Cause Of Heel Pain Research Articles

A Clinical Study to Evaluate the Effectiveness of Kokilakshadhi Kwatha in the Management of Vatakantaka (Plantar Fasciitis)

Pain is a symptom which alters our day to day activities, affecting the quality of life. One among such pain is, pain in the heel, which causes difficulty in walking and in turn disturbs daily routines. Plantar fasciitis is most common cause of heel pain in adults. It is estimated that 1 in 10 people may experience inferior heel pain during their life time. Signs and symptoms of Vatakantaka resembles with Plantar fasciitis according to modern paralines.
 Treatment Modalities according to modern science is NSAIDS, toe stretching, corticosteroid injections, extracorporeal shock wave therapy and surgical correction are the indicated treatments. Analgesics have been used in practice by modern practitioners to give immediate relief to patients from pain. And modern medicine has a huge number of the drug for pain management but they impact body with serious side effects. Therefore there is a large scope of finding a treatment for Vatakantaka So in this study Kokilakshadi Kwatha explained in Yogaratnakara is considered. The study is divided into four sections as Disease review, Drug review, Pharmaceutical study and clinical study.
 Methods: The outcome of Kokilakshadi kwatha is evaluated clinically on minimum of 30 patients. Kokilakshadi kwatha was given for 21 days. The lab test and clinical analysis were done as per requirement for the assessment. Evaluation of parameters of the disease like Pain and Tenderness were done before treatment, after 11 days and after 21days.
 Results: As a result, Out of 30 patients, highly significant results (p<0.001) were obtained with respect to pain (93.3%) and tenderness (60%).
 Conclusion: Kokilakshadi Kwatha showed good results in reduction of signs and symptoms of Vatakantaka. The statistical analysis also supported this by concluding that the improvement after treatment is highly significant.

A randomized clinical trial comparing hip abductors strengthening and manual therapy in patients with plantar fasciitis: a study protocol

BACKGROUND: Plantar fasciitis (PF) is a common cause of heel pain and deformity of the ankle joint. More than 11%-15% of the population with foot symptoms need long-term care. Various physical therapy intervention with conventional therapy, including manual therapy, has been proven to help this condition. OBJECTIVE: To evaluate the effect of Hip abductor strengthening and Manual therapy (MT) in a patient with Plantar Fasciitis (PF). METHODS: The design of the study will be A Two Group Pretest-Posttest randomized control trial. A total of 30 male and female participants aging above 18-60 years experiencing pain provoked by taking the first few steps in the morning, pain in the plantar heel region, will be allocated randomly into two groups- Group A will receive Manual therapy (MT) with conventional physiotherapy while Group B will receive hip abductors strengthening with conventional physiotherapy. Both groups will receive 16 sessions of treatment for 4 days each week for 4 weeks. “Foot function index,” “Podia scan,” “Navicular drop test” will be used as outcome measures and will be evaluated at the first week and fourth week of treatment in both the groups. CONCLUSION: The patients who receive Hip Abductor Strengthening intervention may have positive results compared to the MT intervention among patients with PF. That will be the first study to compare the effect of hip abductors strengthening and manual therapy.

Comparison of laser versus ultrasound therapy in management of chronic plantar fasciitis

The most common cause of heel pain is “plantar fasciitis” which is accountable for 80% of the cases. There are limitations in its treatment availability. The non-surgical treatments although have shown promising response and satisfactory outcomes. Such two treatments viz. laser and ultrasound therapy were studied and compared in plantar fasciitis patients. In the present study 100 plantar fasciitis patients recruited and divided into two groups with 50 patients each, one group was treated with laser therapy and the other with ultrasound therapy. The outcomes were reported in the form of Visual Analog Scale (VAS) and Foot Function Index (FFI) scores. There was a promising improvement noted in VAS score and FFI score when compared within the groups. The comparison of these scores between the groups revealed laser therapy to be more effective in reducing the symptoms than the ultrasound therapy, as the VAS and FFI scores were significantly improved in laser therapy group compared to ultrasound therapy. So here we conclude the laser therapy is more effective in relieving from the symptoms of plantar fasciitis as compared to ultrasound therapy.

