Vol. 2, Issue 2, Part A (2025)

Background: Plantar fasciitis is a leading cause of chronic heel pain and often remains symptomatic despite standard conservative therapies. In Ayurveda, this condition is correlated with Vātakaṇṭaka, for which Agnikarma (therapeutic heat cauterization) is a classically indicated para-surgical intervention. However, contemporary clinical evidence, particularly with long-term follow-up, remains limited.
Objectives: To evaluate the clinical effectiveness, durability of response and safety of standardized Agnikarma in patients with chronic Plantar fasciitis (Vātakaṇṭaka) who had an inadequate response to conventional conservative management.
Methods: This prospective, open-label, single-arm clinical study was conducted in an Ayurvedic teaching hospital Kriyākalpa/Agnikarma unit. Adults aged 18-65 years with clinically diagnosed chronic Plantar fasciitis, fulfilling classical lakṣaṇas of Vātakaṇṭaka and unresponsive to ≥4 weeks of standard conservative care, were recruited. A single standardized sitting of Agnikarma using a heated metallic (Pañcaloha) śalākā was performed over the most tender plantar heel area under aseptic precautions. All patients received uniform advice on plantar fascia and calf stretching, soft footwear and activity modification. Outcomes included VAS pain (first steps and prolonged standing), a foot function score and patient global impression of change, assessed at baseline, 4 weeks, 12 weeks, 6 months and 12 months. Adverse events and recurrences (VAS ≥5 after initial response) were recorded.
Results: Of 40 recruited patients, 36 (90%) completed 12-month follow-up. Mean VAS pain (first steps) reduced from 8.2±0.9 at baseline to 3.6±1.3 at 4 weeks, 1.9±1.2 at 12 weeks and 2.2±1.4 at 12 months; similar improvements were observed for pain on prolonged standing and foot function scores. At 12 weeks, 83.3% achieved ≥50% pain reduction and 61.1% had VAS ≤2; corresponding 12-month values were 77.8% and 55.6%. Recurrence occurred in 6 of 36 completers (16.7%), often associated with non-adherence to footwear and activity advice. Adverse events were mild and local (transient burning, superficial blistering, limited hyperpigmentation), with no serious complications.
Conclusion: Standardized Agnikarma, integrated with basic biomechanical and lifestyle measures, produced rapid, substantial and durable improvements in pain and function in chronic Plantar fasciitis/Vātakaṇṭaka with an acceptable recurrence rate and favourable safety profile. Agnikarma appears to be a promising, low-cost, culturally acceptable para-surgical option for chronic heel pain and warrants further evaluation in controlled comparative trials.