An eccentric heel drop is a calf exercise where you rise up onto your toes with both feet, shift your weight to the sore leg, and then lower that heel down slowly under control. The slow lowering is the whole point — it loads the Achilles tendon in the exact way that stimulates it to rebuild. Done consistently, heel drops are the most-studied home exercise for Achilles tendonitis, and for many people they are the single most useful thing they do between appointments.
They are also easy to do wrong. People rush the lowering, skip the version that targets the deeper calf muscle, or push into the kind of pain that sets them back. And one group — people whose pain sits right where the tendon meets the heel bone — can actually make things worse with the standard version. This guide walks through how to perform the exercise, how much to do, and how to adjust it so it helps instead of hurts.
How to do an eccentric heel drop, step by step
You need a step or a sturdy raised surface and something to hold for balance — a railing, a wall, or a countertop. Here is the movement:
- Stand on the step with the balls of both feet on the edge and your heels hanging off the back.
- Using both legs, push up onto your toes until you are at the top of a calf raise.
- Lift your good foot off the step so all your weight is on the sore leg.
- Slowly lower that heel down below the level of the step until you feel a gentle stretch through the calf and Achilles. Take about three to four seconds to come down.
- Place your good foot back on the step and use both legs to push up again.
That is one repetition. The injured leg does only the lowering; both legs share the lifting. Keep the motion smooth and quiet — no dropping, no bouncing at the bottom.
Why the lowering, not the lifting, is the point
"Eccentric" simply means a muscle is working while it lengthens. When you lower your heel below the step, your calf muscles are firing to control the descent even as they stretch out. That controlled, loaded lengthening is what makes the exercise different from an ordinary calf raise, and it is why you let both legs do the lifting but only the sore leg do the lowering.
Researchers believe this specific kind of load nudges an irritated, degenerated tendon to remodel and lay down healthier tissue. A published trial protocol summarizing the research put it plainly: there is strong evidence for eccentric exercise therapy in chronic midportion Achilles tendinopathy. That is the reassuring part — the exercise is not folk wisdom. The catch is that it only works if the lowering phase is slow and deliberate every time.
Straight-knee and bent-knee: do both versions
Your calf has two main muscles feeding into the Achilles, and they share the load differently depending on whether your knee is straight or bent. To work the whole system, the standard program includes both:
- Straight-leg heel drops keep the knee locked out and bias the big, superficial gastrocnemius muscle.
- Bent-knee heel drops are the same movement with the knee softened about 20 degrees, which shifts the work onto the deeper soleus muscle.
Most people skip the bent-knee version because it feels redundant. It is not. The soleus does a surprising amount of the work when you walk and run, and leaving it out is one of the most common reasons a heel-drop program underperforms.
How many, how often, and for how long
The most-studied version is often called the Alfredson protocol, and it is more demanding than people expect. As described in the research, it calls for three sets of fifteen repetitions with the knee straight and three more with the knee bent, done twice a day — roughly 180 heel drops daily — carried out over about twelve weeks.
That volume is a lot, and it is the reason many people quit. The good news is that lighter, build-up-as-tolerated versions appear to help too, and the right starting dose depends on how irritable your tendon is right now. If you are not sure where to begin, that is a sensible thing to sort out with a provider rather than guessing. What matters most is consistency over weeks, not intensity on day one. Tendons respond slowly; expect to give this a real, uninterrupted stretch of time before you judge whether it is working, and know that the exact timeline is different for every patient.
The insertional modification: don't drop below the step
This is the part most online instructions leave out, and it is the most important adjustment to get right. Where your pain sits changes how you should do the exercise. Pain in the middle of the cord, a couple of inches above the heel, is midportion tendinopathy, and the full heel-drop-below-the-step version is made for it. Pain right at the back of the heel, where the tendon attaches to the bone, is insertional tendinopathy — and letting the heel sink below the step pinches the tendon against the heel bone and tends to flare it up.