Comparison of laser versus ultrasound therapy in management of chronic plantar fasciitis

The most common cause of heel pain is “plantar fasciitis” which is accountable for 80% of the cases. There are limitations in its treatment availability. The non-surgical treatments although have shown promising response and satisfactory outcomes. Such two treatments viz. laser and ultrasound therapy were studied and compared in plantar fasciitis patients. In the present study 100 plantar fasciitis patients recruited and divided into two groups with 50 patients each, one group was treated with laser therapy and the other with ultrasound therapy. The outcomes were reported in the form of Visual Analog Scale (VAS) and Foot Function Index (FFI) scores. There was a promising improvement noted in VAS score and FFI score when compared within the groups. The comparison of these scores between the groups revealed laser therapy to be more effective in reducing the symptoms than the ultrasound therapy, as the VAS and FFI scores were significantly improved in laser therapy group compared to ultrasound therapy. So here we conclude the laser therapy is more effective in relieving from the symptoms of plantar fasciitis as compared to ultrasound therapy.

Comparison of laser versus ultrasound therapy in management of chronic plantar fasciitis

The most common cause of heel pain is “plantar fasciitis” which is accountable for 80% of the cases. There are limitations in its treatment availability. The non-surgical treatments although have shown promising response and satisfactory outcomes. Such two treatments viz. laser and ultrasound therapy were studied and compared in plantar fasciitis patients. In the present study 100 plantar fasciitis patients recruited and divided into two groups with 50 patients each, one group was treated with laser therapy and the other with ultrasound therapy. The outcomes were reported in the form of Visual Analog Scale (VAS) and Foot Function Index (FFI) scores. There was a promising improvement noted in VAS score and FFI score when compared within the groups. The comparison of these scores between the groups revealed laser therapy to be more effective in reducing the symptoms than the ultrasound therapy, as the VAS and FFI scores were significantly improved in laser therapy group compared to ultrasound therapy. So here we conclude the laser therapy is more effective in relieving from the symptoms of plantar fasciitis as compared to ultrasound therapy.

Prevalence of Plantar Fasciitis Among Nurses at A Tertiary Care Centre in A Rural Area: A Cross Sectional Study

Background: The plantar fascia can further encounter a form of pathological degeneration called as plantar fasciitis that is one of the most common causes of heel pain. Plantar fasciitis is a multifactorial in origin and works as a mechanical overloading reaction to multiple instances of microtrauma. Purpose: This research will rule out the prevalence of plantar fasciitis in nurses both male and female with the help of windlass test and also make us aware about the correlation of plantar fasciitis among males and females. Methodology: A simple random sampling of 100 healthy nurses, 70 female nurses and 30 male nurses from Pravara Institute, Loni was included. The participants included were between age group of 20-50 years and were screened according to inclusion and exclusion criteria. Windlass test was performed in all the recruited participants. The test was done both in non-weightbearing (NWB) and weightbearing (WB) position. If pain was reproduced, the subject then marked the location of the pain. If pain was provoked then the test was considered positive. Result: The windlass test (weight bearing and non-weight bearing) showed that out of 100 participants 21% tested positive; out of which 17% females and 4% males responded positive in the study. Conclusion: The study concluded that female nurses are more prone to develop plantar fasciitis when compared with male nurses. KEY WORDS: Plantar fascia, Plantar fasciitis, Plantar fascia thickness, Pain, Nurses, Windlass test.

Manual Therapy Informed by the Fascial Distortion Model for Plantar Heel Pain: Results of a Single-Arm Prospective Effectiveness Study.

