Achilles Tendinitis
Achilles Tendinitis: Support, Stretching, and Recovery
How do orthopedic supports help Achilles tendinitis?
Orthopedic supports for Achilles tendinitis reduce the load and stretch placed on the tendon during activity and rest. A heel lift decreases the angle of dorsiflexion required for walking, reducing Achilles tension. A night splint holds the ankle in a gentle dorsiflexed position overnight to prevent morning stiffness. Neither device heals the tendon; they manage symptoms while the primary treatment, eccentric heel-drop exercises, promotes tendon remodeling.
Understanding Achilles tendinopathy
Achilles tendinitis is now more accurately called Achilles tendinopathy, because the condition in most adults is characterized not by classic inflammation but by degenerative changes in the tendon collagen. The tendon, which connects the calf muscles to the heel bone, develops micro-structural disruption from repeated loading that exceeds its capacity to repair.
The condition typically presents as pain and stiffness at the back of the heel, worst in the morning or after rest, improving with gentle activity, then worsening again with prolonged or high-load activity such as running. It is common in runners but also occurs in recreational athletes, older adults, and people who have recently increased their activity level or changed footwear.
Heel lifts and night splints in Achilles recovery
A heel lift placed inside the shoe raises the heel and reduces the maximum dorsiflexion the foot goes through during the push-off phase of walking. This reduces the stretch placed on the Achilles at peak load. Most clinicians recommend a heel lift of five to ten millimeters in the initial painful phase. Both feet should usually be lifted if possible, to avoid creating a leg-length difference.
A night splint holds the ankle at 90 degrees or in slight dorsiflexion during sleep. This prevents the Achilles from adopting a shortened resting position overnight, which reduces morning stiffness and the painful first-step elongation. The same dorsiflexion-stretch devices used for plantar fasciitis are effective for insertional and mid-portion Achilles tendinopathy.
Eccentric exercises: the primary treatment
The most evidence-supported treatment for Achilles tendinopathy is eccentric heel-drop exercise, often called the Alfredson protocol. Standing on a step with the heel off the edge, the calf is loaded during the controlled lowering phase. This eccentric load stimulates tendon remodeling and, with consistent performance twice daily for twelve weeks, produces significant pain reduction and functional improvement in most patients.
Orthopedic supports such as heel lifts and night splints complement this program by managing symptoms between exercise sessions. Complete immobilization leads to further tendon weakening; the goal is load management, not load elimination.
What to know
Key things to understand
- Heel lifts reduce peak Achilles load. A five to ten millimeter heel raise in both shoes decreases dorsiflexion demand during walking, reducing pain with each step.
- Night splints reduce morning stiffness. Preventing overnight tendon shortening reduces the painful stretching that occurs with first steps each morning.
- Eccentric exercises are the primary treatment. Heel-drop exercises performed consistently over twelve weeks produce the strongest evidence-based outcomes for Achilles tendinopathy.
- Bilateral heel lifts when possible. Lifting only one heel creates a leg-length difference that can cause secondary problems; lift both sides symmetrically.
- Avoid complete rest. Complete immobilization weakens the tendon further; graduated loading via eccentric exercise is essential for remodeling.
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