A 42-year-old recreational runner has 5 months of posteromedial heel cord pain 4 cm above its calcaneal insertion, worst at the start of runs. There is fusiform thickening of the tendon, no palpable defect, and a negative Thompson test. Rest, NSAIDs, and heel lifts have not helped. The single most effective evidence-based next treatment is:

• A Daily heavy-load eccentric calf muscle training ✓
• B Local corticosteroid injection into the tendon
• C Endoscopic tendon debridement
• D Complete cessation of weight bearing for 6 weeks

Explanation

Midportion (noninsertional) Achilles tendinopathy responds to progressive heavy-load eccentric calf exercises performed daily, which stimulate tendon remodeling and produce good results in most patients. Corticosteroid injection into the tendon is avoided because it increases the risk of complete rupture. Surgery is considered only after 3 to 6 months of properly supervised eccentric loading fails, and strict immobilization is counterproductive since controlled loading drives tendon adaptation.

Reference: Campbell's Operative Orthopaedics, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.