-Key investigations to do: - Blood tests ESR, CRP (inflammation) Repeat Rheumatoid factor Anti-CCP (if not recent) ANA Uric acid Vitamin D Imaging X-ray of heel and ankle (both feet) -Internal Medicines 1)Yograj Guggulu – 1 tab BD after food with warm water 2)Rasnasaptakam Kashayam – 15 ml + 15 ml warm water, BD before food 3)Maharasnadi Kashayam – 15 ml + 15 ml warm water, BD before food 4)Shallaki capsule – 1 cap BD after food 5)Gandharvahastadi Eranda Taila – 10 ml HS with warm water (if no loose stools) 2. External Treatment Abhyanga with Mahanarayana Taila or Kottamchukkadi Taila – local application to heel & ankle, once daily Swedana (hot water fomentation) after oil application Upanaha Sweda (if swelling/pain severe) – optional 3. Pathya (Advice) Avoid long walking & standing Use soft cushioned footwear Avoid cold exposure, dry foods, curd at night Warm, light, easily digestible diet 4. Follow-up Review after 14 days If pain persists → we will move towards panchkarma under supervision
