Ozone Injection vs ESWT for Chronic Achilles Tendinopathy

Inclusion Criteria: Patients aged 18 to 65 years. Patients with a diagnosis of Achilles tendinopathy confirmed by ultrasonography or magnetic resonance imaging (MRI). Patients with persistent symptoms despite completion of conservative treatment. Volunteers who agree to participate in the study. 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 \-