Friday, 14 June 2013

HEEL PAIN OR CALCANEAL SPUR AND ITS AYURVEDA TREATMENTS IN KERALA

CALCANEAL SPUR/ HEEL PAIN (VATAKANTAKA) AND ITS AYURVEDA TREATMENTS in KERALA

The most common form of heel pain is mainly due to calcaneal spur. it is one of the most troublesome common health complaint usually affects badly peoples routine work, and once it is manifested very difficult
for the body to heal. a large percentage of people suffer from this disease.this is most often seen in the patients over the age of 35 years. Many surveys tell that women are the common sufferer. it may be due to the use of high heeled foot wear and over weight.
Calcaneum is the name for the heel bone, and spur means tiny projections.pain caused by this thickness at the heel is called as heel spur. actually the pain is not caused by the deranged bone but the inflamed soft tissue causes the pain. Calcaneal spur is as small osteophyte projections located on the calcaneum.it is not an acute disease that manifest suddenly. it occurs due to gradual changes on that region.
Calcaneal spur is mainly seen in two region inferior calcaneal spur and posterior one.Inferior one is located on the inferior aspect of the calcaneum and is typically a response to Plantar Fascitis over a period but may also be associated with Ankylosing spondylitis.An inferior spur consist of a calcification of the calcaneum,which lies superior to the plantar fascia at the insertion of  plantar fascia.it something like an hook shaped one.

A posterior calcaneal spur develops on the back of the heel at the insertion of the Achilles tendon. It is often a large one and palpable through the skin and may need to be removed as the part of the treatment of insertional Achilles Tendinitis. and it is visible to naked eye.
studies reveals that a major percent of people the affected the calcaneal spur are on their feet nearly all day as the part of their job or something.patients always present as symptom like pain behind the heel.

Pathology or Manifestation of disease:

Plantar Fascitis
Middle aged overweight and athletic individuals are more to plantar problems and sometimes non athletic peoples are also affected, who spend a lot of time on their feet and suddenly become active after along period of time.Constant weight and high heeled foot wear exert more pressure over heel region. this lead to stretching or flattening of the calcaneum and hence a thorny hook shaped growth formed in the local regions and gradually it exerts pressure over the soft tissue around it.it will cause inflammation of the soft tissue and pain while walking.In the people that have sedentary habit, and one who have weakness of the calf muscle, the pressure is immediately transferred to the heel region and exerts more pressure over the calcaneal region.When a foot bone is exposed to constant pressure, it causes to build up calcium deposit on the bottom of the heel bone.Repeated damage for a longtime cause these deposit to pile up on each other cause to forming spur shaped deformity.they are frequently associated with plantar fascitis.when the plantar fascia is tight and pull on heel bone,the bone release calcium to protect and for supporting.it will also cause manifestation of the disease and pain.
excess calcium deposit due to high calcium intake diet also reason for the diseases.



Causes:

  • habit of long walk
  • overweight
  • flatfoot
  • age
  • bare foot walk
  • improper foot wear,and use of high heeled footwear,etc

Aggravating Factors:

  • obesity
  • barefoot walk
  • high heeled chapel
  • long walk,running,jogging
  • athletes,health workers,etc
  • pregnancy
  • diabetics
  • shoes having no arch support,and poorly fitted shoes
  • age
  • weight bearing etc.

Symptoms:

Pain in the region surrounding the spur typically increases in intensity after prolonged period of rest, patient may report heel pain to be more severe when waking up  in the morning and also from rest, and pain relieved after few steps.after a short step a dull pain persist.
patient may not able to bear weight on the affected heel comfortably.
patient may experiences gait disturbances or changes in the walking pattern.
intermittent or chronic pain while walking or running.
patient sometime present as pin or knife sticking type of pain into the bottom of their feet when they first stand in morning and later turns to dull ache.they after complaints about sharp pain return after they stand up after sitting for a prolonged period of time.some patient experiences slight numbness.
pain in the heel either below or behind.
the feet or calf muscles may feel stiff in the morning making walking difficult.
spur may cause no symptoms at all.

Investigation:

investigation such as blood test or urine test,etc have no such typical role in this area.
blood test: may show some uric acid elevation and raise in ESR, it is not must.
X-RAY: only x-ray have the particular relevance here. we can see spur in the lateral view of heel X-Ray.
Heel - X ray


Diagnosis:

Usually diagnosis made by the symptoms revealed during a clinical examination. to eventually confirm the diagnosis and exclude other possible causes of heel pain,may order to the investigation such as X-Ray,etc.
patient feel tenderness over that area when palpate.
by noticing the gate.

Differential Diagnosis:

Check for any other causes of heel pain and rule out other possible one by asking the patient about mode,onset,character,and use X-ray etc.
possible one are
plantar fascitis,
retro calcaneal spur etc.

