Ayurvedic Treatment for Heel Pain By Brick Fomentation

Article by Dr Raghuram Y.S. MD (Ay)
Heel Pain is one of the common pains among a list of painful conditions affecting the leg (lower limb). It is difficult to live with any pain and accept that it is a part of us. It is not a human instinct too. Since most of our daily activities depend on our locomotion, on how we move and walk around, it becomes even more frustrating for the person suffering from heel pain.

Man has been a curious explorer of better remedies throughout the journey of evolution. He has constantly searched for better and better remedies bringing all the wisdom and scientific advancement into use and has never given up his fight against pain.

There are many remedies for heel pain which are available at our disposal. Ishtika Sweda – Brick sweating therapy is one of the most effective and time tested remedies for heel pain derived from the wisdom of Ayurvedic science. Ayurvedic doctors are constantly practising this treatment procedure as a heel pain remedy for ages and have given good and soothing relief to the patients. In this treatment, bricks are used for the purpose of treatment.

We have seen bricks being used in the construction of buildings but isn’t it interesting to know that the same bricks are used to provide pain relief!

bricks

What is Istika Sweda?

The term Ishtika Sweda has 2 terms –
Ishtika – means brick
Sweda – means sweat (sweat inducing therapy)
Thus Ishtika Sweda means a treatment done by using brick / bricks so as to induce sweating in the parts of the body afflicted by pain and stiffness

Indications

In which conditions is Ishtika Sweda used?
Ishtika Sweda is used mainly to provide relief from pain, inflammation, swelling and stiffness (catch) associated with heel pain. Many times it also acts as a disease-modifier wherein it provides a substantial relief of more than 90% and a long standing one too.

Ishtika Sweda is used in the treatment of –
Calcaneal Spur (Heel spur) – is one of the main causes of heel pain. Calcaneal Spur is an abnormal growth of the calcaneus bone (calcaneum). Calcaneum is the largest bone forming the foot and also the largest tarsal (Tarsals = bones of the foot, 7 in number). It forms the heel (therefore called heel bone).
In spur, the bone grows abnormally in the form of a hook
Underneath the foot (inferior part of the calcaneum) – when it is called inferior spur.
In relation to the attachment of the bone to plantar fascia or behind the heel (posterior aspect of calcaneum) at the insertion of Achilles tendon (thick rope like structure which we can feel above the heel bone) – when it is called posterior spur. Read related: Calcaneal Spur – Ayurvedic Treatment, Tips and Remedies

Plantar Fasciitis – It is the condition in which the plantar fascia is inflamed. Plantar fascia is a ligamentaneous tissue which extends from the calcaneus bone to the ball of the foot. It helps in maintaining the arch of the foot and bears the body weight while walking or running and subsequent trauma. This fascia is always prone to frequent wear and tear. Plantar fasciitis is another condition which produces heel pain. Plantar fasciitis and calcaneal spur are often inter-related conditions but not always.
Read related: Heel And Foot Arch Pain: Plantar Fasciitis Tips, Remedies

Retro-calcaneal bursitis – This is another condition produced as a result of inflammation of the bursae related to calcaneal bone.

All the above said conditions can be included under a condition called Pada-Kantaka explained in Ayurveda

Achilles tendonitis – In this condition, the heel pain is caused due to inflammation of the Achilles tendon at its insertion over the calcaneum

Tarsal Tunnel Syndrome – This is a painful condition caused due to the compression of posterior tibial nerve. Tibial nerve is the main nerve supplying the foot. It passes through a bony tunnel in the foot (passages amidst the tarsal bones – bones forming the foot). When the structures around the tarsal tunnel are inflamed they cause compression over the nerve causing pain.

Procedure

How is Ishtika Sweda done?
Short explanation of the procedure:
Dhanyamla dhara – A short course of Dhanyamla dhara (stream pouring of medicated fermented liquid is done a few days prior to Ishtika sweda, especially when the heel pain is associated with burning sensation and Pitta symptoms.
Patient is administered with purgation treatment. – Sadyo Virechana with  Gandharvahastadi Kashayam, Gandharvahastadi Eranda tailam, Nimbamritadi Eranda Tailam etc.
Dashamoola Kashaya is prepared or procured from the market.
Foot massage with selected herbal oil is done.
4 Bricks are heated to red hot, are placed in the tray or vessel kept on the stand
The Dashamula Kashayam is poured over the red hot bricks
The bricks start emitting fumes (steam)
The patient is asked to keep his feet over the bricks (a short distance should be maintained between the feet and bricks) exposing them to the fumes.
The temperature of the bricks should be constantly checked. Once the temperature of the bricks come down and when they stop emitting the fumes, they should be replaced by other 2 bricks which are heated till they become red hot. Dashamula Kashayam is once again heated and poured over the heated bricks and the feet exposed to the fumes.
This is repeated for 4-5 times in one sitting. The procedure can be administered twice daily.
Steaming is done till the feet and legs start sweating to moderation – for not more than 5 – 10 minutes.
This is the procedure in short. There are other variants to this method, which are explained below.