Objectives: Plantar heel pain (PHP) is the most common cause of heel pain and can be debilitating; 20% of patients are refractory to standard of care. The Fascial Distortion Model (FDM), a novel manual diagnostic and treatment strategy, is purported to be effective for chronic pain; however, no rigorous studies document its effectiveness. We assessed the FDM for care of PHP. Design: Single arm prospective effectiveness study. Settings/Location: Outpatient primary care clinic; Fort Gordon, GA. Subjects: Outpatient adults. Interventions: Participants received an FDM-informed diagnostic and treatment strategy to identify fascial "distortions" at the foot based on patient-reported pain patterns and palpatory examination and then to provide distortion-specific manual therapy at baseline and 1 week. Outcome Measures: Primary outcome measure (0, 1, and 16 weeks): the Foot Pain subscale on the validated Foot Health Status Questionnaire (FHSQ; 0-100 points on each of eight separate subscales); secondary outcome measures (0, 1, and 16 weeks): the seven remaining subscales on the FHSQ, visual analog pain scale (VAS, 0-100 points), and plantar fascia thickness of the most effected foot assessed by ultrasound (0 and 16 weeks). Analysis was performed per protocol using repeated-measures analysis of variance. Results: One hundred and ninety-seven participants were screened; 33 were enrolled. Twenty-eight participants received two FDM procedures. Compared with baseline, improvement on the FHSQ Foot Pain (33.8-23.6 points) and Foot Function (23.9-19.8 points) subscales and VAS (44.7-27.7 points) at 16 weeks was statistically significant (all p's < 0.001) and clinically important representing large effect sizes. Relative to baseline, 16-week ultrasound demonstrated reduced average plantar fascia thickness (0.6-0.9 mm [p = 0.001]). Demographic characteristics were unrelated to response. Satisfaction was high. There were no serious adverse events; side effects included consistent mild-to-moderate self-limited pain. Conclusions: Participants with PHP who received FDM-informed care reported significant and sustained improvement on validated foot pain and foot function measures; additional findings included decreased plantar fascial thickness. These results require corroboration in a larger randomized controlled study. Clinical Trial Registration No: DDEAMC17005.

Heel fat pad syndrome beyond acute plantar fascitis

Heel pain is a frequent cause of pain and disability in adult active population. In patients with this clinical presentation, several causes must be ruled out, among them plantar fasciitis the most common. Other etiologies of plantar heel pain are the entrapment of muscular branch of the lateral plantar nerve (Baxter nerve) or fat pad atrophy, being the last one the second cause of heel pain after plantar fasciitis.A case series of patients with pathological findings of the heel fat pad area using MRI and US to provide a differential diagnosis of heel pain.Observational case series study. Nine patients visited presented with pain in the plantar aspect of the heel.The plantar aspect of the heel was evaluated in detail with US and MRI. Main inclusion criteria were to present acute or chronic pain on the plantar aspect.In five cases the right heel was affected, in three cases the left heel. One case presented bilateral complaints. All patients presented mechanical pain. Specifically, four of them also described a constant clunk during footstep. Heel fat pad lesion was confirmed with MRI and US in the medial aspect, observed in five patients. In four patients, the heel fat pad was globally affected respectively.This case series tries to put some light on other heel conflicts beside plantar fasciitis that should be ruled out, being one of those, heel fat pad atrophy. Our presentation highlight the role that bed side ultrasound can play in the definition of a specific pattern confirmed with MRI after the US.

Local Percutaneous Radiofrequency for Chronic Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain. It accounts for 80% of the cases and has an estimated prevalence rate of up to 7% in the general population, with bilateral involvement in 20% to 30% of those patients. This condition affects people of working age, thereby limiting and diminishing their quality of life. There are a wide range of treatment options for the management of plantar fasciitis that include both conservative and surgical treatments. Although surgical treatment based on partial or total plantar fascia release has success rates of some 70% to 90%, it is not free of complications. These complications, soft-tissue healing problems, superficial infection, or longitudinal arch collapse in cases of a greater than 40% release of the fascia. Bipolar radiofrequency appears to be a safe procedure for refractory plantar fasciitis that can provide outcomes equivalent to open plantar fascia release with less morbidity. The purpose of this article is to describe the local percutaneous radiofrequency technique for patients with chronic, recalcitrant plantar fasciitis.