Prognosis:

Once a calcaneal spur develops,it can be difficult condition to treat. however in many cases involves only minor pathology which cured in a weak or two.Prevention by taking early corrective measures against any predominate factors will improve the long term prognosis.
In Ayurveda it is clearly mentioned as a curable one.and have a tremendous result for chronic or acute one by Ayurveda medicines and therapies.(Ayurveda management)


How to prevent calcaneal spur:

  • give proper rest.
  • increase the strength of calf muscles through exercise.
  • use proper fitted footwear with having heel arch and support.
  • avoid bare foot walk especially in hard floor.
  • avoid high heeled foot wear.
  • reduce weight.
  • avoid standing for long.
  • take a warm up before every exercise.
  • avoid standing for long.
  • avoid excessive intake of hot and spicy foods. etc

Treatment for CALCANEAL SPUR or HEEL PAIN:

Heel spur don't have a magical cure, but can cure the pain,inflammation and eventually get rid of them.
Treatment methods are described in four steps.before starting the treatment one should understand that primarily avoid possible causes of the diseases.Treatments are:
  • Life style management.
  • Exercise.
  • Medicine
  • shoe recommendations
  • taping or strapping to rest stressed muscles and tendons.
  • orthopaedic molds.
  • shoe inserts 
  • Extra Corporeal Shock Wave Therapy(ESWT)
  • Surgery.

1-LIFE STYLE MANAGEMENT: 

Avoid causative factors emphasis to given to preventive measures.add proper exercises and yoga like therapies in life style.
avoid junk foods,hot and spicy food,which will ultimately lead to obesity, diabetic etc.
use of proper shoes,well fitted not high heeled, etc.
reduce obesity.
give proper rest after work or exercise.

2-EXERCISES: 

All efforts are carried out to reduce the stress and over pressure on weight bearing joints especially heel.
Mainly three types of exercise are used for this disease.
  1. Stretching of Calf Muscles.
  2. Rolling Exercises.
  3. Out stretching of legs.

Stretching of Calf muscles: 

Place your hands on a wall. Extend one foot behind you with your knee straight and place the other foot in front of you with the knee bent.Push your hips towards wall and hold stretch for 10 seconds. you should fell a pull on calf muscles.repeat it for 20 times for each foot.

Stretching Exercise

Plantar Fascia Stretch: 

Perform this exercise in the morning before you have done any standing  or walking. Cross injured leg.grasp toss and gently pull them toward you.if you cant reach toes, then warp a towel around them and pull on the towel. hold stretch for 10 sec and repeat several times for each foot.

plantar fascia stretch

Rolling Exercise:

the person is advised to sit on a chair and a tennis ball or marbles are placed below the sole and is rolled from front to back.

rolling exercises

Out stretching of the legs:

one of the legs is put forward by standing position. Meanwhile another leg should remain in straight line with other leg. back is kept in erect position and knee is bent forward so that the leg below the knee is stretching out for a few minutes..repeat this for other leg also.

Out stretching Exercise


Use of Medicine:

Heel pain may respond to treatment with over-the-counter medications such as acetaminophen,ibuprofen or naproxen.but all these medicines may cause side effects with prolonged use.in these most significant being gastrointestinal discomfort,ulceration and bleeding.

Shoe recommendations:

Generally a calcaneal spur develops when proper care is not given to the foot and heels.
  • choose the new shoes that are the right size.
  • walk around before you buy shoes.-make sure that you can wiggle your toes freely inside of the shoes.and also sure that have enough space between your tallest toe and the end of the shoe.
  • use orthotic inserts inside the shoes.- use heel cups, insoles.
  • avoid high heeled shoes and foot wears.

Strapping or tapping: 

it will help to give rest to stressed muscles and tendons.

Strapping or Tapping- calcaneal spur

Orthopaedic molds.: 

Orthopaedic molds are quite effective in treating heel spurs.they are easily available in market.place these molds under the heel in your shoes on regular basis.
Orthopaedic molds
it will give relief.

Other methods:

  • apply ice pack for 10 to 15mts at least twice a day.or rolling your foot over an iced can.or bottle.
  • get some rest.wear night splints.

Injections:

inject a corticosteroid along with local anaesthetic like xylocane.some may inject botox into foot to relax plantar fascia.but effects will temporary.the side effects of steroids injected in this area can be serious and worse symptoms.complications can include fat necrosis of the heel and rupture of plantar fascia.

Extra corporeal Shock Wave Therapy (ESWT):

ESWT
ESWT uses sound waves to slightly injure the tissue surrounding the heel, which could cause the parts that are causing pain to heel.

