Introduction
Plantar fasciitis is a very common complaint faced in daily OP clinics. The name is less popular among common people, but a severe pain & tenderness in heel which may interfere with walking & running is very common complaint. It is an inflammation of a thick band of tissue that connects the heel bone to the toes.
The inflamed tissue- plantar fascia-runs across the bottom of the foot.
Signs and symptoms
Stabbing pain in the bottom of the foot near the heel.
Causes
Repeated stretching and tearing can irritate or inflame plantar fascia, although the cause remains unclear in many cases of plantar fasciitis.
Pathophysiology
Biomechanical dysfunction of the foot is the most common aetiology of plantar fasciitis, however, infectious, neoplastic, arthritic, neurologic, traumatic, and other systemic conditions can prove causative. The pathology is traditionally believed to be secondary to the development of microtrauma (microtears), with resulting damage at the calcaneal-fascial interface secondary to repetitive stressing of the arch with weight bearing.
Excessive stretching of the plantar fascia can result in microtrauma of this structure either along its course or where it inserts onto the medial calcaneal tuberosity. This microtrauma, if repetitive, can result in chronic degeneration of the plantar fascia fibres. The loading of the degenerative and healing tissue at the plantar fascia may cause significant plantar pain, particularly with the first few steps after sleep or other periods of inactivity.
The term fasciitis may, in fact, be something of a misnomer, because the disease is actually a degenerative process that occurs with or without inflammatory changes, which may include fibroblastic proliferation. This has been proven from biopsies of fascia from people undergoing surgery for plantar fascia release.
In many cases, Fasciosis is the inciting pathology, like tendinosis, defined as a chronic degenerative condition that is characterized by fibroblastic hypertrophy, absence of inflammatory cells, disorganized collagen, and chaotic vascular hyperplasia with zones of avascularity. These changes suggest a noninflammatory condition and dysfunctional vasculature. With reduced vascularity and a compromise in nutritional blood flow through the impaired fascia, it becomes difficult for cells to synthesize the extracellular matrix necessary for repairing and remodeling.
Diagnosis
Physical examination
Treatments
Medications
Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) may ease the pain and inflammation caused by plantar fasciitis.
Therapies
Stretching and strengthening exercises or using special devices may relieve symptoms.
Physical therapy
A series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles.
Night splints.
Orthotics.
Surgical or other procedures
Injections – Injecting steroid medication into the tender area
Extracorporeal shock wave therapy.
Ultrasonic tissue repair.
Surgery – to detach the plantar fascia from the heel bone.
Prognosis
Most people who have plantar fasciitis recover in several months with conservative treatment, including resting, icing the painful area and stretching.
Complications
chronic heel pain that hinders regular activities.
Foot, knee, hip, or back problems due to change in the way of walking & weight distribution.
Disease & Ayurveda
Vaatakantakam
Nidana
Vishamanyasta – walking on an irregular surface
Srama – excess strain to the feet
Purvaaroopa
Not mentioned
Samprapti
Not mentioned separately. Vitiated dosha is Vaata
Lakshana
Pain in the ankle & heels
Divisions
Not mentioned
Prognosis
Saadhya in new & uncomplicated cases
Chikithsa
Samana
Lepanam with Rookshana and soolahara dravyas
Parisheka with soolahara kwathas
Abhyangam
Swedanam
Upanaaham
Sodhana
Asthapanavasti
Anuvasanavasti
Agnikarma
Then treatment of wound should be done
Commonly used medicines
Sahacharadi kashayam
Rasnerandadi kashayam
Yogarajaguggulu
Sahacharadi tailam
Balataiilam
Patented Medicines for Plantar Fasciitis
Capsule Zeotone
Brands available
AVS Kottakal
AVN Madurai
AVP Coimbatore
SNA oushadhasala
Vaidyaratnam oushadhasala
Cold compresses
Heat packs
Stretching exercises
Rest
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, sesame oil, fresh fruits and vegetables
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Avoid walking on irregular surfaces.
Wear protective footwears.
Protect yourself from cold climate.
Better to avoid exposure to excessive sunlight wind rain or dust.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Avoid sedentary lifestyle. Be active
Yoga
Regular stretching and mild cardio exercises are advised. Also, specific yogacharya is recommended.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Yoga for plantar fasciitis
Pavanamuktasana
Nadisudhi pranayama
Simple exercises for lungs and heart health
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183784/
Background: Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach in the management of a number of tendinopathies. Benefit has been shown in calcific tendinitis of the rotator cuff, but evidence for its use in non‐calcific disorders is limited.
Aims: To perform a double blind randomised controlled trial of moderate dose shock wave therapy in plantar fasciitis.