Controversies in Surgical Treatment of Recalcitrant Plantar Fasciitis

Plantar fasciitis is a common cause of heel pain that is seen by both orthopedic surgeons and primary care providers. It is a condition that was previously thought to be because of inflammation of the plantar fascia but has more recently been linked an equinus contracture of the gastrocnemius muscle. The condition can be handled both conservatively and surgically, with the primary management being nonoperative. For operative interventions, the treatment of choice was classically a plantar fasciotomy. Over the past several years, the gastrocnemius recession has become an operative treatment of choice. The gastrocnemius recession has shown better symptom relief with less morbidity. The technique to perform a gastrocnemius recession is described within the chapter, as well as the postoperative management. In the future, the duration of nonoperative management for recalcitrant disease may be reduced. However, more randomized control trials showing positive results of the gastrocnemius recession may allow for shorter nonoperative management period creating a new standard treatment algorithm. Level of Evidence: Diagnostic level I, systematic review of studies.

Is platelet rich plasma superior to corticosteroid injection for recalcitrant plantar fasciitis? Results of a prospective comparative study

Introduction: Plantar Fasciitis is one of the commonest causes of heel pain and can be very challenging for clinicians to treat it successfully in the long run. The results of using autologous platelet-rich plasma(PRP) to treat chronic plantar fasciitis have been very encouraging but there is a dearth of literature comparing its effectiveness with steroid injection in long term for the treatment of chronic plantar fasciitis. This prospective comparative study is conducted to compare the efficacy of PRP over corticosteroids. Materials and Methods: We conducted this prospective comparative study between PRP and steroid injection by enrolling patients who failed the conservative line of management for 6 weeks period. We sequentially followed up the patient at discharge from the hospital, 6 weeks, 3 months, 6 months, and one year. The preoperative and postoperative function was assessed with The American Orthopaedic Foot and Ankle SocietyAOFAS) Score including pain, function, alignment components along with the Visual Analog Scale(VAS) score for pain. Inter and Intragroup comparisons were made with student t-test and paired t-test respectively. Results: 50 patients with a mean age of 37.2 years were enrolled in the study. In comparison, the PRP group showed a significant improvement in the AOFAS score at 6 months (p=0.021) and 1 year(p=0.001) compared to the corticosteroid injection. However, the reduction in pain by the VAS score was comparable between the two groups at 6 months (p=0.542) and one year (p=0.224) respectively. Conclusion: While both PRP and corticosteroid injection significantly reduces the pain at 1-year followup, functional improvement is significantly better in the PRP group compared to the steroids. PRP injection therapy remains more effective compared to steroid injection in the management of recalcitrant plantar fasciitis considering the degenerative component of the disease entity. Keywords: Platelet Rich Plasma, Corticosteroid,

Plantar Fasciopathy, General Concepts, Shock Wave Treatment and Other Additional Therapeutic Considerations

Plantar fasciopathy is the most common cause of heel pain. It is a primarily degenerative and mechanical overuse pathology. The plantar fascia fulfills important biomechanical functions in the foot, being its “windlass” mechanism, the most important function in this regard, allowing the foot to act as a single and efficient motor unit during gait. Its clinical and imaging diagnosis is fully defined, being Baxter’s nerve entrapment neuropathy, its most significant differential diagnosis. The elongation exercises constitute the basic treatment, being the extracorporeal shock wave therapy of significant utility, amplified in its effects by the association with the referred therapeutic exercises. Keywords: Plantar fasciitis, shock waves, fasciopathy.

Autologous PRP injection: A safe solution for plantar fasciitis

BackgroundPlantar fasciitis is one of the most common causes of heel pain and in its severe forms it can lead to functional disability also. This study has been taken up to evaluate the role of Platelet Rich Plasma (PRP) in managing chronic severe plantar fasciitis when other techniques have failed. This article also focuses on the pathophysiology, diagnosis, other non-operative treatment modalities and surgical options earlier used for plantar fasciitis. MethodsFor 92 patients of plantar fasciitis, PRP was prepared by double spinning technique, and then immediately injection was given after dorsiflexion of the ankle and injecting from the medial aspect of the foot. It was done as a day care procedure and the patients were examined after 1 week, 4 weeks and 12 weeks after the procedure. ResultsAfter 12 weeks review, more than 60 patients showed great improvement in pain, with their VAS score of pain being below 7. ConclusionThe article suggests good and effective use of PRP in treatment of plantar fasciitis, along with being a simple and safe procedure.

