Introduction

Introduction:

Calcaneal spur is the growth of calcium around the ligaments and tendons of the foot, growth will be from the bone into the flesh of the foot. This mainly occur due to the anatomical changes of heel bone. Mainly this will be localized, main cause for the origin is stress at the heel bone calcifying the soft tissue attachments. Ayurveda describes this condition as vatakantaka ,condition resulting due to kapha vata vitiation, Ayurveda clearly mention this condition as treatable. In Ayurveda this condition occur due to the excessive kapha vitiation resulting in the enlargement of bone and this enlargement or obstruction in the path of vatadosha which mainly controls the sensory and motor activities resulting in severe pain along with some burning sensation on some cases. In Ayurveda Calcaneal spur can be correlated with vatakantaka, which is common vatavyadhi. In which vata is vitiated due to excessive walking or walking in irregular surface, excessive pressure exerted over ankle region and vata accumulated in ankle region causing heel pain.[1] The main symptoms which is present is pain around the spur region. Patient may complain heel pain more severe after awakening in morning and after excessive walking. On the side of heel pain, bearing weight not so comfortable. This condition may be aggravated by walking, running and lifting heavy weights.[2] Agnikarma has been described as the most effective therapy in the management of all painful conditions especially for musculo-skeletal disorders. Viddha karma is one of the eight Shashtrakarma mentioned by Acharya Sushruta.[3] wherein in a sterile procedure hollow needle are pierced at specific points on the body for pain relief by releasing endorphins. The Experimental amalgamation of these two procedures has provided rapid relief in the pain caused due to calcaneal spur in this study. Agnikarma is done by different methods like Bindu, Vilekha, Pratisaran and Valay[4] and different materials like Pipali, Aja Shakrut, Madhu, Tail, Panchadhatu shalaka, Suvrna shalaka, Loha shalaka  So, in the patient of Calcaneal spur we decided to do agnikarma with Panchdhatu shalaka by bindu with oral medicine [5,6]

Aim:

To assess the efficacy of Viddh agni Karma in Pain Management in Calcaneal spur.

Objective:

-To study available literature and latest research done in viddh-agni karma.

-To analyse the mechanism of action of viddh-agni karma in pain relief of Calcaneal spur.

Methodology:

History of Present illness

A 72 years male having complaints of pain in left heel region, difficulty in walking and tenderness over B/L heel region for six months without having any major illness condition visited to Kayachikitsa OPD of our Hospital. The patient developed pain in B/L  heel after awakening in morning and pain aggravated after standing long time and after excessive walking. He had taken analgesics drug for 3 months from private hospital for this problem, but was not completely relieved. So, he came to our hospital for further treatment.

2.History of Past illness: NAD .

3. Family History: Not Significant

4 Chief complaints and its duration:  heel pain, difficulty in walking and tenderness over left heel for 3months.

5 .General Examination of Patient:

BP - 130/80 mm of Hg,

 P - 86/min,

Sleep – Normal,

Bowel and Bladder Habit – Normal.

6.Systemic Examination

¨ CVS - S1 S2 normal

¨ CNS - conscious and oriented

¨ RS – AEBE, clear

¨ P/A - Soft, not tender, no organomegaly

 ¨ X-ray of left foot: Calcaneal spur extended

7. TREATMENT

The diagnosis was confirmed as Calcaneal spur on the basis of sign and symptoms and x-ray finding of B/L heel. Patient treated with agnikarma with Panchdhatu shalaka by bindu method without giving  oral medication. Five sitting of agnikarma given to the patient continue for year on the maximum tender point at left heel. Viddha karma procedure was performed with  needle No. 26 twice in a week for 5 week .

Shaman Aushadi:

8.CRITERIA FOR ASSESSMENT

Visual Analog Scale was used to get an assessment of pain relief after each sitting.

