effect of foot overpronation on Achilles tendon blood supply in healthy male

K, Kalogeris M, Mandalidis D, Geladas N, Karteroliotis K, & Athanasopoulos
S.  Scan
J Med Sci Sports
. 2016; Accepted for publication May 23, 2016. doi: 10.1111/sms.12722
Take Home Message: Participants with rear foot valgus appear
to have diminished blood flow to the Achilles in comparison to normal rear foot
individuals.  More research is needed to
determine how we can clinically intervene.

Achilles tendon injuries frequently
result in functional limitations and a predisposition to rupturing.  Researchers have implicated that blood supply
may contribute to the susceptibility of major injury, and that blood supply
might be affected by functional foot structure. 
The authors of this study investigated whether foot alignment affected
Achilles tendon blood supply as assessed by Doppler ultrasound.  Thirty male participants (15 with rear foot
valgus and 15 normal rear foot) had their Achilles tendon blood flow examined
by Doppler ultrasound in the non-weight bearing, double stance weight bearing,
and single stance weight bearing positions. 
Participants with overpronation had greater resistance and reduced blood
flow than normal feet regardless of stance. 
In both groups, blood flow was reduced and there was greater resistance
as the participants progressed from non-weight bearing, to double, and then
single stance weight bearing positions.

These findings are interesting
because it supports the “wringing out” mechanism of reduced blood flow as
weight bearing increases, and it is exacerbated in individuals with flat
feet.  It would be interesting to see how
the blood flow and resistance would be altered by the use of orthotics or
taping.  Gait mechanics may also cause
issues and changes in blood flow, and this should be analyzed as well.  There are many ways to measure blood flow,
and a comparison of other blood flow analytics would be interesting as well.  The authors did note that there were unsure
whether the ultrasound was measuring tendon blood flow or surrounding blood
flow.  The Achilles tendon is well
supplied vascularly, but it remains unknown how we can prevent the ischemic
“cut off” or facilitate more blood flow. 
Tracking patient reported outcomes and how these associate to blood flow
measure may help make the connection to when or how we should intervene
clinically.  Further research is
definitely needed in this area.  It
appears that we should keep a watchful eye on Achilles pain in people with flat

for Discussion:  What do you do for
people who present with Achilles tendon pain? 
Are there any other anatomical presentations that you consider to be
risky for Achilles tendon issues?

Nicole Cattano
by: Jeffrey Driban


Karzis, K., Kalogeris, M., Mandalidis, D., Geladas, N., Karteroliotis, K., & Athanasopoulos, S. (2016). The effect of foot overpronation on Achilles tendon blood supply in healthy male subjects Scandinavian Journal of Medicine & Science in Sports DOI: 10.1111/sms.12722