Force in the achilles tendon during walking with ankle foot orthosis

Asa Fröberg, Paavo Komi, Masaki Ishikawa, Tomas Movin, Anton Arndt
American Journal of Sports Medicine 2009, 37 (6): 1200-7

BACKGROUND: Ankle foot orthoses are used for postoperative treatment of Achilles tendon ruptures and decrease calf muscle electromyography activity during walking.

HYPOTHESIS: Achilles tendon load decreases with increased restriction of dorsiflexion and is associated with decreased triceps surae activity.

STUDY DESIGN: Controlled laboratory study.

METHODS: In 8 subjects, the maximum force and rate of force development in the Achilles tendon were measured with an optic fiber technique, and the activity of the gastrocnemius, soleus, and tibialis anterior muscles was recorded using electromyography. Trial conditions were walking barefoot and wearing an ankle-foot orthoses set in 3 different positions: (1) locked at 20 degrees of plantar flexion and with free plantar flexion but restricted dorsiflexion to (2) 10 degrees plantar flexion and (3) 10 degrees dorsiflexion, respectively. The design of the ankle foot orthoses did not provide heel support when fixed in a plantarflexed position.

RESULTS: Maximum Achilles tendon force was highest at the ankle-foot orthoses setting of 20 degrees plantar flexion (3.1 times body weight) and decreased to 2.1 times body weight during barefoot walking (P < .01). The rate of Achilles tendon force showed an increasing trend with less-restricted dorsiflexion. Soleus activity was 52% of mean barefoot walking activity at 3 20 degrees plantar flexion (P < .001) and then increased as dorsiflexion was less restricted.

CONCLUSION: Weightbearing in ankle-foot orthoses when dorsiflexion is restricted beyond neutral may result in increased forces in the Achilles tendon compared with barefoot walking, despite reduced electromyography activity in the triceps surae and decreased rate of force development.

CLINICAL RELEVANCE: If patients bear full weight in an ankle-foot orthoses locked at 20 degrees plantar flexion without heel support, the maximum force in the tendon may exceed that encountered during barefoot walking.

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