An Outlook of Plantar Fasciitis with Correlation in Ayurveda as Vatakantaka

Aetiopathogenesis

Excessive stretching of the plantar fascia Micro trauma of this structure either along its course or where it inserts onto the medical calcaneal tuberosity [7]. If repetitive trauma can result in chronic degeneration of plantar fascia fibres Loading of the degenerative and healing tissue at the plantar fascia may cause significant plantar pain

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Aetiology

Although the cause is unclear, there are a number of independent studies that show the following risk factors for repetitive micro damage to the plantar fascia:

• The most frequent cause of plantar fascia is the tendon that connects the calf muscle to the heel is tight, which prolongs foot flexion and shortens the plantar fascia, so when the person stands, the plantar fascia stretches and the pain intensifies [8].
• Obesity or pregnancy- related excessive abrupt weight stress on the foot. The risk of plantar fasciitis is shown to be two times higher when the body mass index (BMI) is higher than 25kg/m2.
• Diabetes Mellitus, Hypothyroidism, Osteoarthritis.
• Plantar fasciitis has been linked to mechanical imbalances of the foot problems that are caused by foot itself or by excessive walking in footwear with poor arch support, such as ill-mannered shoes, heels . Flat foot, high arches and reduced ankle dorsiflexion are examples of foot and arch issues.
• Heel spurs have been mentioned as a Plantar Fasciitis risk factor. Recent research shows a significantly substantial correlation between Plantar Fasciitis and calcaneal spur.
• Jobs that require standing, walking and working on hard surfaces for the majority of the day have risk of Plantar

Fasciitis. • Prolonged foot flexion causes the plantar fascia to shorten, which is the most typical cause of plantar fasciitis. The condition is brought on by a tight Achilles tendon, which connects the calf muscle to the heel .as a result; standing causes the plantar fascia to stretch and intensifies pain.

According to the Ayurveda, the vitiation of both Vata Dosha and Kapha Dosha is the cause of this ailment. Common causes of Vata Dushti include:

• Constant exercise
• Walking barefoot, which results in Vata Dushti
• Not enough sleep

Symptoms

• It is characterized by the intense pain that occurs along with the first step in the morning which gradually decreases along with the movements.
• Reoccurrence of pain after long period of standing, after exercise or rising from sitting position, or driving the car for a prolonged period.

• When the heel is pressed from inside there is discomfort and perhaps pain along the arch.
• Plantar fascia stretching could be uncomfortable.

Diagnosis

The diagnosis is made on the basis of medical history and physical examination.

Windlass Test

• It is a special test for plantar fasciitis, a:’Windlass” meaning is the tightening of a rope or cable.
• Passively dorsiflexing the toes of a patient with heel pain. Reproduction of pain at the insertion of the plantar fascia is suggestive of plantar fasciitis.
• The windlass test achieves a direct stretch on the plantar aponeurosis which can be effective in examining dysfunction of the plantar fascia.
• The test can be important in the decision making process involved in the evaluation and treatment of plantar fasciitis.

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Investigations

Radiograph of ankle joint antero-posterior, mortise and lateral view.

• Hb %, ESR
• Blood sugar
• S.uric acid
• AST, ALT, S.bilirubin
• S.creatinine, B.urea
• NCV
• EMG
• Neurosensory testing

Prevention

• Maintain a healthy weight.
• Always do a warm-up before exercise.
• Wear supportive shoes that support your arch and heel
• Don’t wear worn- out athletic shoes
• Apply ice
• Stretch your arches.

Treatment

Ayurveda has described treatment of vatakantaka [9] in vatavyadhi chikitsa, Acharya Chakradatta has mentioned the specific treatment of vatakantaka as In Vatakantaka (pain in ankle), bloodletting should be done frequently or castor oil should be taken or the part should be cauterized with needles.

Treatment for it requires both Bahya and Abhyantra Chikitsa, as well as regional Ishtika Sweda, Valuka Sweda, Snehana, Upanaha, Raktavsechana, Bandhana, and Suchikarma (Viddhakarma) and Abhyantara Eranda Snehapana [10].

Panchkarma Plays a Vitol Role in Treatment of Vatakantaka

Raktamokshana: Letting out blood for therapeutic use. People, who undergo raktamokshana, will not suffer from any kind of twakdosha, granthi, sopha and roga due to dushta rakta as the dushya in vatakantaka is also a rakta.

Siravyadha: When the treatments fail, siravyadha has to be done for raktaprakopaja vikaras. Upnaha Sweda: Swedan is commonly mentioned as purvakarma in ayurvedic classics, however it is also used as pradhan karma in treating many conditions like vata and kapha disorders.

• Upnaha is mentioned as Bahya and Ekanga swedan. It is specifically indicated for vantage disorders. Upnaha is best for vatavyadhi with predominance of shoola, sankocha and stambha. Agnikarma: Agnikarma chikitsa introduces agni (heat) in the affected area.
• Physical heat from red hot shalaka is transferred as therapeutic heat to twakdhatu by producing samyak dagdha vrana.
• The ushan , tikshna, laghu, sukshma, vyavayi, vikashi and ashukari properties of agni helps to remove the srotavarodha , pacifies the vitiated vata kapha dosha and maintains their equilibrium thus break the samprapti.