therapy or no treatment at all. There was moderate
evidence that a commercial product called the
AirHeel™ brace was just as effective as an eccentric
exercise program aimed at the calf muscles. The only
strong evidence showed that an ankle dorsiflexion
night splint was not beneficial when added to a calf
muscle eccentric exercise program. (14). Wallace
and his colleagues wanted to find out the effects of
combined conservative and orthotic management
of acute Achilles tendon ruptures instead of surgery.
FIGURE 4: Extracorporeal Shockwave Therapy (ESWT)
is a regenerative of treatment for tendon, muscle and
bone disorders. This technology produces high frequency
sound waves which initiate body’s own reparative reac-
tion in case of chronic degenerative tendon condition.
Their result revealed that 56% of patients treated
conservatively had excellent results, 30% had good
results, 12% had fair results, and 2% had poor results.
They concluded that the results of non-operative
treatment with orthotics had a better overall outcome
than the surgical repair of acute Achilles tendon
rupture (13). Hirschmuller and his co-workers looked
at effectiveness of customized sport shoe orthoses
for overuse injuries in runners. They observed
participants with chronic running overuse injuries
over an eight-week period. Participants were split into
two groups: one without and one with custom made
polyurethane foam orthoses. Their results showed
a statistically significant decrease in the subject's
subjective pain experience scale readings between the
orthoses group and the control group (15).
Extracorporeal Shock Wave Therapy (ESWT) has
been used effectively for Achilles tendinopathy (see:
Figure 4). Wu et al. looked at extracorporeal shock
wave therapy for insertional Achilles tendinopathy
(IAT) with or without Haglund's deformity (IAT)
and found a significant improvement in functional
scores in both groups but with greater success in the
group without the Haglunds deformity (25). Fridman
published a prospective study examining the efficacy
of extracorporeal shockwave therapy in the treatment
of chronic Achilles tendon disorders. Ninety-one
percent of the patients were satisfied or very satisfied
with the treatment. Eighty-seven percent stated that
there was improvement of their condition, and only
13% of the patients stated it had no effect and none
said it made them worse (26). Another slightly more
invasive modality, platelet rich plasma injection, has
demonstrated efficacy as well. This therapy uses the
concentrated growth factors in the platelets in plasma
concentrated in centrifuged blood to induce healing
in chronic musculoskeletal pathologies. Filardo et al.
demonstrated a significant improvement in Achilles
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