If your pain is at the insertion, do the exercise on flat ground instead, lowering only to the point where your foot is level rather than dropping below it. You still get the controlled lengthening without the compression. Because the two problems call for nearly opposite setups, it is worth being sure which one you have — we break that down in our guide to the difference between insertional and midportion Achilles tendonitis. When the location is unclear, an exam settles it quickly.
How much pain is okay while you do them
Heel drops are one of the rare exercises where some discomfort during the movement is expected and acceptable. A useful rule of thumb many clinicians use: mild to moderate pain while you work is fine, but it should settle back to your baseline by the next morning. Sharp pain, pain that climbs set to set, or soreness that is clearly worse the following day means you did too much — scale back the load or the reps rather than stopping altogether.
What you should not push through is pain that feels sudden, tearing, or sharp enough to stop you mid-step. The dull, familiar ache of a cranky tendon is one thing; a new, acute pain is a reason to stop and get it looked at.
How to add load as you get stronger
Once a set stops feeling challenging, the tendon needs more load to keep adapting — more reps alone will not do it. The simplest way to add resistance at home is to wear a loaded backpack and add weight gradually as the exercise gets easier. In the original research, patients added weight in a backpack in small steps as their pain allowed. Go up slowly, one small increment at a time, and only when your current level feels controlled and your tendon tolerates it overnight. Adding too much too fast is a fast track to a flare.
Supportive shoes and, for some people, a temporary heel lift or custom orthotic can take tension off the tendon while you build strength. These are aids, not replacements for the loading work — and a heel lift that helps insertional pain can be the wrong move for midportion pain, which is one more reason to match the plan to your specific problem.
Common mistakes that stall progress
When heel drops do not seem to be helping, it is usually one of a handful of fixable errors:
- Lowering too fast. If you are dropping in a second, you are skipping the eccentric load. Count it out — three to four seconds down, every time.
- Lifting with the sore leg. The injured side should only lower. Use both legs, or your good leg, to get back to the top.
- Doing only the straight-knee version. Skipping bent-knee reps leaves the soleus untrained.
- Dropping below the step with insertional pain. Stay level if your pain is at the heel attachment.
- Quitting at two or three weeks. Tendons remodel over months. Stopping early is the most common reason people conclude the exercise "didn't work."
If you have corrected all of these and genuinely given it time, that is useful information for your podiatrist — it points toward needing a closer look rather than simply more repetitions.
When heel drops aren't enough
Heel drops are a cornerstone of care, but they are not the whole toolbox, and they are not right for every Achilles problem. If you have done the exercise correctly and consistently for a couple of months without meaningful improvement, it is time for an evaluation. Other options — from different loading programs to shockwave therapy to, in select cases, procedures — exist for tendons that stay stubborn, and the earlier a plan is adjusted, the better. You can read more about the first-line steps in our overview of early treatment for Achilles tendonitis, and about the condition itself on our Achilles tendonitis service page.
Some symptoms should not wait for a trial of exercise at all. If you felt a sudden snap or pop at the back of your ankle, cannot push off or rise onto your toes, or have a gap you can feel in the tendon, that may be a rupture and needs urgent evaluation — do not try to rehab it with heel drops. The same goes for the back of the heel becoming red, hot, and swollen, which points to something other than a simple overuse tendon.
Medically reviewed by the board-certified physicians at Wasatch Foot & Ankle Institute — Dr. Jason Campbell, DPM, MHA, AACFAS, Dr. Colby Frost, DPM, MHA, FACFAS, Dr. Mark Woolley, DPM, FACFAS, Dr. Chantel Murrah, DPM, MHA, MPH, MBA, PhD. Our board-certified, fellowship-trained podiatrists provide foot and ankle care in Farmington and South Ogden, Utah. This article is for general education and is not a substitute for an in-person evaluation. Before starting a new exercise program for a painful tendon, check with a qualified provider about what is right for you.
Photo by Benjamin Klaver on Unsplash