ACHILLES TENDINITIS

• It is an overuse injury of the Achilles tendon, the band tissue that connects calf muscles at the back of the lower leg to the heel bone. The loose connective tissue of the Achilles tendon becomes thickened and painful due to excessive use 
• It typically manifests with pain over the posterior aspect of the heel, proximal to the insertion of the Achilles tendon on to the Calcaneus
• Most commonly seen in men than females, in runners who have suddenly increased the intensity or duration of their runs, and in middle-aged people who play sports such as tennis or basketball only on weekends frequently complain of pain and stiffness in the back of the heel, which worsens with activity due to Irritation and inflammation of the Achilles tendon in the back of the ankle

• Achilles tendinopathy is common among athletes participating in racquet sports, track and field, volleyball, and soccer
• Unaccustomed prolonged walking/running 
• Use of ill-fitting shoes 
• Athletes/ individuals who have increased their exercise intensity

• Pain and stiffness along the Achilles tendon in the morning
• Pain along the tendon or back of the heel that worsens with activity
• Generally, Pain occurs at the beginning and end of a training session, with a period of diminished discomfort in between
• Thickening of the tendon
• Swelling gets worse throughout the day with activity 

On examination-

• In the acute phase, the tendon is diffusely swollen and oedematous, and on palpation, tenderness is usually greatest 2–6 cm proximal to the tendon insertion
• A tender, nodular swelling is usually present in chronic cases 

• Clinical diagnosis is made
• Pain on palpation of the tendon and subjective reporting of pain 2-6 cm above the insertion into the calcaneum
• Thompson test examines the integrity of the Achilles tendon by squeezing the calf. It is performed as a clinical test to identify the presence of a complete Achilles rupture
• X-ray
• USG – Tendon thickening, hyperechoic areas within the tendon
• MRI – Increased signal in the abnormal tendon

• Rest
• Ice cube application
• NSAIDs
• Supportive shoes and orthotics 
• Exercise to reduce the stress on the Achilles tendon such as calf stretch, eccentric strengthening, bilateral heel drop, single-leg heel drop, physical therapy, etc

Ayurvedic treatment

Internal medicines

• Amrutothara Kashaya
• Rasna erandadai Kashaya
• Guggulu tikthaka Kashaya
• Manjishtadi kashaya
• Kanchanara guggulu
• Kaisora guggulu
• Yogaraja guggulu
• Guggulu Tiktaka gritha

Procedure

• Lepana - Nagaradi choorna, Jadamayadi, Karuthavattu
• Ext application - Kottamchukkadi Taila, Panchasneha 
• Avagaha – Dhanyamla, Dashamoola kashaya
• Agnikarma