Eccentric Exercises Versus Heel Insole Lift for Achilles Tendinopathy in Football Players

January 13, 2026 updated by: Adnan Hashim

Effect of Eccentric Exercises of Calf Muscles Versus Heel Insole Lift on Pain, Range of Motion, and Function in Football Players With Achilles Tendinopathy

Achilles tendinopathy is a common overuse injury in football players and is associated with pain, stiffness, and reduced functional performance. Conservative treatment options such as eccentric calf muscle exercises and heel insole lifts are frequently used in rehabilitation; however, evidence comparing their effectiveness remains limited.

This randomized controlled trial compared the effects of eccentric calf muscle exercises and heel insole lifts on pain, ankle range of motion, and functional outcomes in male football players with Achilles tendinopathy. Participants were randomly assigned to one of two intervention groups. One group performed a structured eccentric calf muscle exercise program, while the other group used heel insole lifts during daily activities.

Outcomes related to pain intensity, functional ability, calf muscle performance, and ankle range of motion were assessed at baseline and after completion of a 12-week intervention period. The results of this study aim to support evidence-based rehabilitation strategies for the management of Achilles tendinopathy in football players.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

This study was a single-blinded, randomized controlled trial conducted after obtaining ethical approval from the institutional ethics review committee. Male football players aged 18 to 30 years with clinically diagnosed Achilles tendinopathy were recruited from football clubs in Lahore, Pakistan, using a non-probability convenience sampling technique. Participants who met the eligibility criteria were randomly allocated into two parallel intervention groups using a lottery method.

Participants in the experimental group received an eccentric calf muscle exercise program based on Alfredson's protocol. The exercises were performed on a step with the knee extended and slightly flexed to target the gastrocnemius and soleus muscles, respectively. The protocol consisted of three sets of fifteen repetitions, performed twice daily, seven days per week, over a 12-week period. Body weight was used as resistance, and additional external load was progressively added as pain decreased.

Participants in the control group were provided with prefabricated heel insole lifts and instructed to wear them continuously in their regular footwear during daily activities throughout the 12-week intervention period.

Outcome measures were assessed at baseline and after completion of the intervention period. These included pain intensity, functional ability, calf muscle endurance, and ankle dorsiflexion range of motion. The study was conducted in accordance with ethical principles, and written informed consent was obtained from all participants prior to enrollment. The findings of this study are intended to contribute to evidence-based sports rehabilitation practices for the management of Achilles tendinopathy.

Study Type

Interventional

Enrollment (Actual)

24

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Lahore, Punjab Province, Pakistan, 54000
        • FAME Football Club, Model Town, Lahore

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Male football players aged 18 to 30 years
  • Clinical diagnosis of Achilles tendinopathy
  • Achilles tendon pain for at least one month
  • Pain intensity of 3 or higher on the Visual Analogue Scale
  • Pain aggravated by weight-bearing activities
  • Able to understand English and complete questionnaires
  • Willing to avoid other treatments for Achilles tendinopathy during the 12-week study period

Exclusion Criteria:

  • Lower limb injury within the past 6 months
  • Previous Achilles tendon rupture or surgery
  • Chronic ankle instability
  • Recent use of eccentric exercises or heel insole lifts
  • Metabolic or endocrine disorders
  • Current use of medications other than paracetamol
  • Unwillingness to comply with the study protocol

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Eccentric Calf Muscle Exercise Group
Participants assigned to this arm received a structured eccentric calf muscle exercise program based on Alfredson's protocol for the management of Achilles tendinopathy.
Other: Eccentric Calf Muscle Exercises
Eccentric calf muscle exercises were performed according to Alfredson's protocol. Participants completed three sets of fifteen repetitions, twice daily, seven days per week for 12 weeks. Exercises were performed on a step with the knee extended and flexed to target the gastrocnemius and soleus muscles. Resistance was progressively increased as pain decreased.
Active Comparator: Heel Insole Lift Group
Participants assigned to this arm were provided with heel insole lifts and instructed to use them during daily activities throughout the intervention period.
Device: Heel Insole Lift
Participants were provided with prefabricated heel insole lifts (approximately 12 mm) based on shoe size and instructed to wear them continuously in their regular footwear during daily activities for a 12-week period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Functional Ability (Victorian Institute of Sports Assessment-Achilles, VISA-A)
Time Frame: Baseline and at 12 weeks
Functional status was assessed using the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. Scores range from 0 to 100, with higher scores indicating better function (less severe symptoms).
Baseline and at 12 weeks
Pain Intensity (Visual Analogue Scale, VAS)
Time Frame: Baseline and at 12 weeks
Pain intensity was assessed using the Visual Analogue Scale (VAS), a 100-mm scale ranging from 0 (no pain) to 100 (worst imaginable pain). Higher scores indicate worse pain. Outcome is reported in millimeters (mm).
Baseline and at 12 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Adnan Hashim

Collaborators

University of Lahore Hospital (ULH)

Investigators

  • Principal Investigator: Adnan Hashim, DPT, Department of Physical Therapy, The University of Lahore

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

April 5, 2025

Primary Completion (Actual)

July 8, 2025

Study Completion (Actual)

August 12, 2025

Study Registration Dates

First Submitted

January 13, 2026

First Submitted That Met QC Criteria

January 13, 2026

First Posted (Actual)

January 22, 2026

Study Record Updates

Last Update Posted (Actual)

January 22, 2026

Last Update Submitted That Met QC Criteria

January 13, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • PHRI/IREB/26/01/0035

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared because this study was conducted as an academic research project. The informed consent obtained from participants did not include provisions for public data sharing, and the dataset contains sensitive personal health information. Data will be stored securely and used only for academic and research purposes in accordance with institutional ethics approval.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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