title: A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy.
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.
  
  
  OBJECTIVE
  To evaluate the 5-year outcome of patients with chronic midportion Achilles tendinopathy treated with the classical Alfredson's heel-drop exercise programme.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Sports Medicine Department, The Hague Medical Centre Antoniushove, Burgemeester Banninglaan 1, Leidschendam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van der Plas
authors.forename: S
authors.initials: S
authors.lastname: de Jonge
authors.forename: R J
authors.initials: RJ
authors.lastname: de Vos
authors.forename: H J L
authors.initials: HJ
authors.lastname: van der Heide
authors.forename: J A N
authors.initials: JA
authors.lastname: Verhaar
authors.forename: A
authors.initials: A
authors.lastname: Weir
authors.forename: J L
authors.initials: JL
authors.lastname: Tol
mesh_terms: D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D005081:Exercise Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006365:Heel; D006801:Humans; D015601:Injury Severity Score; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology; D017060:Patient Satisfaction; D052256:Tendinopathy / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography
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