Custom Orthotic Devices can be a crucial adjunct in the treatment of achilles tendon problems.
The achilles tendon, like the patellar tendon and the hamstrings, are primarily sagittal plane movers. The more you put them in the center, not deviated in the transverse and frontal planes, the better they work. Dr. Steven Subotnick, Podiatrist out of Hayward, California, was the first to describe the importance of this centering for achilles problems in the 1970s to me. Designing CFOs that hold the heel near subtalar neutral and tibial-calcaneal neutral, can have great influence on achilles rehabilitation.
These 3 images emphasize the pull of the achilles when the heel to leg alignment is (left to right): heel everted to the leg (achilles contracting with a potentially twisted alignment), heel centered to the leg (best position for sagittal plane motion), and the heel inverted to the leg (also twisted while contracting).
The achilles is the strongest tendon in the body, and therefore asked to move heavy loads (up to 11x body weight). How can we help this tendon out, as our athletes require it to perform great tasks? We can measure flexibility, and keep the tendon from being too tight or too loose. We can measure its strength (typically by the ability of one-sided straight knee and bent knee heel raises), and encourage the maintenance of optimal tone. We can design orthotic devices with the emphasis on subtalar neutral positioning. We can encourage shoes with good heel lift for stressful activities (10 mm heel drop or more).
