E-ISSN:2456-3110

Case Report

Plantar Fasciitis

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 9 SEPTEMBER
Publisherwww.maharshicharaka.in

Ayurvedic Intervention for Vatakantak with special reference to Plantar Fasciitis: A Case Study

Shah HM1*, Karve M2
DOI:10.21760/jaims.9.9.52

1* Hemal M Shah, Post Graduate Scholar, Department of Ayurved Samhita and Siddhant, YMT Ayurvedic College Kharghar, Navi Mumbai, Maharashtra, India.

2 Mandar Karve, Associate Professor, Department of Ayurved Samhita and Siddhant, YMT Ayurvedic College Kharghar, Navi Mumbai, Maharashtra, India.

Pain is a significant symptom that disrupts our daily activities and diminishes our quality of life. Heel pain is a particular type of discomfort that can hinder walking, thereby interfering with everyday routines. Among the various causes of heel pain in adults, plantar fasciitis is the most prevalent.[1] It is estimated that 1 in 10 people will develop Plantar Fasciitis during their life time.[2] As per Ayurveda it is mentioned by Acharya Sushruta[4] in the context of Vatavyadhi as a condition of heel due to improper placement of foot on the ground or by walking often correlated to a calcaneal spur which is a calcium deposit causing a bony protrusion on bone often frequently associated with plantar fasciitis, a painful inflammation of tissue. It is a common condition that affects normal routine work. Agnikarma, Snehna, Swedan, & Raktamokshana is the treatment choice of Vatakantaka. A 55-year-old female patient presented with primary complaints of pain in the left heel and sole of the foot which had persisted for one month. The pain intensified during the initial steps taken after rising from bed. The patient underwent Agnikarma treatment, consisting of five sessions at 5-days intervals, at the affected site, along with a regimen of Sinhanaad Guggulu at a dosage of 500 mg thrice daily for 30 days, and Mahavatavidhwansa Rasa 250 mg twice daily for 30 days. The patient’s condition was completely resolved without any recurrence. It is evident that plantar fasciitis can be effectively treated without recurrence through Ayurvedic interventions such as Agnikarma combined with Mruttika Shalaka.

Keywords: Vatakantaka, Plantar Fasciitis, calcaneal spurs

Corresponding Author How to Cite this Article To Browse
Hemal M Shah, Post Graduate Scholar, Department of Ayurved Samhita and Siddhant, YMT Ayurvedic College Kharghar, Navi Mumbai, Maharashtra, India.
Email: 		Shah HM, Karve M, Ayurvedic Intervention for Vatakantak with special reference to Plantar Fasciitis: A Case Study. J Ayu Int Med Sci. 2024;9(9):321-325.
Available From
https://jaims.in/jaims/article/view/3838

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-08-14 2024-08-24 2024-09-04 2024-09-14 2024-09-26
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.35

© 2024by Shah HM, Karve Mand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Hemal M Shah et al. Ayurvedic Intervention for Vatakantak w.s.r. to Plantar Fasciitis

Introduction

Vatakantaka is fundamentally a condition characterized by the disturbance of Vata Doshas, classified under the category of Vatavyadhi. In its normal state, Vayu maintains a balance among the various Doshas and the fundamental elements of the body (Dhatu). It also plays a crucial role in sustaining a consistent metabolic state (Agni) and assists the sensory organs in performing their designated functions.

Acharya Sushruta has documented this ailment in the Nidansthana (Su.Ni. 1)[4] within the Vatavyadhinidanadhyaya. The local Vayu, provoked by an improper step on uneven terrain, becomes lodged in the ankle region (referred to as Khudaka, or instep by some), leading to the condition known as Vatakantaka.

Additionally, Acharya Charaka has referenced this disease in the Chikitsasthana (Cha.Chi.28)[5] within the Vatavyadhi Chikitsa Adhyaya, while Acharya Vagbhata has also mentioned it in Vagbhatnidandhyaya (Vg. Ni. 15/53).[6]

Plantar fasciitis[7] is a prevalent source of foot pain among adults, particularly affecting those aged between 40 and 60 years. The pain typically arises at or near the attachment point of the plantar fascia to the medial tuberosity of the calcaneus. Various factors that heighten the risk of developing plantar fasciitis include obesity, pes planus (flat feet or lack of an arch when standing), pes cavus (high-arched feet), restricted ankle dorsiflexion, prolonged standing, walking on hard surfaces, and inappropriate footwear.

