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Saturday, April 18, 2009

Some aspects of “Achilles tendonitis” with homoepathic mode of treatment

Achilles tendonitis is the inflammation (tendonitis) of the Achilles tendon which is the thickest & strongest tendon in the body connecting the heel to the calf muscles & thus enables a person to stand on the toes, to walk, to run or to jump. Achilles tendonitis is a frequent complaint in athletes, especially runners training under less than ideal conditions.
Causes- Lack of flexibility & overpronation are the two basic causes. Associated causes may be the following-

[A] Extrinsic-
(1) Repetitive stresses to the tendon.
(2) Overuse.
(3) Overtraining.
(4) Poor conditioning.
(5) Improper training surfaces.
(6) Improper stretching exercises.
[B] Intrinsic-
(1) Age.
(2) Tight Achilles tendon.
(3) Different congenital foot & knee deformities.
(4) Medical diseases affecting tendon tissue like diabetes mellitus.
(5) Use of long continued steroids.
Clinical features-
(1) Pain over & above the back of the heel which increases on participation in activities especially after a period of inactivity. Hence patients complain of pain after first walking in the morning & also on running or jumping.
(2) Tenderness over the Achilles tendon.
(3) Stiffness of the tendon in the morning which gradually lessens as the tendon warms up.
(4) Inability to stretch Achilles tendon without pain.
(5) Mild swelling on the tendon.
(6) Occasionally a cracking sensation when the tendon is under pressure.
(1) Blood Tests- Routine Blood Tests for sugar estimation to exclude diabetes mellitus.
(2) X-rays- X-ray is not useful but should be done as a routine to find out other possible conditions.
(3) MRI- MRI is helpful in evaluating a patient for tears within the tendon. It also can provide useful information in refractory cases & helps in preoperative evaluation & planning in patients being considered for surgery.
Differential Diagnosis- Achilles tendonitis may sometimes be confused with Achilles tendon rupture, Ankle Sprain, Ankle fracture, Retrocalcaneal bursitis, Athletic foot injuries, Achilles bursitis, Deep venous thrombosis, etc


[A] General measures to be taken are-
(1) Rest.
(2) Wearing of a heel pad that slightly raises the heel.
(3) Exercises to strengthen the tendon.

[B] Homeopathic medicines to be used- Homeopathy can be very effective if properly used. Homeopathic medicines to be used depend on the clinical features & the causative factors. Ruta Graveolens (Ruta), Thuya, Benzoicum Acidum ( etc. may be used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

(1) Warming up & stretching before any sort of sport.
(2) Strict restriction of overdoing of any sport.
(3) Wearing of correct footwear.
(4) Designing of shoes according to the sport with adequate heel support.

Prognosis- Achilles tendon having a poor blood supply is slow to heal. But with proper treatment the affected tendon usually recovers completely, provided treatment is started in time. In case the starting of treatment is delayed, it may develop into a chronic one. With passage of time the inflammation may lead to degenerative changes within the tendon & may even lead to small tears within it which make it susceptible to rupture. Incomplete rehabilitation or a hasty return to activity should be strictly prohibited as it would hamper the healing process & may also lead to re-injury.

In short, Achilles tendonitis is the inflammation of the Achilles tendon which is manifested as pain, tenderness & stiffness of the tendon that increases on participation in activities especially after a period of inactivity & is treated Ruta, Thuya, etc.

But in every case, a doctor should be consulted.

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