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


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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  1. 1.

    Kvist M. Achilles tendon injuries in athletes. Sports Med. 1994;18(3):173–201.

    CAS  PubMed  Article  Google Scholar 

  2. 2.

    Knobloch K, Yoon U, Vogt PM. Acute and overuse injuries correlated to hours of training in master running athletes. Foot Ankle Int. 2008;29(7):671–6.

    PubMed  Article  Google Scholar 

  3. 3.

    Lopes AD, Hespanhol Júnior LC, Yeung SS, et al. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med. 2012;42(10):891–905.

    PubMed Central  PubMed  Article  Google Scholar 

  4. 4.

    Edouard P, Pruvost J, Kerspern A. Injuries in high-level heptathlon and decathlon. Br J Sports Med. 2011;45(4):346.

    Google Scholar 

  5. 5.

    Van Ginckel A, Thijs Y, Hesar N, et al. Intrinsic gait-related risk factors for Achilles tendinopathy in novice runners: a prospective study. Gait Posture. 2008;29(3):387–91.

    PubMed  Article  Google Scholar 

  6. 6.

    Johansson C. Injuries in elite orienteers. Am J Sport Med. 1986;14(5):410–5.

    CAS  Article  Google Scholar 

  7. 7.

    Lysholm J, Wiklander J. Injuries in runners. Am J Sport Med. 1987;15(2):168–71.

    CAS  Article  Google Scholar 

  8. 8.

    Wilson F, Gissane C, Byrne A. A prospective study of injuries in elite soccer referees and assistant referees. Br J Sports Med. 2011;45:310–84.

    Google Scholar 

  9. 9.

    Kujala UM, Sarna S, Kaprio J. Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med. 2005;15(3):133–5.

    PubMed  Article  Google Scholar 

  10. 10.

    de Jonge S, van den Berg C, de Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45:1026–8.

    PubMed  Article  Google Scholar 

  11. 11.

    Menz HB, Jordan KP, Roddy E, et al. Characteristics of primary care consultations for musculoskeletal foot and ankle problems in the UK. Rheumatology (Oxford). 2010;49(7):1391–8.

    PubMed Central  PubMed  Article  Google Scholar 

  12. 12.

    Rolf C, Movin T. Etiology, histopathology, and outcome of surgery in achillodynia. Foot Ankle Int. 1997;18(9):565–9.

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Hootman JM, Macera CA, Ainsworth BE, et al. Epidemiology of musculoskeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc. 2002;34(5):838–44.

    PubMed  Article  Google Scholar 

  14. 14.

    Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis etiology and treatment. Am J Sports Med. 1984;12(3):179–84.

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Mahieu NN, Witvrouw E, Stevens V, et al. Intrinsic risk factors for the development of achilles tendon overuse injury: a prospective study. Am J Sports Med. 2006;34(2):226–35.

    PubMed  Article  Google Scholar 

  16. 16.

    van der Linden PD, Sturkenboom MC, Herings RM, et al. Fluoroquinolones and risk of Achilles tendon disorders: case-control study. BMJ. 2002;324(7349):1306–7.

    PubMed Central  PubMed  Article  Google Scholar 

  17. 17.

    Fredberg U, Bolvig L, Andersen NT. Prophylactic training in asymptomatic soccer players with ultrasonographic abnormalities in Achilles and patellar tendons: the Danish Super League Study. Am J Sports Med. 2008;36(3):451–60.

    PubMed  Article  Google Scholar 

  18. 18.

    Gaida JE, Alfredson L, Kiss ZS, et al. Dyslipidemia in achilles tendinopathy is characteristic of insulin resistance. Med Sci Sports Exerc. 2009;41(6):1194–7.

    CAS  PubMed  Article  Google Scholar 

  19. 19.

    Gaida JE, Ashe MC, Bass SL, et al. Is adiposity an under-recognized risk factor for tendinopathy? A systematic review. Arthritis Care Res. 2009;61(6):840–9.

    Article  Google Scholar 

  20. 20.

    Kaufman KR, Brodine SK, Shaffer RA, et al. The effect of foot structure and range of motion on musculoskeletal overuse injuries. Am J Sports Med. 1999;27(5):585–93.

    CAS  PubMed  Google Scholar 

  21. 21.

    Munteanu SE, Barton CJ. Lower limb biomechanics during running in individuals with Achilles tendinopathy: a systematic review. J Foot Ankle Res. 2011;4:15.

    PubMed Central  PubMed  Article  Google Scholar 

  22. 22.

    Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med. 2007;41(4):211–6.

    PubMed Central  PubMed  Article  Google Scholar 

  23. 23.

    Magnussen RA, Dunn WR, Thomson A. Nonoperative treatment of midportion Achilles tendinopathy: a systematic review. Clin J Sport Med. 2009;19(1):54–64.

    PubMed  Article  Google Scholar 

  24. 24.

    Paavola M, Kannus P, Paakkala T, et al. Long-term prognosis of patients wih Achilles tendinopathy: an observational 8-year follow up study. Am J Sport Med. 2000;28(5):634–42.

    CAS  Google Scholar 

  25. 25.

    McLauchlan G, Handoll HH. Interventions for treating acute and chronic Achilles tendinitis. Cochrane Database Syst Rev. 2001;(2):CD000232.

  26. 26.

    Humphrey J, Chan O, Crisp T, et al. The short-term effects of high volume image guided injections in resistant non-insertional Achilles tendinopathy. J Sci Med Sport. 2010;13(3):295–8.

    PubMed  Article  Google Scholar 

  27. 27.

    Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE, et al. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. J Foot Ankle Res. 2012;5:15.

    PubMed Central  PubMed  Article  Google Scholar 

  28. 28.

    National Center for Biotechnology Information. US National Library of Medicine. 1974. Available from: http://www.ncb.inlm.nihgov. Accessed 26 Apr 2013

  29. 29.

    Kearney R, Costa ML. Insertional achilles tendinopathy management: a systematic review. Foot Ankle Int. 2010;31(8):689–94.

    PubMed  Article  Google Scholar 

  30. 30.

    Booth AM, Wright KE, Outhwaite H. Centre for Reviews and Dissemination databases: value, content, and developments. Int J Technol Assess Health Care. 2010;26(4):470–2.

    PubMed  Article  Google Scholar 

  31. 31.

    Downs SA, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  32. 32.

    Cotchett MP, Landorf KB, Munteanu SE. Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review. J Foot Ankle Res. 2010;3:18.

    PubMed Central  PubMed  Article  Google Scholar 

  33. 33.

    Gardner MJ, Altman DG. Confidence intervals rather than P values: estimation rather than hypothesis testing. Br J Sports Med. 1986;292:746–50.

    CAS  Google Scholar 

  34. 34.

    Deeks J, Dinnes J, D’Amico R, et al. Evaluating non-randomised intervention studies. Health Technol Assess. 2003;7(27):3–10.

    Article  Google Scholar 

  35. 35.

    Hennessy K, Woodburn J, Steultjens MP. Custom foot orthoses for rheumatoid arthritis: a systematic review. Arthritis Care Res (Hoboken). 2012;64(3):311–20.

    PubMed  Article  Google Scholar 

  36. 36.

    Oxford Centre for Evidence-Based Medicine. OCEBM levels of evidence. 2011. Available from: http://www.cebm.net/index.aspx?o=5653.

  37. 37.

    Guyatt GH, Sackett DL, Sinclair JC, et al. Users’ guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group. JAMA. 1995;274(22):1800–4.

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Carcia CR, Martin RL, Houck J, et al. Clinical guidelines. Achilles pain, stiffness, and muscle power deficits: Achilles tendinitis. J Orthop Sports Phys Ther. 2010;40(9):A1–26.

    PubMed  Article  Google Scholar 

  39. 39.

    Rowe V, Hemmings S, Barton C, et al. Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning. Sports Med. 2012;42(11):941–67.

    PubMed  Article  Google Scholar 

  40. 40.

    Mayer F, Hirschmuller A, Muller S, et al. Effects of short-term treatment strategies over 4 weeks in Achilles tendinopathy. Br J Sports Med. 2007;41(7):e6.

    PubMed  Article  Google Scholar 

  41. 41.

    McAleenan M, McVeigh JG, Cullen M, et al. The effectiveness of night splints in the management of achilles tendinopathy: a pilot study. Physiother Ireland. 2010;31(1):29–33.

    Google Scholar 

  42. 42.

    Donoghue OA, Harrison AJ, Laxton P, et al. Orthotic control of rear foot and lower limb motion during running in participants with chronic Achilles tendon injury. Sport Biomech. 2008;7(2):194–205.

    Article  Google Scholar 

  43. 43.

    de Vos RJ, Weir A, Visser RJ, et al. The additional value of a night splint to eccentric exercises in chronic midportion Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2007;41(7):e5.

    PubMed  Article  Google Scholar 

  44. 44.

