hi i’m ali i’m one of the physios from treatment achilles.com today i wanted to talk a little bit more about heel raises or those heel cups that you can put in your shoe as part of maybe using orthotics to help with achilles pain we at treatment achilles.com are a specialist online service offering a physiotherapy assessment and rehabilitation programs to people suffering with achilles pain or problems if you’d like to find out a little bit more about us or book your appointment then the information is underneath this video on youtube
So we’re talking about heel raises this moves on from some of the videos you may have already seen on our channel about orthotics or about wearing boots so these heel cups or heel raises are quite commonly given to people with an achilles tendon pain they’re really quite useful for one type of achilles pain and they’re not so useful for others so it’s important to have a think about where you get your pains or symptoms if you have an achilles tendinitis or a tendinopathy it’s quite common to be in two locations either it’s one an insertional achilles tendinopathy which tends to be found at the lower part of your heel so if i show you your achilles tendon runs down the back of your leg and an insertion is where it attaches into the heel the second option is a mid portion which tends to be more in this middle section here if you have an insertional achilles tendinopathy then using some of these heel raises particularly at the beginning when it’s quite uncomfortable to walk or put your foot flat onto the floor then that can help offload your achilles tendon so what i mean by that if you have a wedge underneath your heel it’s putting your heel higher than your toes so in effect it’s making that achilles tendon shorter if it’s making it shorter it’s not putting it so much on stretch and if it’s not stretching as much you get less of what i’m going to call a compressive force so a compressive force is typically something that irritates an insertional achilles tendinopathy so you have two different types of forces that go through your achilles tendon one i’m using it and contracting it and moving and two a compressive force when you stretch it so your achilles tendon comes down inserts into that bit on that bone we talked about and when you do a stretching movement so where your foot is going into that angle so if your foot is here and your calf is going forwards so for example a typical achilles stretch or calf stretch would be going into this sort of position what you’re doing there is pushing that achilles tendon closer to the ankle bone where it’s attaching so if it’s a bit irritated here it can act like it’s pressing on a bruise therefore if you raise up the angle so therefore your heel is higher than your toes what you are then doing is stopping that stretch stopping that compressive force or reducing it so therefore it’s really useful from a pain relieving perspective if we look at more of a mid-portion achilles tendinopathy
It can also help if it’s really really sensitive right at the beginning of treatment again just to offload it and give it some help but this is unusual and not something that we would tend to do in the first instance now there has been a recent research paper which has been quite interesting telling us that these heel raises are superior so meaning better than eccentric calf exercises so they’re the typical calf raises if you google what exercises shall i do for my achilles tendon it tends to show people dropping down off a step and stretching that achilles so again creating that compressive force going through that back of that heel they took two different groups one they just put heel raises in and the other group did the centric protocol that you may have seen if you google it from a researcher called alfredson so at the end of a number of weeks they looked to see which was better and actually the symptom response was better in the group that had the heel raises compared to the eccentric exercises so they suggested it was superior it was better to do this now my argument is to think about that a little bit more if they have reduced the compressive force because they have put a heel raise underneath it’s going to be removing that pressure at the back so it’s like a bruise that’s not being pressed on anymore so that symptom has calmed down if you are doing an eccentric stretch where you are coming off a step you are putting more of a compressive force through so if compression is something that hurts your achilles tendon and that’s something that would need to be assessed by a professional
To find out if that is the case then doing those eccentric calf raises could be something that actually aggravates your pain if we were to then not do any eccentric exercises and not do any strength exercises and we’ve settled this pain down because we’re not pressing on the bruise anymore and now we think brilliant i’m going to go off and do my sports or walking or hiking or activities that i would typically do have we changed the reason why your achilles tendinopathy has started in the first place probably not have we made your achilles more robust or the calves that come down and attach into the achilles more robust to cope with these demands that you’re asking it to do all of the activities probably not well definitely not because we’ve not done any strength work so my suggestion is that this would be unlikely to help resolve this achilles tendinopathy in the future it may help in the short term for pain management but once you get back into your activity again the odds are your pain is going to come back so it is important to add in strength exercises and these will be the correct ones depending on your symptoms depending on how strong you are already and depending on the test that we do when we examine you and we would pick the correct strength exercises and if there’s a compression element to your pain then we wouldn’t pick those off a step type movements we may modify or change that this doesn’t mean that there isn’t a place for heel raises and heel cups to go in your shoe and that’s something again that we would consider but it’s important that we do a bit of both i hope that is clear and if you have any comments please put them in the bottom of this video and like i said have a look on our website for any more information thanks very much bye