Background: Eccentric exercises have the most evidence in conservative treatment of midportion Achilles tendinopathy. Although short-term studies show significant improvement, little is known of the long-term (>3 years) results. Aim: To evaluate the 5-year outcome of patients with chronic midportion Achilles tendinopathy treated with the classical Alfredson's heel-drop exercise programme. Study design: Part of a 5-year follow-up of a previously conducted randomised controlled trial. Methods: 58 patients (70 tendons) were approached 5 years after the start of the heel-drop exercise programme according to Alfredson. At baseline and at 5-year follow-up, the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire score, pain status, alternative treatments received and ultrasonographic neovascularisation score were recorded. Results: In 46 patients (58 tendons), the VISA-A score significantly increased from 49.2 at baseline to 83.6 after 5 years (p<0.001) and from the 1-year to 5-year follow-up from 75.0 to 83.4 (p<0.01). 39.7% of the patients were completely pain-free at follow-up and 48.3% had received one or more alternative treatments. The sagittal tendon thickness decreased from 8.05 mm (SD 2.1) at baseline to 7.50 mm (SD 1.6) at the 5-year follow-up (p=0.051). Conclusion: At 5-year follow-up, a significant increase of VISA-A score can be expected. After the 3-month Alfredson's heel-drop exercise programme, almost half of the patients had received other therapies. Although improvement of symptoms can be expected at long term, mild pain may remain.

Achilles tendinopathy, orthopaedics, sport injuries, sports medicine
dx.doi.org/10.1136/bjsports-2011-090035, hdl.handle.net/1765/39310
British Journal of Sports Medicine: an international peer-reviewed journal of sport and exercise medicine
Erasmus MC: University Medical Center Rotterdam

van der Plas, J.F.A.N, de Jonge, S, de Vos, R.J, van der Heide, H.J.L, Verhaar, J.A.N, Weir, A, & Tol, J.L. (2012). A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy. British Journal of Sports Medicine: an international peer-reviewed journal of sport and exercise medicine, 46(3), 214–218. doi:10.1136/bjsports-2011-090035