“For chronic midsubstance Achilles tendinopathy (symptoms lasting longer than 6 weeks), the preferred first-line treatment is an intense eccentric strengthening program of the gastrocnemius/soleus complex (SOR A). In randomized, controlled trials, eccentric strengthening programs have provided 60%–90% improvement in pain and function. Therapeutic modalities such as ultrasonography, electrical stimulation, iontophoresis, and massage and stretching have shown inconsistent results for helping patients achieve a long-term return to function. Surgical techniques are a last resort for severe or recalcitrant cases, but these techniques have not been consistently successful and carry additional risk.
To perform eccentric strengthening for Achilles tendinopathy the patient should stand on the ball of the injured foot with the calcaneal area of the foot over the edge of a stair step. The patient begins with a straight leg and the ankle in flexion. The ankle is then lowered to full dorsiflexion with the heel below the level of the step and then returned to flexion with the assistance of the uninjured leg.” The ABFM