    Dijkstra HJW, Van Enst GC. The therapeutic value of G-brace in the treatment of chronic achilles tendinosis: a pilot study. Geneeskunde en Sport. 2003;36(5):137–40.

    Google Scholar 

  45. 45.

    de Jonge S, de Vos RJ, Van Schie HT, et al. One-year follow-up of a randomised controlled trial on added splinting to eccentric exercises in chronic midportion Achilles tendinopathy. Br J Sports Med. 2010;44(9):673–7.

    PubMed  Article  Google Scholar 

  46. 46.

    Eagleton M. The use of rearfoot positional taping in the treatment of Achilles and peroneal tendinitis in an adolescent female soccer player: a case report. Orthop Phys Ther Pract. 2009;21(1):16–23.

    Google Scholar 

  47. 47.

    Faraj AA, Livesley PJ, Stinchcomb S. Functional treatment of achillodynia. Foot. 1997;7(2):82–5.

    Article  Google Scholar 

  48. 48.

    Fauno P, Kalund S, Andreasen I, et al. Soreness in lower extremities and back is reduced by use of shock absorbing heel inserts. Int J Sports Med. 1993;14(5):288–90.

    CAS  PubMed  Article  Google Scholar 

  49. 49.

    Firth BL, Dingley P, Davies ER, et al. The effect of kinesiotape on function, pain, and motoneuronal excitability in healthy people and people with Achilles tendinopathy. Clin J Sport Med. 2010;20(6):416–21.

    PubMed  Article  Google Scholar 

  50. 50.

    Frignani R, Ferretti M, Romano D. Results with taping in the management of Achilles tendon derangements. Ital J Sports Traumatol. 1989;11(1):57–63.

    Google Scholar 

  51. 51.

    Gross ML, Davlin LB, Evanski PM. Effectiveness of orthotic shoe inserts in the long-distance runner. Am J Sports Med. 1991;19(4):409–12.

    CAS  PubMed  Article  Google Scholar 

  52. 52.

    Hirschmuller A, Baur H, Muller S, et al. Clinical effectiveness of customised sport shoe orthoses for overuse injuries in runners: a randomised controlled study. Br J Sports Med. 2011;45(12):959–65.

    CAS  PubMed  Article  Google Scholar 

  53. 53.

    Johnson MD, Alvarez RG, Swafford R. Nonoperative management of retrocalcaneal pain with AFO and stretching regimen. Foot Ankle Int. 2012;33(7):571–81.

    PubMed  Google Scholar 

  54. 54.

    Knobloch K, Schreimbueller L, Giuseppe L, et al. Eccentric exercises for the management of tendinopathy of the main body of the Achilles tendon with or without the AirHeel Brace. A randomized controlled trial. A: Effects of pain and microcirculation. Disabil Rehabil. 2008;30(20–22):1685–91.

    PubMed  Article  Google Scholar 

  55. 55.

    Larsen K, Weidich F, Leboeuf-Yde C. Can custom-made biomechanic shoe orthoses prevent problems in the back and lower extremities? A randomized, controlled intervention trial of 146 military conscripts. J Manip Physiol Ther. 2002;25(5):326–31.

    Article  Google Scholar 

  56. 56.

    Lee JH, Yoo WG. Treatment of chronic Achilles tendon pain by Kinesio taping in an amateur badminton player. Phys Ther Sport. 2012;13(2):115–9.

    PubMed  Article  Google Scholar 

  57. 57.

    Lohrer H, Wetz HH. Specially designed insoles in sport shoes in achillodynia and medial tibial syndrome. Orthopadische Praxis. 1991;27(2):114–7.

    Google Scholar 

  58. 58.

    Lowdon A, Bader DL, Mowat AG. The effect of heel pads on the treatment of Achilles tendinitis: a double blind trial. Am J Sports Med. 1984;12(6):431–5.

    CAS  PubMed  Article  Google Scholar 

  59. 59.

    MacLellan GE, Vyvyan B. Management of pain beneath the heel and Achilles tendonitis with visco-elastic heel inserts. Br J Sports Med. 1981;15(2):117–21.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  60. 60.

    Petersen W, Welp R, Rosenbaum D. Chronic Achilles tendinopathy: a prospective randomized study comparing the therapeutic effect of eccentric training, the AirHeel brace, and a combination of both. Am J Sports Med. 2007;35(10):1659–67.

    PubMed  Article  Google Scholar 

  61. 61.

