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.

Investigatins-
(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

Treatment-

[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 (Benz.ac) etc. may be used. The potency & frequency of dosage as well as duration of treatment varies with the severity of the condition & the individual

Prevention-
(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, Benz.ac etc.

But in every case, a doctor should be consulted.

Some aspects of Ganglion with homoepathic mode of treatment

A ganglion is a localized, tense, painless, cystic, swelling, containing clear gelatinous fluid. It is the most common soft-tissue tumour of the hand & wrist.

Pathology- The cystic structure of ganglion is formed from the lining of a joint or tendon & is filled with a gelatinous fluid but without any synovial or epithelial lining. A stalk can sometimes be identified communicating between the cyst & an adjacent joint or tendon sheath.

Sex- Ganglion formation is more common in females.

Age-Late teens & young adulthood.

Sites of location- It is commonly seen over the wrist, digital flexor sheath & distal interphalangeal joint, but it can also develop on the shoulder, elbows & knees.

Predisposing factors- Chronic repetitive stress & sometimes injury. Occupational factors may play a vital role in its development. The occupations which require overuse of certain joints such as the wrist, may pose a risk for development of ganglion.

Associated diseases- Some joint diseases like Rheumatoid arthritis are occasionally found to be associated with ganglion.

Clinical features- Ganglion presents itself usually as a painless swelling adjacent to a joint or a tendon mostly on the wrist, especially on the back side & fingers. It is usually asymptomatic & is primarily a cause of cosmetic rather than a functional disturbance to the affected person. The condition, however, may become symptomatic if the ganglion presses on any nearby structure such as an artery, vein, tendon or nerve when the impingement of such a structure may cause pain, triggering of a tendon or vascular compromise. If a nerve is pressed upon, the resulting pain may cause restriction of movements & activity of the affected person. Dorsal wrist ganglion which is most commonly encountered may be small when it is barely palpable but is usually highly symptomatic whereas if it is large it is often soft & only mildly symptomatic. Flexor sheath ganglion may present as a firm mass over the palmar aspect of the flexor sheath & is often confused with a bone exostosis due to its severe degree of firmness.

Differential Diagnosis- Ganglion may have to be differentiated from certain conditions. A few of them are-

(1) Fibroma.
(2) Lipoma.
(3) Neuroma.
(4) Hamartoma.
(5) Tenosynovitis.

Treatment- Homeopathy medicine improves re-absorption of fluid from the ganglion & thus cures the condition. In addition chance of recurrence is minimal. Favourable results are usually noticed within 3-6 months. Treatment should be followed till it subsides wholly; otherwise there is chance of recurrence. Calcarea Fluorica (Calc flour) 200 twice daily or Ruta Graveolens (Ruta) 200 twice daily may be used. Ruta may also be used as a local application over the site of ganglion formation. Other medicines which can also be used include Rhus toxicodendron (Rhus tox), Benzoicum acidum ( Benz.ac), Thuya etc.

Prognosis- Ganglion may increase in size or may disappear spontaneously.

In short, ganglion is a painless, cystic swelling found near a joint or a tendon & is treated by Calcarea fluorica or Ruta.

But in every case, a doctor should be consulted.