Subluxing fractured plantar fat pad: a case series and description of novel sonographic findings.

Plantar fat pad syndrome has received little attention in the literature. A variety of structural changes of the plantar fat pad have been described in the literature, including atrophy, contusion, and fractured fat pad. This case series presents 4 patients (5 heels) with subluxation of a fractured plantar fat pad on dynamic ultrasound. Patients with subluxing fractured fat pad typically present with heel pain and a "snapping" or "popping" sensation when weight-bearing. Other causes of heel pain were excluded, and all patients in this series had an MRI that initially did not report any findings in the fat pad. Retrospective review of the MRI showed evidence of diffuse low T1 and T2 infiltration. To the authors' knowledge, subluxation of the plantar fat pad and the respective correlation to MRI findings have not been described in the literature. Here we describe the sonographic findings of this novel condition.

Development and Validation of a Novel Scoring System for Severity of Plantar Fasciitis.

ObjectivesPlantar fasciitis (PF) is the most common cause of heel pain. Though PF is self‐limited, it can develop into chronic pain and thus treatment is needed. Early and accurate prognostic assessment of patients with PF is critically important for selecting the optimal treatment pathway. Nevertheless, there is no scoring system to determine the severity of PF and no prognostic model in choosing between conservative or surgical treatment. The study aimed to develop a novel scoring system to evaluate the severity of plantar fasciitis and predict the prognosis of conservative treatment.MethodsData of consecutive patients treated from 2014 to 2018 were retrospectively collected. One hundred and eighty patients were eligible for the study. The demographics and clinical characteristics served as independent variables. The least follow‐up time was 6 months. A minimal reduction of 60% in the visual analog scale (VAS) score from baseline was considered as minimal clinically important difference (MCID). Those factors significantly associated with achieving MCID in univariate analyses were further analyzed by multivariate logistic regression. A novel scoring system was developed using the best available literature and expert‐opinion consensus. Inter‐observer reliability and intra‐observer reproducibility were evaluated. The appropriate cut‐off points for the novel score system were obtained using receiver operating characteristic (ROC) curves.ResultsThe system score = VAS (0–3 point = 1; 3.1–7 point = 3; 7.1–10 point = 5) + duration of symptoms (<6 months = 1; ≥1 6 months = 2) + ability to walk without pain (>1 h = 1; ≤1 h = 4) + heel spur in X‐ray (No = 0; Yes = 2) + high intensity zone (HIZ) in MRI (No = 0; Yes = 2). The total score was divided in four categories of severity: mild (2–4 points), moderate (5–8 points), severe (9–12 points), and critical (13–15 points). Inter‐observer agreement with a value of 0.84 was considered as perfect reliability. Intra‐observer reproducibility with a value of 0.92 was considered as perfect reproducibility. The optimum cut‐off value was 10 points. The sensitivity of predictive factors was 86.37%, 84.21%, 91.22%, 84.12%, and 89.32%, respectively; the specificity was 64.21%, 53.27%, 67.76%, 62.37%, and 79.58%, respectively; the area under curve was 0.75, 0.71, 0.72, 0.87, and 0.77, respectively. The Hosmer–Lemeshow test showed a good fitting of the score system with an overall accuracy of 90.6%.ConclusionsBased on prognostic factors, the present study establishes a novel scoring system which is highly comprehensible, reliable, and reproducible. This score system can be used to identify the severity of plantar fasciitis and predict the prognosis of conservative treatment accurately. The application of this scoring system in clinical settings can significantly improve the decision‐making process.

Comparison of Botulinum Toxin A, Corticosteroid, and Anesthetic Injection for Plantar Fasciitis.