In runners, excessive running and transitioning to harder running surfaces may trigger the onset of plantar fasciitis. The clinical manifestations of Vatakantaka can be linked to the symptoms associated with calcaneal spur, particularly when Kaphavruta Vayu[8] is involved. Vatakantaka primarily arises from the aggravation of Vata Dosha due to frequent walking on uneven surfaces[9] and improper foot placement. As indicated by Acharya Sushruta, chronic plantar fasciitis can be correlated with Vatakantaka, which is characterized as Snayu Asthi Sandhi Aashrita.[10] Plantar Fasciitis is a chronic inflammation of plantar fascia and degeneration of fibrous tissue.

Case Report

A case report details a 55-years-old female patient who presented with primary complaints of pain in the left heel and sole of the foot for the past month. She reported that the pain was particularly intense during the initial steps taken after rising from bed and after sitting for long.

History of Present Illness: The patient was in good health until one month ago, when she began experiencing pain and stiffness in the left heel. She sought medical attention from a general practitioner, who prescribed non-steroidal anti-inflammatory drugs (NSAIDs). Although she adhered to this treatment for one week, she only experienced temporary relief, and her symptoms progressively worsened, ultimately interfering with her daily activities. Hence came for further evaluation.

Past history

No history of Hypertension, Diabetes Mellitus, Hypothyroidism. No any history of surgical or chronic illness.

Personal history

Occupation: Housewife
Family history: Calcaneal spur in mother
Addiction: Non-alcoholic, non-smoker

General examination

General condition of patient was good and afebrile.

Pulse: 80/min
Blood pressure: 120/80 mmHg
Respiratory rate: 18/ min
Pallor: Absent

Systemic examination

CVS: S1 S2 normal
CNS: Well oriented, conscious
RS: AEBE clear
P/A: Soft, non-tender

Asthavidh Pariksha

Nadi (Pulse): Vaat Pradhan
Mala (Stool): Constipation
Mutra (Urine): Prakrut
Jivha: Saama
Shabda: Prakrut
Sparsh: Ushna,


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Hemal M Shah et al. Ayurvedic Intervention for Vatakantak w.s.r. to Plantar Fasciitis

Druk: Prakrut
Akriti: Madhyam
Weighed 60 kg with 5’ 04” height

Therapeutic Intervention

1. Agnikararma

Materials

  • Mruttika Shalaka
  • Ghrut

Procedure

  • Points of maximum tenderness on the left heel were marked.
  • The Mruttika Shalaka was heated until it reached a hot temperature.
  • Agnikarma was performed on the marked points utilizing the Mruttika Shalaka.
  • Ghrut was subsequently applied.
  • The same procedure was repeated for a total of five sessions, with intervals of five days between each.

2. Internal Medications

  • Mahavatavidhwansa Rasa was prescribed for a duration of 30 days, at a dosage of 250mg twice daily.
  • Sinhanaad Guggul 500 mg thrice daily for 30 days

3. Patient was advised to use soft padded slippers.

Assessment Criteria

SNGrades0123
Signs and Symptoms
1.PainNo painMild
(Not disturbing
daily routine
activity and pain
only during
morning hours)		Moderate
(Continuous pain in the morning hours and walking after
Rest)		(Pain throughout
the day and
disturbing daily
routine)
2.TendernessNo tendernessPain in deep pressurePain on slight pressurePain on touch
3.SwellingNo swellingMild swellingMild swellingMild swelling
4.Burning sensationNo burning sensationMild burning sensationMild burning sensationMild burning sensation
5.RednessNo rednessMild rednessMild rednessMild redness

Observations and Results

Following an initial treatment period of 30 days, the patient was evaluated for an additional 15 days. The patient experienced complete relief from symptoms.


SNSigns and symptomsBefore treatmentAfter treatment
1.Pain30
2.Tenderness30
3.Swelling10
4.Burning sensation00
5.Redness10

jaims_3838_01.JPG

Discussion

Vatakantak can be associated with Plantar Fasciitis. In Vatakantak, there is an imbalance in the Vata Dosha. Therefore, Agnikarma is a significant treatment option for this condition. In modern medical practice, the management of Plantar Fasciitis typically involves the prescription of nonsteroidal anti-inflammatory drugs (NSAIDs), the administration of corticosteroid injections, and the use of iontophoresis. However, the long-term results of these treatment methods have proven to be unsatisfactory.

Discussion on Agnikarma

Agnikarma is recognized as one of the most effective treatments for pain[12] associated with conditions affecting the bones (Asthi), tendons (Snayu), and joints (Sandhi). This method is noted for its ability to provide lasting relief without recurrence[13] of symptoms. The hot property (Ushna) of Agnikarma counteracts the cold property (Sheeta) of Vata Dosha, thereby alleviating pain and stiffness. Additionally, Agnikarma enhances local blood circulation, leading to the softening of tissues and relaxation of muscles through the application of heat, which further reduces stiffness.