Detailed explanation of Ishtika Sweda – Brick fomentation:
a. Purvakarma (Pre-treatment procedures): This includes –
Preparation of the patient:
The patient is thoroughly examined. The Prakriti (basic constitution) and Vikriti (details of morbidity) are documented in detail. The disease is also examined. The treatment line-up, materials and medicines which need to be used are enlisted.
Patient is given a Sadhyo-virechana (instant purgation) for detoxification

Preparation for treatment

Materials needed for the treatment are collected beforehand. They are:
For Abhyanga (massage) – Taila (medicated oil), Ghee (medicated ghee) or both suitable to the disease and diseased are collected and stored beforehand
Bricks or brick pieces
Sterile clothes, Stove, bowls, vessels, water, small foot stand etc
Dashamula Kashayam (decoction prepared using roots of 10 herbal roots)Note: Dashamoola kashayam is readily available in the market.  Its coarse powder – Dashamoola kashayam powder is also available.

1 portion of the Kashayam powder is boiled with 16 times water and reduced to ¼ proportions. It is filtered so as to obtain the required Kashaya. The quantity can just be reduced to ½ since it is to be used for external treatment. A small portion of the Kashaya is kept as reserve. This portion should be served to the patient for internal consumption after the treatment is finished.

  • In some cases, Ishtika Sweda can be clubbed with Matra Vasti (oil / ghee enemas given in a fixed dose, everyday). If this is planned, the medicated oil / ghee and enema syringe should be kept ready
  • Dhanyamla dhara – A short course of Dhanyamla dhara (stream pouring of medicated fermented liquid is done a few days prior to Ishtika sweda. This is preferred when there is severe inflammation and pitta vitiated symptoms. It also alleviates ama (sticky toxins binding with vata and pitta in the joint spaces and around the soft tissues and bones causing inflammation and pain).

b. Pradhana Karma (Treatment proper):
Abhyanga – learn how to do foot massage

  • The medicated oil / ghee is passively made warm by placing a small bowl having oil in a vessel with hot water
  • Though the treatment is targeted towards healing the heel pain, the whole foot and leg should be given a gentle massage so as to provide soothing relief. Abhyanga relaxes your nerves and enhances circulation. It strengthens the bones, soft tissues and joints, removes swelling and mitigates the morbid Vayu. The oil / ghee are liberally applied to the feet, including the soles, heel, ankle joint and legs (between knee and ankle).
  • Oil is rubbed energetically into the whole ankle joint including the bones of the joint and Achilles tendon (a cord like structure at the back of your foot connecting the calf muscles of your leg to your heel). Knead and stroke the tendon repeatedly.
  • Next, the top of the foot (dorsum) is attended. Slowly give a soothing massage from the ankle joint moving downwards towards the toes. Massage the spaces between each of the tendons while supporting the heel with the other hand.
  • Later, pinch and massage each toe between your fingers from its root to the tip. Start from the big toe and end with the small one.
  • Next end by massaging the soles, the under-surface of the foot which is in contact with the ground. Attend the lower part of the calcaneum and plantar fascia, giving them a gentle massage. Since we are concentrating much on the heel pain, an extra bit of time can be given for massaging the above said parts.
  • Massage is done with hands by applying moderate pressure (pressure is altered and adjusted according to the nature and intensity of pain)
  • Circular motions are done around the joints and vertical massage is done over the legs (from above downwards)
  • It is better that a single masseur does Padabhyanga in both feet so that the synchronicity is maintained
  • Each foot is attended for 15-20 minutes, if both feet are painful. Even if one foot is involved, massage should still be given to both feet. The affordability of the patient should be checked.

Oils and ghees used

Oils / ghee used for Padabhyanga / foot massage:

Simple options of oil:
When Vata is predominant or for those with Vata constitution – Sesame oil, ghee or olive oil is used
When Pitta is predominant or for those with Pitta constitution – ghee, coconut oil or sunflower oil is used
When Kapha is predominant or for those with Kapha constitution – ghee, sesame oil or jojoba oil is used

c. Ishtika Sweda(The brick fomentation):
Method 1-
The patient who has been given Padabhyanga (foot massage) should be made to sit comfortably on a chair
A small stool / foot stand is kept near the foot of the patient. Over the stool a big tray or broad vessel is kept
Bricks, 4 in number should be taken and heated on fire until they become red hot
The heated bricks are placed in the tray or vessel kept on the stand
The Dashamula Kashayam is poured over the red hot bricks
The bricks start emitting fumes (steam)
The patient is asked to keep his feet over the bricks (a short distance should be maintained between the feet and bricks) exposing them to the fumes
The temperature of the bricks should be constantly checked. Once the temperature of the bricks come down and when they stop emitting the fumes, they should be replaced by other 2 bricks which are heated till they become red hot. Dashamula Kashayam is once again heated and poured over the heated bricks and the feet exposed to the fumes.
This is repeated for 4-5 times in one sitting. The procedure can be administered twice daily.
Steaming is done till the feet and legs start sweating to moderation

