Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial.
OBJECTIVES
To compare the efficacy of in-shoe heel lifts to calf muscle eccentric exercise in reducing pain and improving function in mid-portion Achilles tendinopathy.


METHODS
This was a parallel-group randomised superiority trial at a single centre (La Trobe University Health Sciences Clinic, Discipline of Podiatry, Melbourne, Victoria, Australia). One hundred participants (52 women and 48 men, mean age 45.9, SD 9.4 years) with clinically diagnosed and ultrasonographically confirmed mid-portion Achilles tendinopathy were randomly allocated to either a (1) heel lifts (n=50) or (2) eccentric exercise (n=50) group. The primary outcome measure was the Victorian Institute of Sport Assessment-Achilles (VISA-A) questionnaire at 12 weeks. Differences between groups were analysed using intention to treat with analysis of covariance.


RESULTS
There was 80% follow-up of participants (n=40 per group) at 12 weeks. The mean VISA-A score improved by 26.0 points (95% CI 19.6 to 32.4) in the heel lifts group and by 17.4 points (95% CI 9.5 to 25.3) in the eccentric exercise group. On average, there was a between-group difference in favour of the heel lifts for the VISA-A (adjusted mean difference 9.6, 95% CI 1.8 to 17.4, p=0.016), which approximated, but did not meet our predetermined minimum important difference of 10 points.


CONCLUSION
In adults with mid-portion Achilles tendinopathy, heel lifts were more effective than calf muscle eccentric exercise in reducing pain and improving function at 12 weeks. However, there is uncertainty in the estimate of effect for this outcome and patients may not experience a clinically worthwhile difference between interventions.


TRIAL REGISTRATION NUMBER
ACTRN12617001225303.
['Rabusin|Chantel L|CL|http://orcid.org/0000-0001-8111-703X', 'Menz|Hylton B|HB|http://orcid.org/0000-0002-2045-3846', 'McClelland|Jodie A|JA|http://orcid.org/0000-0002-9317-7571', 'Evans|Angela M|AM|http://orcid.org/0000-0002-5527-1161', 'Malliaras|Peter|P|http://orcid.org/0000-0001-5879-4139', 'Docking|Sean I|SI|http://orcid.org/0000-0001-7051-7548', 'Landorf|Karl B|KB|http://orcid.org/0000-0002-3882-5206', 'Gerrard|James M|JM|http://orcid.org/0000-0002-6827-0408', 'Munteanu|Shannon E|SE|http://orcid.org/0000-0001-6780-2743']
D000125:Achilles Tendon D015444:Exercise D005081:Exercise Therapy D005260:Female D061826:Foot Orthoses D006365:Heel D006801:Humans D008297:Male D008875:Middle Aged D018482:Muscle, Skeletal D017063:Outcome Assessment, Health Care D059408:Pain Management D010349:Patient Compliance D057240:Patient Preference D052256:Tendinopathy
exercise tendinopathy achilles tendon orthotics randomised controlled trial