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A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy
  1. A van der Plas1,
  2. S de Jonge1,2,
  3. R J de Vos1,2,
  4. H J L van der Heide3,
  5. J A N Verhaar2,
  6. A Weir1,
  7. J L Tol1
  1. 1Sports Medicine Department, The Hague Medical Centre, Leidschendam, The Netherlands
  2. 2Department of Orthopaedics, Erasmus Medical Centre, Rotterdam, The Netherlands
  3. 3Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
  1. Correspondence to Dr J L Tol, Sports Medicine Department, The Hague Medical Centre Antoniushove, PO Box 411, Burgemeester Banninglaan 1, 2260 AK Leidschendam, The Netherlands; h.tol{at}mchaaglanden.nl

Abstract

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.

This paper is freely available online under the BMJ Journals unlocked scheme, see http://bjsm.bmj.com/info/unlocked.dtl

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Footnotes

  • Competing interests None.

  • Ethics approval The study was approved by the Medical Ethics Committee of the Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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