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Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial


Tags: Achilles tendinitis, orthotics, bad news, foot, leg, limbs, pain problems, biomechanics, etiology, pro, self-treatment, treatment, devices

Two articles on PainSci cite Munteanu 2015: (1) Are Orthotics Worth It?(2) Achilles Tendinitis Treatment Science

PainSci summary of Munteanu 2015: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

A good quality controlled test of customized orthotics for Achilles tendinitis, compared to a sham of off-the-shelf orthotics. This is a solid, straightforward design, and it has plenty of statistical power, with 140 subjects in two groups. The report on it was even refreshingly well-written. So this is a rare case of a study that actually produced a persuasive answer, instead of just more low quality evidence that has to be taken with a huge grain of salt.

They checked up everyone at intervals for a year, and found no difference at any point. Everyone improved somewhat, but the custom orthotics did not grant any advantage: “Customised foot orthoses… are no more effective than sham foot orthoses.”

This is the kind of conclusion that orthotics makers really do not want anyone to know about. Achilles tendinitis is exactly the kind of condition that custom orthotics can supposedly treat, and failing this test so completely is really damning for that industry. Unsurprisingly, the researchers were harshly criticized, and they responded at length — and I don’t think any of the criticisms hold up.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

AIM: To evaluate the effectiveness of customised foot orthoses in chronic mid-portion Achilles tendinopathy.

METHODS: This was a participant-blinded, parallel-group randomised controlled trial at a single centre (La Trobe University, Melbourne, Australia). One hundred and forty participants aged 18-55 years with mid-portion Achilles tendinopathy were randomised to receive eccentric calf muscle exercises with either customised foot orthoses (intervention group) or sham foot orthoses (control group). Allocation to intervention was concealed. The Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire was completed at baseline, then at 1, 3, 6 and 12 months, with 3 months being the primary end point. Differences between groups were analysed using intention to treat with analysis of covariance.

RESULTS: After randomisation into the customised foot orthoses group (n=67) or sham foot orthoses group (n=73), there was 70.7% follow-up of participants at 3 months. There were no significant differences between groups at any time point. At 3 months, the mean (SD) VISA-A score was 82.1 (16.3) and 79.2 (20.0) points for the customised and sham foot orthosis groups, respectively (adjusted mean difference (95% CI)=2.6 (-2.9 to 8.0), p=0.353). There were no clinically meaningful differences between groups in any of the secondary outcome measures.

CONCLUSIONS: Customised foot orthoses, prescribed according to the protocol in this study, are no more effective than sham foot orthoses for reducing symptoms and improving function in people with mid-portion Achilles tendinopathy undergoing an eccentric calf muscle exercise programme.

TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry: number ACTRN12609000829213.

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