Plantar fasciitis is the most common cause of heel pain, and injection therapies are part of the treatment modalities. This study aimed to compare 2 intralesional injection therapies for plantar fasciitis: corticosteroid and botulinum toxin A, compared with a third control group using a local anesthetic. The clinical evolution, as well as changes in the thickness of the plantar fascia and ankle dorsiflexion, was evaluated. A randomized, controlled, double-blind trial design was used. Patients were divided into 3 groups: group 1, anesthetic only; group 2, corticosteroid; and group 3, botulinum toxin A (BoNT-A). We used an ultrasonographic evaluation to measure the plantar fascia thickness. The results were evaluated using the Maryland Foot Score and a 10-cm visual analog scale. Clinical scores were recorded at the beginning of the study, at 2 weeks, and at 1, 3, and 6 months. We evaluated 78 patients for study eligibility. The 3 intervention groups were homogeneous. All patients showed better clinical outcomes compared with their initial evaluations, without differences between groups at the end of follow-up. The thickness of plantar fascia diminished at the final evaluation, and ankle dorsiflexion was better compared with the initial values without difference between treatment groups. Considering all the evaluated outcomes, no significant differences between treatment groups were observed. The pain relief and functional improvement obtained with the different treatments was maintained during the 6-month follow-up. Level I, therapeutic study.

Comparison of midterm results of Platelet Rich Plasma (PRP) versus Steroid for plantar fasciitis: A randomized control trial of 118 patients

BackgroundPlantar fasciitis, which is a common cause of heel pain, often results in significant morbidity. In cases who are not responsive to initial conservative treatment, invasive procedures, often in the form of local infiltration of steroid are required. These procedures are associated with significant complications. Local Platelet Rich Plasma (PRP) infiltration is an emerging addition to these treatments. However, whether it is more effective in reducing pain and improving function than other treatments (such as steroid injections or whole blood) remains controversial. MethodsSkeletally mature patients with plantar fasciitis who had failed conservative therapy were randomized using envelope method into 2 groups: PRP and Steroid group. The participants were assessed for pain using Visual Analog Scale on the day of presentation, and then after therapy at 2 weeks, 4 weeks, 3 months, and 6 months. They were additionally assessed on final follow-up using AOFAS hind-foot Score. Results118 patients were randomized into 2 groups: 58 patients to the PRP group and 60 to the Steroid group. PRP was associated with greater improvement in VAS score and resulted in superior AOFAS score at 6 months as compared to steroid injection. The authors did not find any local or systemic complications in any of the groups. The result and difference were more pronounced as the time from injection increased and maximal benefit was observed at 6 months follow-up. None of the patients needed a repeat injection at 6 months. ConclusionOur study expands on the previous studies to provide a better evidence for superiority of PRP over local injection of steroid in plantar fasciitis, and the authors conclude that PRP provides better pain relief and function as compared to steroid injection. Level of evidenceLevel 1 Prospective Randomized Control Trial (RCT);