Surgery:

More than 90 percent of people get better with non-surgical treatments.if conservative treatments failed to cure the symptoms after a period of 10 to 12 months surgery may be necessary to relieve pain and restore mobility.some of the surgical techniques includes:
  • release of plantar fascia.
  • instep plantar fasciotomy: remove part of the plantar fascia to ease pressure on the nerves in the foot.
  • removal of spur.
  • Endoscopy: this is same functions as instep plantar fasciotomy but uses small insertions so that heal faster.however it has high rate of nerve damage.
per-surgical test are required to identify optimum patients.it is important to observe post surgical recommendations like rest,ice compression etc and when to to place weight on the operated foot.in some cases, it may be necessary for patients to use bandages, splint, casts etc.
complications of surgery: possible complications of surgery include nerve pain,recurrent heel pain,permanent numbness of the area, infection and scarring. in addition with plantar fascia release,there is risk of instability, foot cramps, stress fracture, and tendinitis.

SOME HOME REMEDIES:

1-Cold and heat therapy:
two bottles (plastic or glass) are filled with cold water and hot water respectively.Alternatively these are rolled with the affected sole. significant relief in pain can be observed by this.but the effect will be for short duration.
2-Salt water Immersion:
Advised to keep foreleg or sole on immersion with salt water and can be carried out for 20mts daily.
3- Immersion in a sour butter milk:
in a vessel 2to 3 liter sour buttermilk is taken(to get sourness add some lemon juice) and the sole is immersed in it for 20mts.
4-Chlorinated water is helpful to bringing down the inflammation and to relieve pain.
5-Applying flax seed pack on the affected area.try to soak feet regularly in borax solution.
6-Apple cedar vinegar is one of the effective remedies.all you have to do is cut a paper in the shape of a heel and soak it in apple cedar vinegar.try this daily for next four to five days.etc.

HEEL PAIN OR CALCANEAL SPUR OR VATAKANDAKA AND ITS AYURVEDA MANAGEMENT

Heel pain
Ayurveda describes this condition as vatakandaka, condition resulting due to kapha-vata vitiation.Ayurveda clearly mentioned this condition as treatable.vatakandaka is a very common disease especially in old age as vata rogas/diseases occurs particularly in this time.But usually this disease seen commonly in middle ages.
According to Ayurveda this condition occurs due to kapha dosha vitiation along with vata dosha. as a result kapha dushti/vitiation bone formation in that area malfunctioned.lead to inflammation etc. excess calcium deposition and spur formation occurs. these vitiated kapha block or alter the normal path of the vata srothas/channels.vata has the main dosha in three of them and has the main functions like movement,neurological and motor activities.the vitiated vata also causes burning sensation and pain.
In Ayurveda it can cure successfully and can avoid injections,surgery and other proceeding complications.

some common causes of vata dushti: (detail)

  • excessive exercise.
  • bare foot walk-which ultimately lead to vata dosha due cold etc.
  •  excess use of hot and spice food.
  • age-old age time of vata vitiation.
  • lack of sleep
  • mental stress- lead to vata kopa
  • etc.

some causes of kapha Dushti:(detail)

  • lack of exercise.
  • excess use of sweet and oily food- lead to over weight.
  • obesity
  • diabetics-is one of the kapha vikara/disease.
  • etc.
due to all these causes disease occurs.

Ayurveda Treatments In Kerala for vatakantaka:

while treating a vatakandaka patient it should be remind that depending on the vyadhi lakshanas or symptoms vitiation of vata along with kapha should be considered.vata dosha has the more importance and has its own value.and vata vitiation along with kapha was considered here and treatment ease planning according to this.here vata is the predominant one and along with/anubandhi kapha we can opt treatment like snigdha-ruksha treatment.also remember that here asthi dathu vaishamya or weakness also is there.
we can opt treatment like:
  • abyanga-snigdha
  • sweda- ruksha sweda especially ishtika sweda.
  • some internal medicines.etc.
  • panchakarma-like abyanga,rakthamoksha(blood letting),agnikarma,suci daha.etc
  • proper rest
  • exersice
  • yoga- for mental releif.

SHODHANA Chikitsa/treatment:(shodhana and samana chikitsa)

  1. VIRECHANA- with gandharvahasthadi oil, or sukumarerandam etc.
  2. MAATRA VASTHI: with gulgulu thikthakam ghrtham, or with narayana taila+gulgulu thikthakam ghrtham or gulgulu thikthakam+dhanwantaram tailam (mezhuku pakam).

