title: Force in the achilles tendon during walking with ankle foot orthosis.
abstract: BACKGROUND
  Ankle foot orthoses are used for postoperative treatment of Achilles tendon ruptures and decrease calf muscle electromyography activity during walking.
  
  
  OBJECTIVE
  Achilles tendon load decreases with increased restriction of dorsiflexion and is associated with decreased triceps surae activity.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Karolinska Institute, Department of Clinical Science, Intervention and Technology, Division of Orthopedic Surgery, Stockholm 14186, Sweden. asa.froberg@ki.se
authors.forename: Asa
authors.initials: A
authors.lastname: Fröberg
authors.forename: Paavo
authors.initials: P
authors.lastname: Komi
authors.forename: Masaki
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Tomas
authors.initials: T
authors.lastname: Movin
authors.forename: Anton
authors.initials: A
authors.lastname: Arndt
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000502:physiology; D000328:Adult; D000842:Ankle; D001696:Biomechanical Phenomena; D004576:Electromyography; D004867:Equipment Design; D005260:Female; D005528:Foot; D006801:Humans; D008297:Male; D009989:Orthotic Devices; D011184:Postoperative Period; D012421:Rupture / Q000601:surgery; D016138:Walking / Q000502:physiology*; D016474:Weight-Bearing / Q000502:physiology*; D055815:Young Adult