Precaution

Care should be taken to see that the legs and feet don’t sweat too much due to heat.
Care also should be taken to see that the feet don’t get burnt due to excess heat. To do this, the feet should be kept at a proper distance (not too near) from the bricks.
The feet should not be kept too far away from the fumes. This causes less fomentation and might not provide desired relief

Samyak swinna lakshana

Parameters for proper sweating (Samyak Swinna Lakshana) –

  • Sheeta uparama – pacification of the feeling of cold
  • Shula uparama – pacification of pain
  • Stambha nigraha – alleviation of stiffness
  • Gaurava nigraha – alleviation of heaviness
  • Maardavam – smoothness of the part
  • Svedam – manifestation of sweat
  • Laghutvam – feeling of lightness
  • Vyadhi hani – alleviation of disease

Heena / Aswinna lakshana

Parameters for improper / less sweating (Asamyak / Heena Swinna / Aswinna Lakshana) – In this the symptoms opposite to those explained in the Ati Swinna Lakshana are manifested i.e.

  • Sheeto anuparama – no relief from the feeling of cold
  • Shula anuparamam – non-pacification of pain
  • Stambha anigraha – no relief from stiffness
  • Gaurava anigraha – no relief from heaviness
  • Amaardavam – lack of smoothness of the part
  • Aswedam – absence of manifestation of sweat
  • Alaghutvam – no feeling of lightness
  • Vyadhi anupashama – no relief from disease

Ati swinna lakshana

Parameters of excessive / over sweating (Ati Swinna Lakshana) –

  • Pitta prakopa – aggravation of pitta
  • Asra prakopa – aggravation of rakta
  • Trushna – thirst
  • Murcha – loss of consciousness
  • Swara sadana – weakness of voice
  • Anga sadana – weakness of the body
  • Bhrama – giddiness
  • Sandhi peeda – joint pains
  • Jwara – fever
  • Shyava-rakta mandala – brownish-red eruptions
  • Chardi – vomiting

Method 2 –
The red hot bricks are dipped in hot Dashamula Kashayam
The bricks are immediately removed from the Kashayam and placed on the tray
The patient is asked to expose the feet to the upcoming fumes until sweating occurs

Method 3 –
Take small brick pieces and heat them on the fire till they become red hot
Dip them in hot Dashamulam Kashayam
Tie the brick pieces in a sterile cloth and prepare a bolus
When the temperature of the bolus becomes tolerable, the bolus should be applied over the painful part. It should be intermittently removed so as not to cause burns after continuous contact with the skin.
Once the bolus gets cold, the procedure is repeated as said above

Method 4 –
Red hot bricks are dipped in hot Dashamulam Kashayam, tied in a cloth and placed in the tray
The patient is asked to keep his feet on the brick enveloped with cloth and advised to remove the feet after every few seconds so as to avoid burning
Once the brick gets cold, the procedure is repeated as said above

Paschat karma

Paschat Karma (Post-treatment procedures):

  • The feet of the patient is wiped with sterile cloth dipped and squeezed in warm salt water
  • The patient is asked to relax for a while
  • Matra Vasti – Enema is given daily with medicated oil or ghee or both in pre-fixed constant dose. This helps in controlling Vayu and Pitta, hence heals pain and inflammation (optional and strictly based on the decision of the doctor)

Medicines used for Matra Vasti – Guggulutiktakam Ghritam, Mahanarayana Tailam, Dhanwantaram tailam / mezhupakam  etc

  • Nitya Virechana – Daily metered dose of purgation with purgative decoctions or oils like Gandharvahastadi Kashayam, Gandharvahastadi Eranda tailam, Nimbamritadi Eranda Tailam etc can be administered if a small amount of detoxification is essential on a daily basis or if morbid Vata and Pitta need to be tackled (optional and strictly based on the decision of the doctor)
  • Bandhana / Pichu – Some doctors prefer tying a bandage after applying medicinal pastes (bandhana) or a cotton pad dipped in herbal oils (pichu) as a post-treatment procedure. This is done to enhance the effect of the treatment. If any of these is to be done, they should be done after a couple of hours following treatment. I generally do it in the evening (in selected cases) after having done Ishtika Sweda in the morning session. This also avoids over-doing the treatment. I prefer it in severe cases and only if the patient can come over twice in a day (his / her protocol allowing them to do it). I have advised the patients to do the bandaging at home after demonstrating the procedure for the first time.

