AYURVEDIC MANAGEMENT OF PLANTAR FASCITIS

PLANTAR FASCITIS

·        Plantar fasciitis is a disorder that results in pain in the heel and bottom of the foot.

·        The pain is usually most severe with the first steps of the day or following a period of rest.

·         Pain is also frequently brought on by bending the foot and toes up towards the shin and may be worsened by a tight Achilles tendon.

·        The condition typically comes on slowly. In about a third of people both legs are affected.

·        The causes of plantar fasciitis are not entirely clear. Risk factors include overuse such as from long periods of standing, an increase in exercise, and obesity.

·         It is also associated with inward rolling of the foot and a lifestyle that involves little exercise.

·        While heel spurs are frequently found it is unclear if they have a role in causing the condition.

·        Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring.

·        Most cases of plantar fasciitis resolve with time and conservative methods of treatment. Usually for the first few weeks people are advised to rest, change their activities, take pain medications, and stretch.

·        If this is not sufficient physiotherapy, orthotics, splinting, or steroid injections may be options.

Pathophysiology

·        The cause of plantar fasciitis is poorly understood and is thought to likely have several contributing factors.

·        The plantar fascia is a thick fibrous band of connective tissue that originates from the medial tubercle and anterior aspect of the heel bone. From there, the fascia extends along the sole of the foot before inserting at the base of the toes, and supports the arch of the foot.

·        Originally, plantar fasciitis was believed to be an inflammatory condition of the plantar fascia. However, within the last decade, studies have observed microscopic anatomical changes indicating that plantar fasciitis is actually due to a noninflammatory structural breakdown of the plantar fascia rather than an inflammatory process.

·        Due to this shift in thought about the underlying mechanisms in plantar fasciitis, many in the academic community have stated the condition should be renamed plantar fasciosis.

·        The structural breakdown of the plantar fascia is believed to be the result of repetitive microtrauma (small tears).

·        Microscopic examination of the plantar fascia often shows myxomatous degeneration, connective tissue calcium deposits, and disorganized collagen fibers.

·        Disruptions in the plantar fascia's normal mechanical movement during standing and walking (known as the Windlass mechanism) are thought to contribute to the development of plantar fasciitis by placing excess strain on the calcaneal tuberosity.

·        Other studies have also suggested that plantar fasciitis is not actually due to inflamed plantar fascia, but may be a tendon injury involving the flexor digitorum brevis muscle located immediately deep to the plantar fascia.

PLANTAR FASCIITIS AYURVEDIC ASPECTS

·        Plantar Fasciitis come under the category of foot related pathological conditions explained in Ayurvedic texts, especially in the context of Vata Vyadhi (chapter dealing with diseases manifesting due to morbid Vata),viz Padakantaka and Vatakantaka

·        Vitiated (morbid) Vayu gets located in the Gulpha(ankle and foot) and produces a painful condition of the foot. This is called Vatakantaka.This condition seems to be a variant of Padakantaka but this is an extended version wherein the ankle joint too is involved along with foot.

AYURVEDIC MANAGEMENT

·         Taking control over the morbid doshas, especially Vata and Pitta

·         Relieving the pain, inflammation and other symptoms associated with plantar fasciitis

·         Treatment on the lines of Vatarakta / Vatashonita Chikitsa (Treatment for Gout / Inflammatory or crystal arthritis) can be done in plantar fasciitis. Vatashonita is a disease manifested by the combined effect of morbid Vata and Rakta. This disease too starts manifesting by having its roots in the foot and when localized in foot and heels (plantar fascia), provides similar clinical picture.

Effective treatments:

Bahya / Sthanika chikitsa (External treatments):

Abhyanga (medicated massages) / Samvahana (soothing medicated massages) –

·        Massage of the foot and heel with medicated oils is always a preferable and convenient option in relieving pain and inflammation instantly. Patients will start feeling better right from the first sitting itself.

·        Padabhyanga (foot massage) is a speciality of Ayurveda. Pada or foot is said to be an important Karmendriya (motor organ of locomotion) without which we cannot carry on our daily activities. Foot health is important for our daily activities to go on smoothly and is hooked up with the main health.

·        Care should be taken in not giving a hard or deep massage. The pain and inflammation may worsen by doing so. Samvahana or soothing massages without application of pressure is the best option in dealing with plantar fasciitis.

·        Care should also be taken in choosing the medicament (medicated oil or ghee or both) for massage or pouring as in dhara.

Dhara: Stream pouring of medicated oils / ghee / decoction/ milk etc

·         Sneha dhara: In this medicated oils / ghee / oils and ghee are poured over the affected part for a fixed schedule of time period. Samvahana can be simultaneously done. The oil can be used as such or made lukewarm. Too much heat can aggravate inflammation.