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The therapeutic heat also activates the lateral spinothalamic tract, stimulating descending pain inhibitory pathways and promoting the release of endogenous opioid peptides that inhibit pain transmission.[14]

Discussion on Mahavaatvidhwans Ras

Mahavatavidhwansa Rasa[15] is beneficial for enhancing the strength of bones and joints. It possesses remarkable anti-inflammatory and analgesic properties. According to Ayurvedic principles, pain is believed to be associated with Vata. Mahavatavidhwansa Rasa acts as a Vatashamak, primarily soothing Vata and alleviating pain. Its primary function is to restore Vata-Samya by addressing Vatadushti, leading to rapid pain relief.

Discussion on Sinhanaad Guggul

The properties of Simhanad Guggulu,[11] characterized by its Ushna quality, contribute to the alleviation of Vata-related disorders and address obstructive pathophysiology (Srotorodhjanya Samprapti) by removing blockages, thereby alleviating both pain and stiffness. Ingredients such as castor oil and Guggulu exhibit Vatashamak effects. The components of Triphala, namely Haritaki, Bibhitaki, and Amalaki, possess Rasayana properties, which facilitate rejuvenation at both systemic and tissue levels. Additionally, the use of soft padded footwear helps to prevent further microtrauma to the tissues.

Conclusion

From above discussion we can conclude Agnikarma and Abhyantar Vaatshaman Chikitsa is effective in the management of Vaatkantak (Plantar fascitis).

References

1. Nitin Ajitkumar Menon, Jitendra Jain Plantar Fasciitis: A review Indian Journal of Pain., 2018;32(1): 24-29.
2. Mohammad Ali Tahririan, Mehdi Motififard, Mohammad Naghi Tahmasebi, and Babak Siavashi Plantar Fasciitis, Journal of Research in Medical Sciences, Aug, 2012; 17(8): 799–804. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687890/

3. Agnivesha, charaka samhita with Ayurveda dipika Commentary, edited by vaidya yadavji trikamji Acharya, Varanasi, Chaukhambha Sanskrit Sansthan, Chikitsa sthana, 28.
4. An English translation of the Sushruta Samhita Vol. 2: edited by Kaviraj Kunjalal Bhishagratna, The Author Publication nidana sthan, 1 / 64, 1911, pp15.
5. Agnivesha,charaka samhita with ayurveda dipika commentary,edited by vaidya yadavji trikamji Acharya, Varanasi, chaukambha sanakrit sansthan, chikitsa sthana, 28
6. Vagbhata, Ashtanga hridaya with Sarvanga sundara & ayurveda rasayana commentary, edited by Pdt.Harisadashiva shastri paradakara,Varanasi, chaukamba Sanskrit samsthana, , nidana sthana 15/53 pp 535.
7. Harrison’s principles of internal medicine, volume 2, 18th edition chapter 337, pp 2862. Harrison’s Principles of Internal medicine, Volume 2, 18th edition chapter 337, pp 2863.
8. Kuchanur S, Santosh YM (2014) Innovative Practice of Agnikarma in Vatakantaka. Journal of Ayurveda 8(4).
9. Maragalawaththa SK, Goyal M, Chandimarathne PB (2017) Efficacy of Sri Lankan Traditional Paste on Vatakantaka with special reference to Calcaneal spurs-A Case Report. International Journal of AYUSH Case Reports 1(2): 20-24.
10. Shekokar AV, Borkar KM (2013) Role of Agnikarma in the management of chronic plantar fasciitis. International Journal of Ayurvedic Medicine 4(4): 421-425.
11. Govinda Bhaishajya Ratnavali, Chapter 29, Verse 191-194,  15th  Edition,  Varanasi:  Chaukhambha  Sanskrit Samsthana; 2002, p.1286.
12. Acharya Yadavji Trikamji, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana, Reprint edition Ch.25. Ver.40, Varanasi: Chaukhambha Prakashan; 2009. P.132.
13. Shashtri A, editor. Sushruta Samhita of Sushruta, Sutra Sthana. Reprint Edition. Ch.12. Ver.3. Varanasi: Chaukhambha Surbharti Prakashan;2001. P.38.
14. Sherkhane Rahul Nagnath. Critical Appraisal of Agnikarama and its therapeutic Aspects. Int. Res. J. Pharm. 2013, 4(5): p.75-77.
15. Indradev Tripathi, Yogaratnakara of Vaidya Laxmipati sastri,1st1, Chaukhamba Krishnadas Academy Varanasi;1998. P. 436-437.


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