Paste made out of Kottamchukkadi churnam, Grihadhoomadi churnam, Jatamayadi churnam etc are used for application on painful part before tying the Bandhana. Cotton pad dipped in any of the oil / ghee mentioned in the context of Abhyanga can be used for Pichu.

  • Ksheera dhara – I have also used Ksheeradhara (streamed pouring of milk processed with Dashamula / Laksha / Yashtimadhu in the second sitting after the Ishtika Sweda. This is used especially in high inflammatory conditions wherein we can find symptoms and signs highly pointing towards Pitta and or Rakta vitiation like redness, swelling, rise in temperature, burning sensation etc.

I have even given a space of around 1 week to 10 days after a course of Ishtika Sweda and conducted Bandhana and or Ksheeradhara as a part of different schedule.

  • Discharge – The patient is discharged on daily basis (out-patient) or after the course has been completed (in-patient) after giving proper lifestyle and diet advises along with suitable medicines (oral). The patient is also advised to undergo the treatment twice or thrice in a year.

Duration of the course –
The number of days of treatment varies from 7-14 days depending on the nature and intensity of the disease

Contraindications

Diabetes mellitus (can be done for a short period with caution, giving proper medicines to treat diabetes or in controlled and uncomplicated diabetes)
High blood pressure (Hypertension)
Severe varicosity of veins
Deep vein thrombosis
Fractures related to foot
Fever

Read related:
Calcaneal Spur – Ayurvedic Treatment, Tips and Remedies
Heel And Foot Arch Pain: Plantar Fasciitis Tips, Remedies
4 effective Ayurveda sore feet remedies

Ayurvedic medicines

Medications to heal ‘heel pain’ –
Kashaya’s (Herbal decoctions):

  • Amrutottaram Kashayam
  • Guggulutiktakam Kashayam
  • Sahacharadi Kashayam
  • Sahacharabaladi Kashayam
  • Kokilaksham Kashayam
  • Rasnasaptakam Kashayam
  • Guluchyadi Kashayam
  • Gandharvahastadi Kashayam

Ghritam and Tailam (medicated ghee and oils):

  • Guggulutiktakam Ghritam
  • Varanadi Ghritam
  • Rasnadi Ghritam
  • Dhanwantaram Ghritam
  • Tiktakam Ghritam
  • Ksheerabala Tailam
  • Sahacharadi Tailam
  • Ksheerabala tailam 101
  • Dhanwantaram tailam 101

Vati and Gulika (Tablets):

  • Kaishora Guggulu
  • Yogaraja Guggulu
  • Panchatikta Ghrita Guggulu
  • Trayodashanga Guggulu
  • Ksheerabala Tailam 101 caps
  • Dhanwantaram Tailam 101 caps
  • Mahavata vidhwamsini Rasa etc.

External applications

The same herbal oils mentioned in Abhyanga etc. can be used for external application.
Shatadhouta Ghritam & Jatyadi Ghritam / Tailam are excellent in relieving pain, inflammation and other associated symptoms.

Other treatments done in heel pain:
Ksheera dhara – Stream pouring of medicated milk (milk processed with Dashamula group of herbs, Yashtimadhu – Liquorice etc)
Dhanyamla dhara – Stream pouring of medicated fermented liquids
Taila dhara – stream pouring of herbal oils / ghee (those mentioned in Abhyanga)
Lepam – application of medicinal pastes such as (made from) Dashanga lepam, Rasnadi churnam, Jatamayadi churnam etc
Pada Avagaha – Dipping the painful foot in a tub filled with medicated milk / oil / ghee
Agnikarma – cauterization
Suchi daha – hot needle cauterization
Raktavasechana – blood letting

Ishtika Sweda is the best treatment which Ayurveda provides to heal your heel pain. All you need to do is to meet an experienced Ayurvedic doctor and put forth your problems. The doctor will help you to get fit and walk back on your feet.

Caution Ishtika Sweda is an ‘easy form of treatment’ which can be carried out at home but make sure you are properly diagnosed in an Ayurvedic way. The best way of taking the treatment is to have it done under the supervision of the doctor.
Click to Consult Dr Raghuram Y.S. MD (Ayu)

Read more about sweating therapy:
Why You Should Sweat – To Treat Disease, For Better Health
Charaka Samhita Chapter on Sweating therapy – Swedana chikitsa
Astanga Hrudayam chapter on Swedana chikitsa

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