·         Ksheeradhara: Medicated milk (milk processed with herbal drugs which have analgesic and anti-inflammatory properties or with decoctions prepared from the same drugs) is poured in streams over the affected part just is in Sneha Dhara. Milk processed with Dashamula, Laksha, Bala etc provides good relief.

Avagahana: Foot dip in herbal oils:

A foot dip or immersion is given to the afflicted part. The patient is asked to dip his or her afflicted foot in herbal oils or processed milk (explained above).

Medicines used for Abhyanga, Dhara and Avagaha:

·         Murivenna

·         Ashwagandhabala Lakshadi Taila

·         Mahanarayana Tailam

·         Ksheerabala Tailam

·         Prabhanjanavimardana Tailam / Kuzhampu

·         Pinda Taila

·         Kottamchukkadi Tailam

·         Sahacharadi Tailam

·         Dhanwantaram Tailam

·         Guggulutiktakam Ghritam etc

Lepa – Application of herbal pastes

Pastes prepared using the below said herbal powders can be used as applicants:

·         Rasnadi churnam

·         Kottamchukkadi churnam

·         Grihadhumadi churnam

·         Ellumnishadi churnam

·         Jatamayadi churnam etc

Upanaha / Bandhana: Poultices and Bandaging

Poultices prepared by combining the above saidchurnas (mentioned in lepa) and oils mentioned in the context of Abhyanga can be used for applying analgesic and anti-inflammatory poultices. Bandages around the painful part too are helpful.

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Abhyantara Chikitsa: Internal Treatment –

Virechana – Therapeutic purgation to eliminate morbid pitta and vata from the system and aid healing

Nitya virechana or daily purgation can be given with –

·         Nimbamritadi Eranda Tailam

·         Gandharvahastadi Eranda Tailam

·         Sukumara Ghritam

·         Avipatti Churnam

·         Trivrit Leham

·         Sukumara Leham etc

Vasti – Enemas

Enemas with medicated herbal oils (Matra vasti or Anuvasana Vasti) and medicated milk (Ksheera Vasti) are extremely beneficial in healing the pain and inflammation of plantar fasciitis.

The below said enemas are highly effective:

·         Ksheera Vasti with Dashamula siddha ksheera(milk processed with Dashamula)

·   Anuvasana or Matra Vasti with Guggulutiktaka Ghritam, Tiktaka Ghritam, Ksheerabala Tailam, Dhanwantara tailam, Dhanwantara Ghritam, Sahacharadi Tailam etc

Agni Karma. It is another important treatment that helps in Vatika or Kaphaja predominant Padakandakas.

Simple tests to identify the involvement of morbid Dosha in Plantar Fasciitis:

·         If morbid Vayu is involved – Pain is predominant along with numbness, tingling sensation etc

·         If morbid Pitta is involved – Burning sensation is predominant

·         If morbid Kapha is involved – Stiffness is predominant

We know that alternate heat and cold application is a useful remedy in plantar fasciitis like alternating with ice and warm water application. We also know that heat application can aggravate plantar fasciitis symptoms in a few patients. In such patients we should consider the vitiation of Pitta and go ahead with cold application.

Abhyanga, Avagaha, Sweda, Dhara etc should be done without heating the oil / ghee/ milk too much. Lukewarm oils will help to an extent but not hot.

If heat application or treatments involving heat provides relief in plantar fasciitis it indicates towards involvement of morbid Vayu and / or Kapha, because for Vayu and Kapha which are basically cold in nature, heat application is antagonistic.

Useful Ayurvedic medicines in Plantar Fasciitis:

Kashaya’s (Herbal decoctions):

·         Guggulutiktakam Kashayam

·         Sahacharadi Kashayam

·         Sahacharabaladi Kashayam

·         Kokilaksham Kashayam

·         Rasnasaptakam Kashayam

·         Guluchyadi Kashayam

·         Gandharvahastadi Kashayam

Ghritam and Tailam (medicated ghee and oils):

·         Guggulutiktakam Ghritam

·         Varanadi Ghritam

·         Rasnadi Ghritam

·         Dhanwantaram Ghritam

·         Tiktakam Ghritam

·         Ksheerabala Tailam

·         Sahacharadi Tailam

·         Ksheerabala tailam 101

·         Dhanwantaram tailam 101

Vati and Gulika (Tablets):

·         Kaishora Guggulu

·         Yogaraja Guggulu

·         Panchatikta Ghrita Guggulu

·         Ksheerabala Tailam 101 caps

·         Dhanwantaram Tailam 101 caps

·         Mahavata vidhwamsini Rasa etc.

External applications:

The same herbal oils mentioned in Abhyanga etc. can be used for external application.

Shatadhouta Ghritam is one of the excellent applications for plantar fasciitis. It is available in the form of medicated ghee or ointment. It is excellent in relieving pain, inflammation and other associated symptoms.

Jatyadi Ghritam / Tailam has a similar healing impact.