ANATOMICAL IDENTIFICATION OF THE IDEAL AGNI-KARMA SITE IN CHRONIC PLANTAR FASCIITIS

Abstract

Background Chronic plantar fasciitis is a common cause of plantar heel pain, usually associated with repetitive mechanical loading and degenerative changes near the proximal attachment of the plantar fascia. In Ayurveda, its clinical presentation may be correlated with Vatakantaka, a painful disorder of the heel produced by aggravated Vata Dosha, particularly after improper placement of the foot or walking over irregular surfaces. Agni-Karma is described as an important para-surgical procedure for painful disorders involving Twak, Mamsa, Sira, Snayu, Sandhi and Asthi.

Aim To anatomically identify the ideal site for Agni-Karma in patients with chronic plantar fasciitis.

Objectives To review the classical concept of Vatakantaka and its management through Agni-Karma. To study the anatomy and biomechanics of the plantar fascia. To identify the principal pathological and tender region in chronic plantar fasciitis. To correlate the site of Vatakantaka pain with the proximal attachment of the plantar fascia.

Materials and Methods A structured narrative review of classical Ayurvedic texts, anatomical literature, clinical guidelines and published studies related to Vatakantaka, Agni-Karma and plantar fasciitis was undertaken. The origin, course and insertion of the plantar fascia and the position of nearby nerves, vessels, fat pad and muscles were analysed. The probable therapeutic site was determined through anatomical-pathological correlation and clinical tenderness mapping.

Discussion and Conclusion The ideal Agni-Karma site in chronic plantar fasciitis is the clinically tender proximal plantar fascial region immediately distal to its attachment at the medial calcaneal tubercle. Accurate palpation, anatomical localisation and appropriate thermal depth are necessary to maximise clinical benefit and minimise complications.