Shear wave elastography for treatment monitoring of plantar fasciitis

Plantar fasciitis is a common cause of heel pain. Monitoring therapy effects is challenging with conventional B-mode ultrasound. Shear wave elastography (SWE) provides important diagnostic information beyond B-mode, with typically lower tissue stiffness in symptomatic plantar fascia. Up to now little is known about SWE features for therapy monitoring in plantar fasciitis. We evaluated the clinical effects of a 3-month physical therapy based treatment and its influence on B-mode and SWE ultrasound findings in patients suffering from plantar fasciitis, correlating ultrasound findings to score-based symptom development. Prospective, IRB-approved clinical study in plantar fasciitis patients undergoing a 3-month physical therapy based treatment. Measurement time points were before (T0), after 1 (T1) and 3 (T2) months of treatment, consisting of clinical orthopedic (FFI, AOFAS-Score) and multimodal radiologic sonographic examinations (B-mode/SWE) using a high-resolution linear 18-MHz probe. A total of 33 patients with 43 symptomatic plantar fascia were included. We found a significant (P<0.001) clinical score improvement (AOFAS +14, FFI-Pain -21, FFI-Function -18) between T0 and T2. Mean initial thickness (T0) of symptomatic plantar fascia was 4.2 (±1.2) mm, compared to 3.2 (±0.7) mm at the asymptomatic contralateral side (P<0.001). No significant thickness changes were seen at T1 (4.2±1.1 mm) and T2 (4.5±1.3 mm), even though clinical scores improved significantly. Mean initial stiffness (T0) of symptomatic plantar fascia was 59.57 (±43.3) kPa, compared to 83.23 (±47.3) kPa at the asymptomatic contralateral side (P<0.001). In contrast to B-mode ultrasound, SWE values increased significantly between T0 (59.6±43.3 kPa), T1 (82.6±47.3 kPa) and T2 (102.5±47.2 kPa) (P<0.001-0.009), with positive correlations for AOFAS/FFI-Pain/Function scores (r=0.285-0.473, P<0.001-0.002). A physical therapy based treatment relieves plantar fasciitis symptoms during a 3-month period. In line with symptom reduction, stiffness (Young's-moduli) of plantar fascia increased significantly, while B-mode ultrasound revealed no measurable changes during the healing process. Shear wave elastography was able to quantify plantar fascia pathologies and their recovery under therapy.

Platelet-Rich Plasma Versus Corticosteroids for the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis

Background: Plantar fasciitis is a common cause of heel pain. Corticosteroid injections are commonly used and proven to be effective, and lately platelet-rich plasma (PRP) has been used with mixed results. Purpose: To perform a systematic review and meta-analysis comparing intralesional injections of PRP and steroid infiltration. Study Design: Systematic review and meta-analysis. Methods: A systematic review of Medline, Embase, Scopus, and Google Scholar including all level 1 and 2 studies from 2010 to 2019 was perfomed. American Orthopaedic Foot and Ankle Society and visual analog scale for pain scores were used as outcome variables. Publication bias and risk of bias was assessed with the Cochrane Collaboration tools. The Grading of Recommendations, Assessment, Development and Evaluations system was used to assess the quality of the body of evidence. Heterogeneity was assessed with χ2 and I2 statistics. Results: Fifteen studies were included in the analysis. Nine studies had a high risk of bias. There was 1 study with high quality, 9 with moderate, 2 studies with low, and 3 with very low quality. The pooled estimate for the American Orthopaedic Foot and Ankle Society score demonstrated nonsignificant differences at 1 month (P = .4) and 3 months (P = .076). At 6 months (P = .009) and 12 months (P = .009), it indicated significant differences in favor of PRP. The pooled estimate for visual analog scale demonstrated nonsignificant differences at 1 month (P = .653). At 3 months (P = .0001), 6 months (P = .002), and 12 months (P = .019), it yielded significant differences in favor of PRP. Conclusion: The results of this systematic review and meta-analysis suggest that PRP is superior to corticosteroid injections for pain control at 3 months and lasts up to 1 year. In the short term, there is no advantage of corticosteroid infiltration. However, the low study quality, high risk of bias, and different protocols for PRP preparation reduce the internal and external validity of these findings, and these results must be viewed with caution.

Vatakantaka and its management through Ayurveda- A Case review.

Vatakantaka is characterized by pain in the heel region and included in Vatavyadhi by Acharya Sushruta. It causes due to silent and repeated injury resulting into inflammation of plantar fascia which results in the painful heel. It is a common cause of heel pain occurs in about 10% of the general population. Women are twice more prevalent than men. Vatakantaka is mainly caused due to vitiation of Vatadosha and continuous pressure on the heel region. It can be correlated with Chronic planter fasciitis or Calcaneal spur. It is more prevalent in female gender and having Sthul akruti (obesity). Various chikitsa measures for management of Vatakantaka are given in classics of Ayurveda. Here bahya and abhyantar chikitsa with Agnikarma gives improvement in subjective criteria like vedana (pain), stambha (stiffness), shotha (swelling) and kriyahani (restricted movements) in short duration of time.