We report the results of nonsurgical treatment of chronic Achilles tendinopathy in 22 patients with a follow-up of 33 to 72 months. Immediately after the treatment period, 70% of the patients were either improved or cured. At follow-up, 65% were improved or cured, and 35% failed treatment or had a poor long-term result. In these patients, early surgery might have been considered, but only one patient received a peritendinitis operation in the follow-up period. In athletic individuals with chronic Achilles tendinopathy, nonsurgical treatment with emphasis on active training is recommended. Surgery should be considered if the athlete has been treated for 3 to 6 months without progress.