Ozone Injection vs ESWT for Chronic Achilles Tendinopathy

Exclusion Criteria

• •Patients with symptoms lasting less than 12 weeks.
• •Presence of contraindications to extracorporeal shock wave therapy (ESWT), including pregnancy; history of thrombosis; use of anticoagulant medications; coagulation disorders such as hemophilia; systemic conditions; or localized conditions at the treatment site such as active infection or malignant tumors.
• •Presence of contraindications to local ozone injection, including pregnancy; glucose-6-phosphate dehydrogenase (G6PD) deficiency; favism; uncontrolled hyperthyroidism; thrombocytopenia; severe cardiovascular conditions; and use of angiotensin-converting enzyme (ACE) inhibitors.
• •History of neurological disease, muscle disease, or peripheral vascular disease.
• •Presence of congenital or acquired deformities of the knee and/or ankle.
• •Receipt of physical therapy modalities applied to the Achilles tendon within the last 6 weeks.
• •Receipt of any therapeutic injection to the Achilles tendon within the last 12 weeks.
• •History of direct trauma to the symptomatic Achilles tendon or Achilles tendon rupture.
• •History of surgical treatment involving the Achilles tendon or ankle for any reason.
• •History of foot or ankle dislocation or fracture within the past 1 year.
• •Presence of systemic inflammatory diseases that may affect tendon structure, such as ankylosing spondylitis, reactive arthritis, or psoriatic arthritis.
• •Patients with isolated insertional Achilles tendinopathy without tenderness in the mid-portion of the tendon
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