Alghamdi Nabeel Hamdan, Pohlig Ryan T, Seymore Kayla D, Sions Jaclyn Megan, Crenshaw Jeremy R, Grävare Silbernagel Karin
Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
Department of Epidemiology, University of Delaware, Newark, Delaware, USA.
Orthop J Sports Med. 2024 Feb 7;12(2):23259671231221583. doi: 10.1177/23259671231221583. eCollection 2024 Feb.
Physical therapists frequently employ heel lifts as an intervention to reduce Achilles tendon pain and restore function.
To determine the short-term effect of heel lifts on clinical and gait outcomes in participants with insertional Achilles tendinopathy (IAT).
Case series; Level of evidence, 4.
Participants with IAT underwent eligibility screening and completed assessments at baseline and 2 weeks later. Primary outcomes included symptom severity (Victoria Institute of Sports Assessment-Achilles [VISA-A]), gait analysis with the 10-m walk-test at 2 speeds (normal and fast), and pain during walking. Pain and gait analysis were assessed under 3 conditions: before fitting 20-mm heel lifts, immediately after heel-lift fitting, and after 2 weeks of wearing heel lifts. Ultrasound images and measurements at the Achilles insertion were obtained from prone and standing positions (with and without heel lifts). Spatiotemporal gait parameters and tibial tilt angles were evaluated at normal speed using inertia measurement units during the 3 study conditions. Differences between the conditions were analyzed using paired test or analysis of variance.
Overall, 20 participants (12 female, 13 with bilateral IAT; mean age, 51 ± 9.3 years; mean body mass index 31.6 ± 6.8 kg/m) completed all assessments. Symptom severity (VISA-A) of the more symptomatic side significantly improved at 2 weeks (60 ± 20.6) compared with baseline (52.2 ± 20.4; < .01). Pain during gait (Numeric Pain Rating Scale) was significantly reduced immediately after heel-lift fitting (0.7 ± 2.0) when compared with baseline (2.2 ± 2.7, = .043). Spatiotemporal gait parameters and tibial tilt angle before and after using heel lifts at normal walking speed were not significantly different; however, gait speed, stride length, and tibial tilt angle on both sides increased significantly immediately after using heel lifts and were maintained after 2 weeks of wear.
Using heel lifts not only improved symptom severity after 2 weeks but also immediately reduced pain during gait and had a positive impact on gait pattern and speed.
物理治疗师经常使用足跟垫高作为一种干预措施，以减轻跟腱疼痛并恢复功能。
确定足跟垫高对插入性跟腱病（IAT）患者临床和步态结果的短期影响。
病例系列；证据等级，4级。
IAT患者接受资格筛查，并在基线和2周后完成评估。主要结局包括症状严重程度（维多利亚运动评估机构-跟腱[VISA-A]）、以两种速度（正常和快速）进行10米步行测试的步态分析以及步行时的疼痛。在三种情况下评估疼痛和步态分析：佩戴20毫米足跟垫高前、足跟垫高佩戴后即刻以及佩戴足跟垫高2周后。从俯卧位和站立位（有和没有足跟垫高）获取跟腱插入处的超声图像和测量值。在三种研究情况下，使用惯性测量单元以正常速度评估时空步态参数和胫骨倾斜角度。使用配对检验或方差分析分析不同情况之间的差异。
总体而言，20名参与者（12名女性，13名双侧IAT；平均年龄51±9.3岁；平均体重指数31.6±6.8kg/m）完成了所有评估。与基线（52.2±20.4）相比，症状更严重一侧的症状严重程度（VISA-A）在2周时显著改善（60±20.6；P<0.01）。与基线（2.2±2.7，P=0.043）相比，足跟垫高佩戴后即刻步态时的疼痛（数字疼痛评分量表）显著降低（0.7±2.0）。正常步行速度下使用足跟垫高前后的时空步态参数和胫骨倾斜角度无显著差异；然而，使用足跟垫高后即刻两侧的步态速度、步幅和胫骨倾斜角度均显著增加，并在佩戴2周后保持。
使用足跟垫高不仅在2周后改善了症状严重程度，还立即减轻了步态时的疼痛，并对步态模式和速度产生了积极影响。
