Effectiveness of orthotic devices in the treatment of Achilles tendinopathy

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Master of Applied Science to the School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora.

Achilles tendinopathy (AT) is a common source of pain and disability, being one of the most prevalent musculoskeletal lower limb conditions. Mid-portion AT is the most common type of AT and is characterised by pain localised to the posterior leg within the Achilles tendon, 2 to 6 cm proximal to the insertion on the posterior calcaneus. Achilles tendinopathy affects both athletic and sedentary populations. The aetiology of AT is likely to be multifactorial with intrinsic and extrinsic risk factors contributing to the development of the pathology 1. Non-surgical management is recommended for the initial management of AT. In addition to physical therapy such as calf muscle eccentric exercise and calf muscle stretching, orthotic devices such as foot orthoses, heel lifts, ankle joint dorsiflexion splints, ankle braces and strapping are recommended as second line options for mid-portion AT. However, at present there is little evidence available to support the use of orthotic devices for this condition. This thesis set out to investigate the effectiveness of orthotic devices for AT, with a focus on foot orthoses for mid-portion AT. The findings from the study conducted in this thesis will contribute to the knowledge of an intervention that is frequently recommended, however with little evidence. Therefore, the findings have the potential to improve treatment outcomes for people with AT and maximise the efficiency of health care expenditure of this condition Chapter 1 introduces the research problem and provides an overview of the aim and objectives of the thesis. Chapter 2 provides an overview of AT including anatomy of the Achilles tendon and associated structures, as well as the prevalence, pathophysiology, aetiology and management of mid-portion AT. This chapter reviews in detail the biomechanical risk factors for mid-portion AT and the use of calf muscle eccentricexercise and foot orthoses as interventions for this condition. Chapter 3 provides the results of a systematic review that helped define the research question for this thesis. The findings of this review support the rationale for the randomised controlled trial in Chapter 4. Chapter 4 presents the results of the randomised controlled trial that evaluated the effectiveness of customised foot orthoses for AT. Chapter 5 provides an overview of the literature review and studies conducted in this thesis and answers to the research questions posed.