Achilles & Calf Issues: A Science Based & Real World Approach to Treatment & Healing

Achilles & Soleus injuries and problems are incredibly complex, and there is a lot of outdated and ineffective advice (i.e. icing or heel lifts) still being given out by doctors and on the internet, etc. The main thing that a more up to date standard of care indicates is that the Achilles tendon needs heavy loading to remodel properly, and that Soleus (lower calf) control is essential. 

Many researches and medical professionals believe that some of the most prominent acute causes of Achilles and posterior chain problems are actually from:

  • The body's "landing response" (muscle tuning) to "brace for impact" as the foot comes down to engage the ground.

  • Instability strain or wobble caused by weak foot and lower calf musculature and control, as well as tight laces and/or firm heel counters in shoes slightly yanking the foot and Achilles one way or the other each step. 

Many medical professionals also believe that wearing shoes with elevated heels (98% off shoes) consistently can shorten & weaken the area over time, which seems obvious. For casual activity, going barefoot and/or avoiding elevated heel shoes as much as possible (to tolerance) is recommended---to slowly lengthen & strengthen the posterior chain.

Let's take a look at interventions that have been shown to work in the real world and/or shown to be effective through research:

  1. Loosen shoe laces significantly to reduce wobble and instability strain caused by the shoe pulling the foot and achilles off plane. When shoe laces are loose, the Achilles doesn't have to "fight" the shoe to stay vertical. 

  2. Avoid treadmill & sand as they increase wobble/instability strain(9).

  3. Avoid forefoot striking or landing up on the toes, as this increases Achilles loads dramatically(10).

  4. Temporarily use a PU insole with a deep heel cup and metatarsal pad (like Bridge Soles) to reduce strain from landing response and help fight instability strain. See more below for the research behind this. 

  5. Shockwave Therapy, and even more so, Electromagnetic (EMG) Therapy (PEMF), are emerging treatment options showing promise.

  6. Use a Myostorm Meteor for research backed vibration and heat therapy before (to prevent strain) & after activity (to promote healing and tendon remodeling).

  7. Correct Toes worn in-shoe during activity provides stability that reduces wobble and strain on the Achilles. At a professional level, significant anecdotal evidence points to this being extremely effective. 

  8. Eccentric Heel Drop therapy with added 20+ pounds is the most research(5) backed (Google "Achilles Gold Standard Eccentric Exercises"), but heavily weighted bent-knee calf raises and drops.

  9. Heavily weighted (20+ pounds) Bent Knee Calf Raises (within pain tolerance) and drops are becoming the new standard taking over for the Eccentric Drops mentioned above, as Soleus control reduces Achilles strain. Heavily loading the Achilles a couple of times a week is likely the single most important that can be done for long term, permanent recovery. 

How to choose the correct insoles for Achilles Tendinosis/tendinitis and for pulling pressure off the lower calf (soleus) area:

  1. Research has shown that insoles made from PU were associated with significant reductions in Achilles load...likely due to reduced landing response(1).

  2. Many medical professionals also believe that stability from a deep heel cup is preferable to a traditional heel lift as the foot doesn't slide around & cause instability strain on the posterior chain. Significant anecdotal evidence backs this up. 

  3. Along the same lines, metatarsal pads have been effectively used for decades to reduce instability strain by gently spreading the metatarsals apart and helping provide the foot with a wider base of support.   

  4. Scientific literature questions the idea that heel lifts alone reduce loading on the Achilles(2), and some newer research indicates that wearing a shoe with a raised heel actually increases load on the Achilles compared to walking barefoot(3). Insoles that are a heel lift, but lack PU and a deep heel cup are less likely to be effective. 

  5. Furthermore, a 2015 study showed that insoles improved symptoms significantly, but that custom orthotics were no more effective than basic insoles(4).

  6. Lastly, much of the positives above can be negated if the toes become restricted at all, so a 3/4 length insole that leaves the toes free to spread and help stabilize is an important consideration. 

Bridge Soles are 3/4 length PU insoles with a soft heel cup, soft arch, & met pad that aim to reduce instability and the 'landing response' of the foot & lower leg that may be responsible for Achilles and other lower leg pain and discomfort.

As a result, we believe Bridge Soles are far better than traditional heel lifts or typical insoles for Achilles and lower calf issues.

Much like other insoles with a heel lift, Bridge Soles are intended to be worn only while or when anticipating discomfort. Bridge Soles are meant to pull pressure off the Achilles and posterior chain. In the meantime, barefoot therapy, foot strengthening & exercises should be done to lengthen & strengthen the area to help promote recovery and prevent future injury. As recovery happens, the insoles can be shortly phased out and kept around to be used somewhat like an ankle brace---only being used as flare ups occur or as needed. 

Research References:

  1. Sinclair J, et al...Clin Biomech 2014;29(4).

  2. Reinschmidt C, Nigg BM...Med Sci Sports Exerc 1995;27(3)

  3. Wearing SC, et al....Med Sci Sports Exerc 2014;46(8)

  4. Munteanu SE, et al. Br J Sports Med 2015; 49(15)

  5. Jonsson P, et al. ...Br J Sports Med. 2008;42(9):746-749.

Scientific References from the in-box user guide:

  1. Lemont H, Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7. 

  2. Jacobs, J.L., et al. J Foot Ankle Res 12, 50 (2019).       

  3. *Shulman, S. 1949 Journal of the Natl Assoc. of Chiropodists   

  4. Sinclair J, et al...Clin Biomech 2014;29(4). 

  5. Reinschmidt C, Nigg BM...Med Sci Sports Exerc 1995;27(3)   

  6. Wearing SC,  et al....Med Sci Sports Exerc 2014;46(8)

  7. Munteanu SE, et al. Br J Sports Med 2015; 49(15)     

  8. Jonsson P, et al. ...Br J Sports Med. 2008;42(9):746-749.

  9. Willy, et al 2016, JOSPT, Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running 

  10. Almonroeder T, Willson JD, Kernozek TW. The effect of foot strike pattern on Achilles tendon load during running. Ann; Biomed Eng. 2013;41: 1758- 1766.

  11. Barefoot Running on Grass as a Potential Treatment for Plantar Fasciitis: A Prospective Case Series. MacGabhann S, Kearney D, Perrem N, Francis P.Int J Environ Res Public Health. 2022 Nov 22;19(23):15466. doi: 10.3390/ijerph192315466. PMID: 36497540; PMCID: PMC9741467. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9741467/#:~:text=Barefoot%20running%20on%20grass%20appears,completing%20a%20barefoot%20running%20intervention.

  12. High Load strength training and plantar fasciitis. Rathleff, M.S., Mølgaard, C.M., Fredberg, U., Kaalund, S., Andersen, K.B., Jensen, T.T., Aaskov, S. and Olesen, J.L. (2015), Scandinvavian Journal of Med Sci Sports, 25: e292-300.  https://doi.org/10.1111/sms.12313    https://blogs.bmj.com/bjsm/2014/09/15/plantar-fasciitis-important-new-research-by-michael-rathleff/

Original Article: https://prgear.co/pages/achillesrelief