    Roos EM, Engstrom M, Lagerquist A, et al. Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy: a randomized trial with 1-year follow-up. Scand J Med Sci Sports. 2004;14(5):286–95.

    PubMed  Article  Google Scholar 

  62. 62.

    Smith M, Brooker S, Vicenzino B, et al. Use of anti-pronation taping to assess suitability of orthotic prescription: case report. Aust J Physiother. 2004;50(2):111–3.

    PubMed  Article  Google Scholar 

  63. 63.

    Wooten B, Uhl TL, Chandler J. Use of an orthotic device in the treatment of posterior heel pain. J Orthop Sports Phys Ther. 1990;11(9):410–3.

    CAS  PubMed  Article  Google Scholar 

  64. 64.

    Thoms TL. Chronic Achilles tendinopathy: a prospective randomized study comparing the therapeutic effect of eccentric training, the AirHeel brace, and a combination of both. Foot Ankle Q Sem J. 2007;19(4):156–8.

    Google Scholar 

  65. 65.

    Donoghue OA, Harrison AJ, Coffey N, et al. Functional data analysis of running kinematics in chronic Achilles tendon injury. Med Sci Sports Exerc. 2008;40(7):1323–35.

    PubMed  Article  Google Scholar 

  66. 66.

    Rosenbloom KB. Pathology-designed custom molded foot orthoses. Clin Podiatr Med Surg. 2011;28(1):171–87.

    PubMed  Article  Google Scholar 

  67. 67.

    Maffulli N, Kader D. Tendinopathy of the tendo Achilles. J Bone Joint Surg. 2002;84(1):1–8.

    Article  Google Scholar 

  68. 68.

    Ryan M, Grau S, Krauss I, et al. Kinematic analysis of runners with achilles mid-portion tendinopathy. Foot Ankle Int. 2009;30(12):1190–5.

    PubMed  Article  Google Scholar 

  69. 69.

    Hertel J, Sloss BR, Earl JE. Effect of foot orthotics on quadriceps and gluteus medius electromyographic activity during selected exercises. Arch Phys Med Rehab. 2005;86:26–30.

    Article  Google Scholar 

  70. 70.

    Wyndow N, Cowan SM, Wrigley TV, et al. Neuromotor control of the lower limb in achilles tendinopathy: implications for foot orthotic therapy. Sports Med. 2010;40(9):715–27.

    PubMed  Article  Google Scholar 

  71. 71.

    Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166(12):1305–10.

    PubMed  Article  Google Scholar 

  72. 72.

    Collins N, Crossley K, Beller E, et al. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. BMJ. 2009;43:169–71.

    Google Scholar 

  73. 73.

    Ahmed IM, Lagopoulos M, McConnell P, et al. Blood supply of the Achilles tendon. J Orthop Res. 1998;16(5):591–6.

    CAS  PubMed  Article  Google Scholar 

  74. 74.

    Chen TM, Rozen WM, Pan WR, et al. The arterial anatomy of the Achilles tendon: anatomical study and clinical implications. Clin Anat. 2009;22(3):377–85.

    PubMed  Article  Google Scholar 

  75. 75.

    Kase K, Wallis J, Kase T. Clinical therapeutic applications of the Kinesio taping method. Tokyo, Japan: Ken Ikai Co Ltd.; 2003.

    Google Scholar 

  76. 76.

    Jonsson P, Alfredson H, Sunding K, et al. New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study. Br J Sports Med. 2008;42(9):746–9.

    CAS  PubMed  Article  Google Scholar 

  77. 77.

    James AM, Williams CM, Haines TP. Effectiveness of interventions in reducing pain and maintaining physical activity in children and adolescents with calcaneal apophysitis (Sever’s disease): a systematic review. J Foot Ankle Res. 2013;6(1):16.

    PubMed Central  PubMed  Article  Google Scholar 

  78. 78.

    Farris DJ, Buckeridge E, Trewartha G, et al. The effects of orthotic heel lifts on Achilles tendon force and strain during running. J Appl Biomech. 2012;28(5):511–9.

    PubMed  Google Scholar 

  79. 79.

    Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Ann Intern Med. 2010;152(11):726–32.

    PubMed  Article  Google Scholar 

  80. 80.

    Robinson JM, Cook JL, Purdam C, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med. 2001;35(5):335–41.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  81. 81.

    Munteanu SE, Landorf KB, Menz HB, et al. Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial. J Foot Ankle Res. 2009;2:27.

    PubMed Central  PubMed  Article  Google Scholar 

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