the achilles tendon attaches the plantaris , gastrocnemius , and soleus muscles to the 
 heel1 .
excessive stress or tight or 
 fatigued gastrocnemius and soleus muscles can result in microtrauma , degeneration , or 
 inflammation of the tendon  a condition called achilles tendonitis / tendinosis1 . this condition can occur in the general 
 population2 and is exacerbated by 
 prolonged walking , excessive running , jumping , or walking hills .
mountaineering and 
 mountain - related activities are associated with significant risk of injury in the ankle 
 joint and achilles tendon3 .
the 
 nomenclature for disorders of the achilles tendon is important , as the treatment is 
 dependent on the underlying tendon pathology4 achilles tendon conditions such as tendinosis are often chronic and 
 non - inflammatory , although the area can be painful to touch .
based on the 
 etiology , achilles tendinosis can be caused by a combination of factors such as failure of 
 the normal healing mechanisms and repeated trauma5 .
the achilles tendon serves to attach the plantaris , gastrocnemius , 
 and soleus muscles to the calcaneus ( heel ) bone1.this study developed heel support banding ( hsb ) using an elastic 
 band for flexible heel support and investigated its effect on chronic achilles tendon pain 
 of a mountaineer .
a 40-year - old male mountaineer with chronic achilles tendon pain participated in this 
 study .
the purpose and methods of the study were explained to the participant and informed 
 consent was obtained according to the principles of the declaration of helsinki .
the patient 
 complained of chronic pain in the achilles tendon of the right leg .
he developed severe pain 
 during active plantar flexion and palpation of the pre - insertion area of the achilles tendon 
 after mountain climbing , which he does three times per week .
active dorsiflexion and active 
 plantar flexion , measured with a goniometer , were 13 ( population normal angle , 20 ) and 28 
 ( population normal angle , 45 ) , respectively , due to pain . the visa - a questionnaire is a 
 reliable and valid instrument for the evaluation of pain intensity and levels of function in 
 patients with achilles tendon disorders .
the visa - a questionnaire score was 56 ( normal population 
 range > 95 ) , and the load - induced pain , assessed on a numeric rating scale from 0 to 10 , 
 was 7 . the pressure - pain threshold , assessed with an algometer ( pain test - model fpk ; wagner 
 instruments , greenwich , ct ) , was 2.0  kg .
rompe et al.6 defined tenderness using a numeric rating scale following the 
 application of 3  kg of pressure to the most tender area of the achilles tendon .
the 
 tenderness at 3  kg , assessed on a numeric rating scale from 0 to 10 , was 8 .
hsb is an 
 elastic band ( about 250  cm long ) , divided into four sections with the center piece binding 
 together to form a figure x. to apply the band , the center of the band was placed above the 
 knee approximately 5  cm from the patella .
second , the other two pieces were placed longitudinally along the lower leg , while the 
 third section of the band wraps around the lower leg , approximately 5 to 7  cm below the 
 knee , and was bound to itself laterally .
the third and fourth pieces of the band crossed each other at half of the distance between 
 the foot and patella .
finally , these pieces of the band were placed around the foot and 
 support the heel and foot arch .
an elastic band of proper strength for the patient was 
 selected by a therapist for maximum support of the heel and foot arch .
the range of elastic 
 bands includes black , silver , blue , green , red , and yellow .
the patient in the study applied 
 a level silver band prior to mountain climbing and proceeded to climb three times a week for 
 one month .
after one month of applying the hsb , the dorsiflexion and plantar flexion angles increased 
 to 18 and 37 , respectively , compared to the initial 13 and 28. the visa - a questionnaire 
 score increased to 79 compared to the initial 56 .
the load - induced pain assessment decreased 
 to 4 compared to the initial 7 .
the pain threshold increased to 5.2  kg compared to the 
 initial 2.0  kg and tenderness at 3  kg , assessed on a numeric rating scale , decreased to 3 
 compared to the initial 8 .
the function of this musculotendinous unit is to serve as the chief plantar flexor of the 
 ankle joint during walking and running , providing the primary dynamic force for locomotion 
 and jumping5 , 7 .
based on the etiology , the achilles tendinosis was caused by a 
 combination of failure of the normal healing mechanisms and repeated trauma5 .
the severe pain may have occurred gradually 
 as repetitive microtrauma was imposed on the achilles tendon . for this , this study developed 
 hsb using an elastic band and investigated its effect on chronic achilles tendon pain of a 
 mountaineer .
the result showed that after one month after applying hsb , the dorsiflexion and 
 plantar flexion angles increased , the visa - a questionnaire increased , the load - induced pain 
 assessment decreased , the pain threshold increased and tenderness at 3  kg , assessed on a 
 numeric rating scale , decreased .
the tension of hsb created by increased stimulation during 
 active ankle movement may have also created tension in the soft tissue structures . increased 
 tension may facilitate a pain inhibitory mechanism by providing an afferent stimulus to 
 large - diameter nerve fibers to mitigate nociception .
as the patient s pain level reduced , 
 the fear of pain during ankle movement might have reduced by proper sensory feedback , thus 
 improving ankle range of motion .
a thera - band , which provides varied resistance through the 
 range of movement , has been used for rehabilitation in combination with therapeutic 
 exercise8 .
it is light and portable , has 
 low resistance , and can be adjusted to accommodate various situations9 . in conclusion , one month of hsb for flexible heel support 
 improved range of motion in the ankle and reduced pain .
therefore , the hsb could provide a 
 new approach for effective intervention and management of chronic achilles tendon pain .
 [ purpose ] this study developed heel support banding ( hsb ) using an elastic band for 
 flexible heel support and investigated its effect on chronic achilles tendon pain of a 
 mountaineer . [ subject ] a 40-year - old male mountaineer with chronic achilles tendon pain 
 [ methods ] ankle dorsiflexion and plantar flexion angles , visa - a questionnaire , 
 load - induced pain , total pain threshold and tenderness at 3  kg of pressure were measured 
 before and after applying hsb . 
 [ results ] after one month of applying hsb , the dorsiflexion 
 and plantar flexion angles increased ; the visa - a questionnaire score increased ; the 
 load - induced pain assessment score decreased ; the pain threshold increased ; and tenderness 
 at 3  kg decreased . [ conclusion ] these results indicate that hsb use improves ankle range 
 of motion , decreases pressure and pain , and could provide a new approach for effective 
 intervention and management of chronic achilles tendon pain . 
INTRODUCTION
SUBJECT AND METHODS
RESULTS
DISCUSSION