Plantar fasciitis (PF) is one of the most common lesion that presents as heal and ankle pain. Nearly 15 % of these patients require a professional care. The intensity of the pain aggravates with weight bearing activities, obesity and increased activity.
Anatomy:
The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus, runs forward to inset into the deep, short transverse ligaments of the metatarsal heads, dividing into 5 digital bands at the metatarsophalangeal joint. The fascia is made of 3 parts, which are medial, central and lateral bands. Among them the central fascia is the thickest and strongest part, this is the most common part that involved in recurrent injury and leads to plantar fasciitis. The diagnosis is mainly based on the patient’s history and clinical examination, further investigation is rarely needed.
Pathophysiology:
Intrinsic factors such as increased BMI and age, reduced ankle dorsiflexion, seronegative arthritis and spondyloarthropathies and pes planus (Flat foot) and pes cavus incresesd curvature of the foot.
Extrinsic factors
Increases high intensity training activities, training errors, inappropriate running techniques, prolonged walking on hard surfaces, inappropriate shoes, increased weight bearing activities
Traumatic factors
Sudden forcible load and plantar fascia and repetitive injury.
PF is considered as a degenerative tissue condition and inflammation of fascia at the tuberosity of the calcaneus. Small tears of the fascia and surrounding tissue are replaced by angiofibroblastic hyperplastic tissue. The lesion sites do not show inflammatory cell invasion with scar tissue and fibrosis are one of the main histological features of PF.
Treatment:
The predominant treatment is NASIDS, resting and cold compression treatment, seeing podiatrists to find the right shoes and techniques, doing physiotherapy treatments will strengthen the movements and strengthen the local area and prevent further injury, Finally the use of steroidal injections at the site.
Use of injectable platelet rich plasma (PRP) in the chronic cases of PF, it is a biological treatment that initiated and promotes natural healing and allows for direct repair of the damaged tissue without the associated risks of surgery. It can be rich in transforming growth factor; vascular endothelial growth factor and platelet-derived growth factor. The PRP has some anti-inflammatory and pro-inflammatory cytokines and interleukins such as IL4, IL 8 and IL 13 and Interferon –alpha and tumor necrosis factor.
The combination of these growth factors and anti-inflammatory components is necessary to initiate the healing stage and to reverse the degenerative process at the base of the plantar fascia.
Conclusion:
PF is a common and degenerative condition that has significant burden on the day-to-day life; require often a multi- disciplinary approach to get better. That may often include using NSAID’s and Steroidal injections and using of PRP injections are still under the evaluation. There is a need for further research is warranted.
Ayurvedic Treatment Approach:
The heal pain and heal spur is considered as vatakandaka, this condtion results due to Kapha and vata vitiation. According to Ayurveda classical texts this condition is treatable, the aggravation of vata and kapah leads to the persistent inflammation and pain. By avoiding the vata aggravating activities such as long standing habits, excess exercise, bare foot walking, lack of proper sleep, mental stress etc., use of very gentle activity and using warm oil self massages may help prevent the further damage.
Some of the Ayurvedic Treatments may be helpful:
- Abhyangam: Regular massage with oils that are indicated
- Dry poultice massage with valuka or ishtika swedam
- Internal medicines such as anti-inflammatory herbs
- Panchakarma / Detox to prevent further degenerative changes
- Specific Detox treatments such as Virechana karma ( Purgations) and Matra vasti (Oil enema) to prevent further aggravation of VATA.
Some useful Ayurvedic tips:
- Hot water fomentation with salt
- Dry sand or brick poultice application
- Black sesame oil massage
- Using – fried moringa leaves in castor oil made it like a small poultice bag and apply every day for 15minute will be able to help prevent the pain and inflammation.
- Using the preparations like AYUNA – JOINT-S will helps to reduce the pain.
If the symptoms persists, please contact your healthcare provider, or make a booking with our experienced practitioners at Jeeva health Melbourne and Canberra to see how Ayurvedic medicine can be able to help your condition can get better.
