Hi, I'm Ali! I'm one of the physios from treatmyachilles.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 treatmyachilles.com are a specialist online
service offering 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
eccentric 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!