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Symptoms
Many calcaneal spurs are painless and an incidental finding on X-rays. When symptoms do occur, the pain is often caused by inflammation and irritation of the soft tissues surrounding the spur, not the spur itself.
Common symptoms include:
• Sharp, knife-like pain in the heel when taking the first steps in the morning or after a period of rest.
• A dull ache in the heel throughout the day, which may worsen with prolonged activity.
• Inflammation, swelling, and warmth in the affected area of the heel.
• A point of tenderness on the bottom or back of the heel.
Causes and Risk Factors
Calcaneal spurs develop gradually over time due to chronic, long-term stress and strain on the foot muscles and ligaments.
Key risk factors include:
• Plantar fasciitis: The most common association, where chronic inflammation and microtears in the plantar fascia lead to calcium deposits.
• Abnormal gait: Issues with how a person walks can place excessive stress on the heel bone and surrounding tissues.
• Excess body weight/obesity: Added pressure on the feet can accelerate tissue damage.
• Improper footwear: Poorly fitted, worn-out, or unsupportive shoes (including high heels or very flat shoes) can increase strain on the plantar fascia.
• Repetitive stress: Activities like running, jogging, or jobs that require prolonged standing on hard surfaces can contribute to spur formation.
• Age: As people age, the foot's arch can sag and the heel's protective fat pad can thin, increasing vulnerability.
• Underlying medical conditions: Certain types of arthritis (osteoarthritis, rheumatoid arthritis, ankylosing spondylitis) and diabetes are associated with a higher risk.
Treatment
Treatment focuses on managing the pain and inflammation associated with the spur and its underlying causes (such as plantar fasciitis). More than 90% of people find relief with non-surgical treatments.
Conservative treatments include:
• Rest and ice to reduce pain and inflammation.
• Stretching exercises for the calf muscles and plantar fascia to improve flexibility and reduce tension.
• Supportive footwear and orthotics: Heel pads, arch supports, or custom-made shoe inserts can help absorb shock and distribute pressure.
• Over-the-counter anti-inflammatory medications (NSAIDs) like ibuprofen or naproxen.
• Corticosteroid injections for more severe inflammation and pain.
• Physical therapy to develop a personalized treatment plan.
Surgery to remove the spur and/or release the plantar fascia is a last resort, typically considered if conservative treatments fail after 9 to 12 months.

Agnikarma in Practice
In Ayurvedic terms, calcaneal spur is often correlated with a condition called Vatakantaka, which is primarily caused by an imbalance of the Vata and Kapha doshas (energies/elements) in the heel region. Agnikarma is believed to counteract these imbalances through the application of controlled heat, which helps alleviate pain and stiffness.
The Procedure
The procedure involves applying targeted, controlled heat to specific tender points on the heel using a specialized metallic instrument called an Agnikarma Shalaka (often made of five metals, Pancha Dhatu Shalaka).
• Identification: The points of maximum tenderness on the heel are first identified and marked.
• Application: The Shalaka is heated to a specific temperature (sometimes red hot) and applied briefly in a dot-like shape (bindu akruti) to the marked points.
• Post-Procedure Care: After the treatment, the treated area is typically anointed with Ghee (clarified butter) or a medicated ointment like Shatadhauta Ghrita to promote healing and prevent infection.
Effectiveness
Multiple case studies and reviews suggest that patients experience significant pain relief and improved mobility after a few sessions of Agnikarma (typically 3 to 6 sessions at intervals of 5-7 days).
The proposed mechanism of action includes:
• Improved local blood circulation, which helps flush out pain-producing substances and reduces inflammation.
• Counter-irritation, where the heat application stimulates sensory nerve endings, overriding the pain signals.
• Tissue metabolism enhancement, which aids the natural repair process.
• Prevention of recurrence, which is a noted benefit in many case reports.
Important Considerations
• Agnikarma should be performed only by a qualified and experienced Ayurvedic practitioner to ensure safety and effectiveness.
• While promising, more large-scale clinical studies are needed to validate the efficacy of Agnikarma according to modern scientific standards.
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