VISUAL ANALOG SCALE

are rated as 0------1----- 2------ 3------ 4----- 5------ 6------- 7------ 8------- 9------ 10

  - No pain, 1-3: Mild pain, 4-7: Moderate pain, 8-10: Severe pain

Table 1 : Pain Gradation

Table 2: Sign And syptoms gradation before and after  Agnikarma and Viddha

Womac Score 54 to 30

Result:

VAS score was 8 to 4 and  WOMAC score 54 to 30.Viddh-agni karma blocks pain by activating a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms.[7] According to Ayurveda, vatakantaka produced due to vitiation of vata with anubandha of kapha dosha which responsible for shool (pain), stambha (stiffness) and shotha (inflammation) in the heel. Acharya Charaka described agni is best management for decrease

Assessment was done before and after treatment by relief of the Pain, Tenderness over heel region and Walking capacity. Table 1 shows Pain Gradation.

Table 2 shows sign and symptoms gradation before and after agnikarma.

After first sitting of agnikarma heel pain relieved partially and complete reduction in heel pain after fifth sitting and similarly gradual decrease in the symptoms of tenderness and difficulty in walking after fifth sitting

In Agnikarma, Agni is introduced to the affected area by hot shalaka. External/ physical heat is transferred to twak dhatu by hot shalaka producing samyak dagdha vrana. The Ushna, Tikshna, Laghu, Sukshma, Vyavayi, Vikasi and Aashukari properties of Agni helps to remove strotoavarodha, pacifies the vitiated vatakapha dosha and break the pathogenesis and reduces pain and inflammation[6].

¨ After Agnikarma, the Ushna guna of Agni pacifies the Shita guna of vayu and reduces pain. It reduces Kaphanubandha thereby relieving the inflammation and also causes pachan of ama. [8]

 ¨ The Agni increase blood circulation at the heel region, leading to the proper nutrition of the tissue. This increase circulation helps to flush out toxins material from blood and reduce pain and local inflammation.[9]

¨ Therapeutic heat stimulates the lateral Spinothalamic tract, leading to stimulation of descending pain inhibitory fibres, causing release of endogenous opioid peptide, which blocks the transmission of pains pathway, the temperature at the applied site is increased which reduces nerve reflexes resulting in relaxation of muscle thereby causing reduction of stiffness.

Discussion

When patient came to OPD, patient was suffering from the disease almost for 6 months. Pain at bilateral heel region & Difficulty in walking. After the Agnikarma therapy of one month no pain at B/L heel  & patient walk without difficulty. There is no other complains. In this study conventional Agnikarma therapy has done with the help of panchlohdathu shalaka. Calcaneal spur is Asthisnayugata ashrita vyadhi and sushruta indicated Agnikarma in this disease. The cardinal symptom of Calcaneal spur is pain at heel. According Ayurveda, basic humor responsible for pain is Vata. Vata Dosha is predominantly having sheeta guna which is exactly opposite to Ushna Guna of Agni. So Agni is capable of producing relief of pain by virtu of its ushna guna. In Agnikarma the temperature at the applied site is increased which reduces nerve reflexes resulting in relaxation of muscle. The use of local heat (thermotherapy) may provide relief of pain and painful muscle spasm by acceleration of metabolic processes whereby the concentration of pain including toxic metabolites is reduced. This is accomplished by increase in local circulation. Viddhagni karma blocks pain by activating a variety of bioactive chemicals through peripheral, spinal, and supraspinal mechanisms. These include opioids, which desensitize peripheral nociceptors and reduce pro-inflammatory cytokines peripherally and in the spinal cord, and serotonin and norepinephrine, which decrease spinal n-methyl-d-aspartate receptor subunit GluN1 phosphorylation to inhibit pain. Shaman aushadi like ashwagandha Kshirpaka,Kaishor guggul play important role in pain Management.

Conclusion

On the basis of the clinical observation and discussion, it may be concluded that there is significant result of Viddh-agni karma in the treatment of Calcaneal spur and gives relief in pain and other symptoms of this condition. On the basis of this study it can be concluded that the trial treatment therapy i.e. Viddh-agni Karma can be used as a way of treatment in the pain management of patients of Calcaneal spur who are trying to get treated by modern ways without effect. There was no adverse treatment reaction seen during the period of trial and it is a safe, convenient and effective measure for the treatment of patients suffering from Calcaneal spur that can be performed by health professionals on OPD basis