Centre for Health, Exercise and Sports Medicine, Melbourne Physiotherapy School, University of Melbourne, Melbourne, Victoria, Australia.
Sports Med. 2010 Sep 1;40(9):715-27. doi: 10.2165/11535920-000000000-00000.
Achilles tendinopathy (AT) is a common injury in running sports. While the exact aetiology of Achilles injury is still unclear, foot orthoses are often effectively employed in the conservative management of the condition. Foot orthoses have traditionally been provided for people with AT on the basis that they may reduce the rearfoot eversion associated with excessive foot pronation. This increased rearfoot motion is thought to produce excessive Achilles tendon loads. To date, the available literature indicates that foot orthoses have small and unsystematic effects on rearfoot kinematics. However, limitations of foot kinematic measurement currently restrict the ability to conduct truly valid investigations into kinematic responses to foot orthoses. Therefore, the roles of alternate mechanisms, for which orthoses may provide clinical success in pathology such as AT, are now being investigated. One alternative theory is that foot orthoses alter neuromotor recruitment patterns and thus lower limb loads in response to the additional sensory input provided by the device. In AT, altered neuromotor recruitment patterns of the triceps surae have been hypothesized to create differential intratendinous loads. This may lead to pathological changes within the tendon. Furthermore, it is possible that foot orthoses may aid to normalize intratendinous loads via altering neuromotor activity in the triceps surae in AT. This review examines the literature with regard to changes in neuromotor recruitment as an associated aetiological factor in AT and the role foot orthoses may play in the management of this condition.
跟腱病（AT）是跑步运动中的常见损伤。虽然确切的跟腱损伤病因仍不清楚，但矫形鞋垫在该疾病的保守治疗中常被有效采用。传统上，为 AT 患者提供矫形鞋垫的依据是，它们可能会减少与过度足内旋相关的后足外翻。这种增加的后足运动被认为会产生过度的跟腱负荷。迄今为止，现有文献表明，矫形鞋垫对后足运动学的影响较小且无系统性。然而，目前足部运动学测量的局限性限制了对足矫形器的运动反应进行真正有效的研究的能力。因此，现在正在研究替代机制的作用，对于 AT 等病理学，矫形器可能通过这些替代机制提供临床成功。一种替代理论是，矫形鞋垫改变神经运动募集模式，从而通过设备提供的额外感觉输入来降低下肢负荷。在 AT 中，推测三腿肌的神经运动募集模式改变会导致跟腱内的差异负荷。这可能会导致肌腱内的病理变化。此外，矫形鞋垫可能通过改变 AT 中三腿肌的神经运动活动来帮助使跟腱内的负荷正常化。这篇综述检查了神经运动募集变化作为 AT 的一个相关病因因素的文献，以及矫形鞋垫在这种疾病的管理中可能发挥的作用。
