Jonsson et al. 2008, Eccentric calf training without dorsiflexion for insertional Achilles tendinopathy

Pilot study (Jonsson P, Alfredson H, Sunding K, Fahlström M, Cook J), British Journal of Sports Medicine 42(9):746-9. Twenty-seven patients (34 tendons, mean symptom duration 26 months) with chronic insertional Achilles tendinopathy performed an eccentric heel-drop programme limited to floor level, stopping at neutral rather than dropping into dorsiflexion below the step. Sixty-seven per cent were satisfied and back to previous activity at four months, with pain falling from a mean VAS of about 70 to about 21. The authors note the standard full-dorsiflexion Alfredson protocol succeeds in only about 32% of insertional cases, the key reason midportion and insertional disease are loaded differently. Limited (small uncontrolled pilot), but the central distinction is consistent with later reviews.