You are here

  • Home
  • Archive
  • Volume 55, Issue 9
  • Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial

Article Text

Article menu

Download PDFPDF

Original research
Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial
Free
  1. Chantel L Rabusin1,2,
  2. Hylton B Menz1,2,
  3. Jodie A McClelland2,3,
  4. Angela M Evans1,
  5. Peter Malliaras4,
  6. Sean I Docking2,
  7. Karl B Landorf1,2,
  8. James M Gerrard1,2,
  9. Shannon E Munteanu1,2
  1. 1 Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
  2. 2 La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
  3. 3 Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
  4. 4 Department of Physiotherapy, Monash University Faculty of Medicine Nursing and Health Sciences, Frankston, Victoria, Australia
  1. Correspondence to Chantel L Rabusin, Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia; c.rabusin{at}latrobe.edu.au

Abstract

Objective(s) To compare the efficacy of in-shoe heel lifts to calf muscle eccentric exercise in reducing pain and improving function in mid-portion Achilles tendinopathy.

Methods This was a parallel-group randomised superiority trial at a single centre (La Trobe University Health Sciences Clinic, Discipline of Podiatry, Melbourne, Victoria, Australia). One hundred participants (52 women and 48 men, mean age 45.9, SD 9.4 years) with clinically diagnosed and ultrasonographically confirmed mid-portion Achilles tendinopathy were randomly allocated to either a (1) heel lifts (n=50) or (2) eccentric exercise (n=50) group. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 12 weeks. Differences between groups were analysed using intention to treat with analysis of covariance.

Results There was 80% follow-up of participants (n=40 per group) at 12 weeks. The mean VISA-A score improved by 26.0 points (95% CI 19.6 to 32.4) in the heel lifts group and by 17.4 points (95% CI 9.5 to 25.3) in the eccentric exercise group. On average, there was a between-group difference in favour of the heel lifts for the VISA-A (adjusted mean difference 9.6, 95% CI 1.8 to 17.4, p=0.016), which approximated, but did not meet our predetermined minimum important difference of 10 points.

Conclusion In adults with mid-portion Achilles tendinopathy, heel lifts were more effective than calf muscle eccentric exercise in reducing pain and improving function at 12 weeks. However, there is uncertainty in the estimate of effect for this outcome and patients may not experience a clinically worthwhile difference between interventions.

Trial registration number ACTRN12617001225303.

  • achilles tendon
  • tendinopathy
  • orthotics
  • exercise
  • randomised controlled trial

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplementary information. The dataset supporting the conclusions of this article is available on request in the La Trobe University Figshare repository: https://latrobe.figshare.com/.

https://doi.org/10.1136/bjsports-2019-101776

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplementary information. The dataset supporting the conclusions of this article is available on request in the La Trobe University Figshare repository: https://latrobe.figshare.com/.

    View Full Text

    Footnotes

    • Twitter @CRabusin, @hyltonmenz, @JodieMcClelland, @angelamfevans, @DrPeteMalliaras, @SIDocking, @karllandorf

    • Contributors SEM, HBM, KBL, JAM, AME and PM obtained funding for this trial and were responsible for the design of this study. CLR, SID and JMG conducted data collection. CLR, HBM and JMG conducted data analysis and interpreted findings. CLR wrote the initial draft of the manuscript, which was then revised and approved by all authors.

    • Funding This trial was funded by an Australian Government Research Training Program Scholarship 2015 and a grant from La Trobe University Sport, Exercise and Rehabilitation Research Focus Area (SER RFA Grant Scheme). HBM is currently a National Health and Medical Research Council of Australia Senior Research Fellow (ID: 1135995).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.