A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy
Two articles on PainSci cite van der Plas 2012: 1. Complete Guide to Plantar Fasciitis 2. Achilles Tendinitis Treatment Science
PainSci notes on van der Plas 2012:
This follow-up study showed that patients were doing pretty well five years after a program of eccentric training (heel drop) exercises for Achilles tendinitis. However, the results are of questionable value due to the fact that many patients had received other treatments in the interim. What we really need to know is not how well these patients did, but how well they did compared to patients who did no heel drop exercises.
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
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.
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