analysis and interpreted the data. Lisa A. Scott, Shannon E. Munteanu and Hylton B. Menz drafted the manuscript. All authors have read and approved the final manuscript.

Lisa A. Scott, Shannon E. Munteanu and Hylton B. Menz have no potential conflicts of interest that are directly relevant to the content of this review.

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Scott, L.A., Munteanu, S.E. & Menz, H.B. Effectiveness of Orthotic Devices in the Treatment of Achilles Tendinopathy: A Systematic Review. Sports Med 45, 95–110 (2015). https://doi.org/10.1007/s40279-014-0237-z

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Keywords

  • Achilles Tendon
  • Achilles Tendinopathy
  • Orthotic Device
  • Pain Disability Index
  • Plantar Heel Pain