Achilles Tendinopathy

Isometric plantar flexion can be useful in the very early phase of Achilles tendinopathy, particularly for short-term pain reduction. A practical isometric dosage for Achilles tendinopathy is six rounds of ten-second pain-free hard holds. Transverse friction massage lacks strong research support for Achilles tendinopathy. Achilles tendon terminology evolved from tendonitis to tendinosis to tendinopathy, with the current term reflecting an uncertain or mixed mechanism including inflammation and degenerative change. A more plantar-flexed and inverted foot position creates a more concentric Achilles orientation, while dorsiflexion and eversion places it on greater stretch. After tolerating isometrics for several days, heel raises using a slow concentric-eccentric tempo can rebuild dynamic tendon loading tolerance. For insertional Achilles tendinopathy, the heel raise should not go past neutral early because doing so places excessive stress on the insertional area. Heel wedges are less preferred but can reduce Achilles load in the short term, and are more appropriate for an everted foot than for an inverted one.