Research Supports Treatment of Achilles Rupture and Tendonitis
Dr. Richie explains the research and motivation to find a better way to treat Achilles rupture or Achilles tendonitis.
How does the AeroSpring Achilles Offloading System work for Achilles Ruptures or Tendonitis?
My experience using AFO braces to treat Achilles tendon pathologies led to the development of the AeroSpring Achilles Offloading System. For many years, I have been seeking an improved strategy to offload the Achilles during recovery and rehabilitation. Many years ago, walking boots with graduated heel wedges were introduced to treat Achilles tendon ruptures and were used for recovery from Achilles tendon surgery. With heel wedges of 30 to 40 mm in height, patient ambulation becomes challenging. Using a 40 mm lift required equivalent lift on the contralateral side, which is impossible to accomplish inside of any shoe. Is it any wonder that patient compliance with these “Achilles Boots” was so poor?
Medical literature showed evidence supporting the use of carbon fiber AFO bracing combined with much lower heel lifts in providing very good clinical outcomes in treating Achilles injuries. It became clear that most clinicians, including myself, were not aware of this research which warranted a complete change of strategy to off-load the Achilles tendon.
Studies from Kauranen et al., Rantanen et al. and Speck et al. demonstrated that patients with rupture of the Achilles tendon can be treated with off-loading devices which do not position the ankle in extreme plantar flexion. That research revealed that we do not need extreme 30-40 mm heel lifts that are used in conventional Achilles offloading boots. A study published in The British Journal of Sports Medicine showed that a simple 1-inch heel lift will adequately off-load the Achilles to allow healing. This is equivalent to the 20 mm heel wedge used in the AeroSpring Achilles Offloading System.
A study by Rebecca Kearney published in The American Journal of Sports Medicine studied gait with a carbon fiber AFO and a 1-inch heel raise which is identical to the AeroSpring Achilles System and compared to gait with a walking boot. Kearney concluded that the carbon fiber AFO with 1-inch heel wedge provided a near normal gait pattern while off-loading the Achilles. The walking boot showed significant gait disturbance.
The scientific evidence supported the use of a carbon fiber brace combined with a 2 cm heel wedge to offload the Achilles. It made sense to combine this system with a custom foot orthosis to stabilize the ankle and hindfoot. Thus, the AeroSpring Achilles Offloading System was born.
The system limits ankle joint dorsiflexion, controls the load on the Achilles, and positions the ankle up to 20 degrees plantar flexed. The brace controls rearfoot pronation and the wedges lateral offloads the medial-central band of the plantar fascia.It diminishes the need for active contraction of the calf muscles at toe off.
- Injured Achilles tendon will heal faster when subjected to dynamic loading. (Thevendran G, Sarraf KM, Patel NK, Sadri A, Rosenfeld P. The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg 2013;97(1):9.
- Patients with Achilles injuries heal faster when allowed to bear weight compared to the non-weight bearing conditions. Kearney RS, McGuinness KR, Achten J, Costa ML. A systematic review of early rehabilitation methods following a rupture of the Achilles tendon. Physiotherapy 2012;98(1):24–32.
- Positioning the ankle in extreme plantar flexion (30 degrees) actually slows the rate of healing in the Achilles tendon compared to slight plantar flexion (10-20 degrees). Froberg A, Komi P, Ishikawa M, Movin T, Arndt A. Force in the achilles tendon during walking with ankle foot orthosis. Am J Sports Med. 2009 Jun;37(6):1200-7.
- Kearney RS, Lamb SE, Achten J, Parsons NR, Costa ML In-shoe plantar pressures within ankle-foot orthoses: implications for the management of achilles tendon ruptures. Am J Sports Med 2011; 39-2685.