Wednesday, 26 June 2013

Plantar Fascitis and its Ayurveda Management

PLANTAR FASCIITIS AND ITS AYURVEDA MANAGEMENT

Plantar Fascitis
Plantar Fasciitis is a painful inflammatory process of the plantar fascia ,the connective tissue on the sole of the foot. The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. It supports the arch of the foot.  The most common causes of the heel pain is the inflammation of this area. Main causes are overuse of the plantar fascia or arch tendon of the foot.by the over strain of the plantar fascia, it gets weak ,swollen and inflamed. Sometimes small tears may also be occur and this will causes the severe pain. The pain is mainly seen in the anterior part of the calcaneous. Commonly seen in middle aged peoples however pain also occur in younger people whose are on their feet a lot. It can also be termed as "policeman's heel".

Causes of Plantar Fasciitis: 

It is mainly caused by over straining of the Plantar Fascia. The straining may occur in different ways and its finally lead to inflammation, pain, swelling etc.
  • Flat foot.
  • calcaneal spur.
  • Over straining like long walk, running etc. especially on hard surface.
  • Bare foot walk.
  • Feet roll inward too much while walking.
  • Over weight.
  • Improper shoes,
  • High heeled foot wears.
  • Weak calf muscles etc.

Pathology: 

Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes. Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed. Instead, injury to the tendon is usually the result of an accumulation over time of microscopic tears at the cellular level. Tears or lesions affects the soft tissue at the site of attachment of the Plantar Aponeurosis to the inferior aspect of tuberosity of calcaneus.

These repeated type of trauma and strain may cause to develop calcaneal spur also. This will lead to aggravate the condition like pain etc.

Symptoms of Plantar Fascitis: 

Symptoms are all same as symptoms due to calcaneal spur.
  • Pain when the patient take their first steps after they get out of bed or sit for a long time and after that pain reduced and a dull type of pain persist.
  • Pain aggravated while climbing steps, long walk etc.
  • Stiffness and sometimes numbness may occur.
  • Slight inflammatory symptoms like swelling etc.

Aggravating Factors:

  • Long walk and running.
  • Bare foot walk.
  • Improper foot wear.
  • Lack of rest etc.

How to diagnose: 

The diagnosis of plantar fasciitis is usually made by clinical examination. Check the feet and watch the patients stand and walk. Ask the patient about medical history, physical activity, foot pain symptoms and etc. If needed advice the patient to take X-Ray, diagnostic ultrasound and MRI to rule out other possible causes of heel pain.
On Examination can find the location of pain, tenderness, etc

site of pain on plantar fasciitis

Investigations:

X-Ray-

Differential Diagnosis:

An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus heel bone, in which case it is the underlying plantar fascitis that produces the pain, and not the spur itself. The condition is responsible for the creation of the spur; the plantar fascitis is not caused by the spur.
Sometimes ball-of-foot pain is mistakenly assumed to be derived from plantar fascitis. A dull pain or numbness in the metatarsal region of the foot could instead be metatarsalgia, also called capsulitis. Some current studies suggest that plantar fascitis is not actually inflamed plantar fascia, but merely an inflamed flexor digitorum brevis muscle (FDB) belly. Ultrasound evidence illustrates fluid within the FDB muscle belly, not the plantar fascia.

Prognosis:

Once a Plantar Fascitis 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.(Described below) 


How to prevent Plantar Fascitis:

  • 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

Treatments for Plantar Fasciitis: 

Treatment options for plantar fasciitis include rest, massage therapy, stretching, night splints, physical therapy, cold therapy, heat therapy, orthotics, anti-inflammatory medications, injection of corticosteroids and surgery in refractory cases. Also in some cases, massaging of the inflamed location serves as a temporary relief.
it will not cure completely, 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 feel a pull on calf muscles. Repeat it for 20 times for each foot.

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 should be 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.



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 Plantar Fasciitis develops when proper care is not given to the foot and heels.
  • Choose new pair shoes/foot wear with correct size.
  • Walk around before you buy shoes, make sure that you can wiggle your toes freely inside of the shoes and also make 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.

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. 
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 anesthetic 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 worsen 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.

[Surgery carries the risk of nerve injury, infection, rupture of the plantar fascia, and failure to improve the pain. Traditional surgical procedures, such as plantar fascia release, are a last resort, and often lead to further complications such as a lowering of the arch and pain in the supero-lateral side of the foot due to compression of the cuboid bone. This will allow decompression of the nearby FDB muscle belly that is inflamed, yet does not fix the underlying problem. This allows more space for the inflamed muscle belly, thus, relieving pain/pressure. An ultrasound-guided needle fasciotomy can be used as a minimally invasive surgical intervention for plantar fascitis. A needle is inserted into the plantar fascia and moved back and forwards to disrupt the fibrous tissue.
Coblation surgery (aka Topaz procedure) has been used successfully in the treatment of recalcitrant plantar fasciitis. This procedure utilizes radio frequency ablation and is a minimally invasive procedure.(ref Wikipedia)]

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 PLANTAR FASCIITIS OR VATAKANDAKA AND ITS AYURVEDA MANAGEMENT

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.

Ayurveda Treatments In Kerala for vatakantaka/ Plantar Fasciitis:

First of all while treating a disease according to Ayurveda is based on the concept that "NIDANA PARIVARJANAM CHIKITSA" that is avoiding the causes of diseases is the primary steps in Ayurveda. 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.

SHODANA Chikitsa/ Purification treatment:(what is shodana 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):

The easiest form of treatment of Plantar Fascitis and 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 / oils 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 Plantar Fasciitis: 



Agnikarma is a type cauterization method.

Materials required: 

Loha Shalaka, Jatyadi Taila, aloe vera leaf.turmeric powder, burner etc.

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 Plantar Fascitis:

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. ental distress is also an aggravating factor of this problem.


2-Katakali Posture:


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,some images and data internet(Wikipedia,etc) and of course my experience.
Read it and write your feed back.

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