Methods: Adults with plantar fasciitis for at least 3 months were randomised to receive either active treatment (0.12 mJ/mm) or sham therapy, monthly for 3 months. Pain in the day, nocturnal pain and morning start‐up pain were assessed at baseline, before each treatment and 1 and 3 months after completion of therapy.
Results: Eighty‐eight subjects participated and no differences existed between the groups at baseline. At 3 months, 37% of the subjects in the ESWT group and 24% in the sham group showed a positive response (50% improvement from baseline) with respect to pain. Positive responses in night pain occurred in 41% and 31% in the ESWT and sham groups, respectively. Positive responses in start‐up pain occurred in 37% and 36% in the ESWT and sham groups, respectively. Both groups showed significant improvement over the course of the study, but no statistically significant difference existed between the groups with respect to the changes were seen in any of the outcome measures over the 6‐month period.
Conclusions: There appears to be no treatment effect of moderate dose ESWT in subjects with plantar fasciitis. Efficacy may be highly dependent upon machine types and treatment protocols. Further research is needed to develop evidence based recommendation for the use ESWT in musculoskeletal complaints
The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia‐specific stretching vs shoe inserts and high‐load strength training in patients with plantar fasciitis. Forty‐eight patients with ultrasonography‐verified plantar fasciitis were randomized to shoe inserts and daily plantar‐specific stretching (the stretch group) or shoe inserts and high‐load progressive strength training (the strength group) performed every second day. High‐load strength training consisted of unilateral heel raises with a towel inserted under the toes. Primary outcome was the foot function index (FFI) at 3 months. Additional follow‐ups were performed at 1, 6, and 12 months. At the primary endpoint, at 3 months, the strength group had a FFI that was 29 points lower [95% confidence interval (CI): 6–52, P = 0.016] compared with the stretch group. At 1, 6, and 12 months, there were no differences between groups (P > 0.34). At 12 months, the FFI was 22 points (95% CI: 9–36) in the strength group and 16 points (95% CI: 0–32) in the stretch group. There were no differences in any of the secondary outcomes. A simple progressive exercise protocol, performed every second day, resulted in superior self‐reported outcome after 3 months compared with plantar‐specific stretching. High‐load strength training may aid in a quicker reduction in pain and improvements in function.
This study examined the effect of botulinum toxin upon plantar fasciitis through a randomized, controlled, and blinded trial.
Materials:
Between 2012 and 2015, 50 patients presented with plantar fasciitis. Twenty-five patients each randomly received an IncobotulinumtoxinA (IBTA) or saline injection of their affected foot. Pre- and postinjection function and pain were graded with the Foot and Ankle Ability Measures (FAAM) and visual analog scale (VAS), respectively. All 50 study patients who randomly received either placebo or IBTA presented at 6 and 12 months after injection.
Results:
At 6 months, the mean FAAM increased from 35.9 to 40.9 of 100, and the mean pain score decreased from 8.4 to 7.9 of 10 within the placebo group. At 6 months, the mean FAAM increased from 36.3 to 73.8 of 100, and mean pain score decreased from 7.2 to 3.6 of 10 within the IBTA group. These postinjection scores were significantly better than the placebo group (P = .01). At 12 months after injection, the IBTA group maintained significantly better function and pain than the placebo group (P < .05). By that time, 0 (0%) and 3 (12%) patients who received IBTA and saline, respectively, underwent surgery for recalcitrant plantar fasciitis (P < .005).
Conclusion:
Compared with placebo saline injection, using IBTA to treat plantar fasciitis resulted in significantly better improvement in foot function and pain. IBTA also lessened the need for operative treatment of plantar fasciitis
These statements have not been evaluated by the Food and Drug Administration, United States. This product is not intended to diagnose, treat, cure or prevent any disease. Please consult your GP before the intake.
Writer:
Dr. Rajesh Nair, the co-founder and chief consultant of Ayurvedaforall.Com, is a graduate of prestigious Vaidyaratnam Ayurveda College (affiliated with the University of Calicut), Kerala, India. Additionally, he holds a Postgraduate Diploma in Yoga Therapy from Annamalai University.
Dr. Nair offers consultation at two busy clinics in and around Haripad, Alleppey, Kerala, the southern state famous worldwide for authentic ayurvedic treatment and physicians. While offering consultation on all aspects of ayurvedic treatments Dr. Nair has a special interest in Panchkarma, Yoga, and Massage.
Through Ayurvedaforall Dr. Nair offers online consultation to patients worldwide and has served hundreds of patients over the last 20 years. In addition to his Ayurvedic practice, he is the chief editor of ayurveda-amai.org, the online portal of Ayurveda Medical Association of India, and the state committee member of Ayurveda Medical Association of India.
Dr. Nair is a regular speaker at Ayurveda-related conferences and has visited Germany to propagate Ayurveda. You can write directly to him-
rajesh@ayurvedaforall.com
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