Kashaya suitable for this: 

  1. Rasnadi kashaya.
  2. Dhanada nayanadi kashaya.
  3. Rasnerandadi kashaya.
  4. Dashamoola kashaya.
  5. jeeraka satapushpa ksheera kashaya
  6. Adaree sahacharadi kashaya.
  7. gulgulu thikthakam kashaya.
  8. sahacharadi kashaya
  9. sundi baladi kashaya,etc

Arishta suitable:

  1. balarishta
  2. jeeerakarishta,etc

Tablets or gulika:

  1. Chandraprabha gulika
  2. yoga raja gulgulu
  3. rasnadi gulgulu
  4. kaisora gulgulu,etc

Lepam with:

  1. dasanga lepam.
  2. karutha vattu in egg white yolk.,etc

Taila for External and internal use: 

  1. Chinchadi taila
  2. kottamchukkadi taila
  3. gandha taila -internally
  4. ksheerabala-internally
  5. Mahanarayana taila-for abyanga
  6. pinda taila
  7. Dhanwantaram tailam- Abyangam,etc

Ghrtham:

  1. rasnadi ghrtham
  2. gulgulu thikthakam ghrtham, etc

Churna/ powder:

  1. turmeric powder
  2. thriphala powder

other useful therapies:
  • hot water fomentation with saindhava.
  • dasamoola kashaya immersion.
  • warm brick fomentation or ishtika sweda
  • coconut oil massage
  • wrap cabbage leaf around the region.
  • warp arka leaf and give fomentation around it.

ISHTIKA SWEDA (BRICK FOMENTATION):

Ishtika Sweda -Calcaneal spur
The easiest form of treatment of calcaneal spur is ishtika sweda with some internal medicines and rest.it can be performed by the patient itself at home,because it is simple and cost effective.

Materials required:

  1. taila/ oil -for local abyanga/ massage (pinda taila,mahanarayana taila,ksheeramala,dhanwantharam tailam,etc)
  2. two medium sized piece of Ishtika or brick.
  3. superintend water of boiled rice/ dhanyamlam, or dasamoolam kashayam-1ltr
  4. additional two cloth piece for making bolus in method 2

Method of Procedure and Preparation:

Method-1:
first of all the painful area should be given an oil massage/abyangam (without force) using any tailas mentioned above with conditions.
After abhyanga Ishtika/brick Sweda was done. Ishtika/brick was heated on moderate
flame till red hot, after that immediately it was kept in a vessel and prepared rice water or dasamoola kashaya poured over it. It yields hot fumes and affected foot held over it, till ishtika/brick became cold.
When Ishtika/brick became cold it was replaced by another red hot ishtika/brick and
thereby temperature was maintained. The procedure was repeated till the appearance
of Samyak Swinna Laxanas(like red color,softness,reduce of pain,sweat formation etc)

Methode 2-
in this method only change is here brick should be taken and broken into small pieces.they should be heated red hot and dipped in rice washed water/tandulodaka or dasamoola kashaya.and immediately tied in a cloth in the form of bolus.the red hot bolus should be placed in the massaged part removing intermittently.before fomenting tie affected part the heat of the bolus should be tested by putting it on the palm by the person doing it to avoid burns.Contraindicated to Diabetic patients having sense disturbances.
it helps two improve the kharatwa of asthi dhathu and give strength to it.

Agnikarma in Calcaneal spur: 


Agni karma - calcaneal spur

Agnikarma is a type cauterization method.

Materials required: 

Loha Shalaka,Jatyadi Taila,aloe vera leaf.turmeric powder,burneretc.

Method of procedure: 

Agnikarma was followed with Loha Shalaka and making the signs of Bindu, all over the heel of the affected heel.apply aloe vera leaf intermittently to give cooling affect to the patient.After Agnikarma application of Jatyadi Taila or turmeric powder was done on the same area where Agnikarma was done, as Paschat karma /post operative procedure of Agnikarma.
following internal medicines will give dramatic change to the patient.

Yoga for Calcaneal Spur:

1-VAJRASANA:

sit in Vajrasana followed by Viparitha karani or sarvangasana at least three times in the day. Whenever you need to sit down at home sit in vajrasana. This asana gives the pressure on the vajra nadi which is the acupressure point to correct the prana imbalance. On very painful days an elastic support bandage to foot and elevate the foot with support on the chair or pillow.
vajrasana
 and some pranayama like anuloma vilomaetc, and padmasana like procedures also will give calmness to the mind and body.mental distress is also an aggravating factor of this problem.

SO PREVENT THIS DISEASE BY KNOWING THAT OUR HEEL IS VICTIM OF OUR BODY OVERWEIGHT EXCESS WALK ETC.SO KEEP IT SAFE.
DO NOT OVER ESTIMATE YOUR ABILITIES.
SUPPORT HEALS.AVOID HIGH HEELED WEARS,SEEK CORRECT TREATMENT IN CORRECT TIME
GIVE LESS STRAIN TO HEEL AND PREVENT THIS PAIN.
AND ONE MORE THING "PREVENTION IS BETTER THAN CURE"






by:Dr.Rimin Razak
Thank you.  ref: some medical books,advice of seniors,internet and of course my experience.
Read it and write your feed back.

11 comments:

  1. Dear doctor,
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