Homoeopathic management of Plantar Fasciitis and Calcaneal Spur

Homoeopathic management of Plantar Fasciitis and Plantar Calcaneal Spur:  Rubrics in various Homoeopathic Repertories

Dr Sowgandhika K N

Most common cause of plantar heel pain is Plantar Fasciitis in which most of the cases are usually associated with Plantar Calcaneal Spur. The treatment for plantar heel pain varies due to the diverse etiologies and unknown pathogenesis of the disease. Therefore therapeutic efficacy of treatments varies, and there is a high relapse rate. Since previous studies have demonstrated that Homoeopathy provides long term solutions and treats the root cause of the disease through law of similar, thus through this article an attempt is made to enumerate the rubrics in different homoeopathic repertories for homoeopathic management of Plantar Fasciitis and Plantar Calcaneal Spur.

Key words: Plantar Calcaneal Spur(PCS), Plantar Fasciitis(PF), Homeopathy, Repertory, Rubrics

Plantar heel pain (PHP) is a common musculoskeletal disorder, affecting up to 10% of the population, and is responsible for 15% of all clinical foot symptoms1. Recent studies have reported the presence of Calcaneal Spur in most of the cases of Plantar Fasciitis and thus frequently coexist2. Severe cases can develop chronic plantar heel pain3. Plantar Fasciitis is associated with significant gait related disability4. Previous retrospective studies have demonstrated the therapeutic utility of homoeopathy in the treatment of heel pain with or without Calcaneal Spur5 thus homoeopathy can play a major role in reducing the burden of this disease in society.

Plantar Calcaneal Spur is a bony outgrowth at the inferior part of the calcaneus, arising from medial or lateral process of calcaneal tuberosity, located on the posterior plantar surface of the calcaneus6. Plantar Fasciitis is a chronic degenerative condition causing marked thickening and fibrosis of plantar fascia and collagen necrosis, chondroid metaplasia and calcification7 recent studies have reported the presence of Calcaneal Spur in most of the cases of Plantar Fasciitis and thus frequently coexist2.”

The Plantar Calcaneal Spurs are not a common cause of the plantar heel pain. Spurs are present in 50% of patients with plantar fasciitis. Over 15% of the general population has a radiologically asymptomatic spur. Repeated corticosteroid injection, for treatment of the Plantar Fasciitis, can lead to heel fat pad atrophy and rupture of the plantar fascia, due to attenuation of the fascia. Physicians should treat the underlying cause of the plantar fasciitis, such as flat feet and ankle instability; otherwise, symptoms will recur shortly after the injection under ultrasound guidance8

The burden of conventional symptomatic treatment, surgical intervention and other costly treatment options are difficult to bear by the low socioeconomic group of patients. As observed in previous studies, Homeopathy can play a vital role in alleviating the burden of Plantar Calcaneal Spur associated with Plantar Fasciitis5. Homeopathy has a holistic approach in the treatment of diseases that is through individualisation. Repertory is an important tool in selecting the similimum, and is an index of symptoms which are represented in the form of rubrics9. Thus in this article rubrics related to Plantar fasciitis and Plantar Calcaneal Spur are represented which can help in the treatment of respective conditions.

Plantar heel pain is a common condition that affects ∼10% of the general population and is associated with activity limitation and depression10.

Plantar fasciitis is most common between 40 and 60 years of age and contributes to 15% of foot injuries in general population without gender difference. The conditions may affect both athletic and non-athletic populations, but the incidence is higher among runners11.

The plantar fascia is a thick fibrous connective tissue composed of mostly collagen supporting the plantar arch of the foot. It originates on the medial calcaneal tuberosity in the hind foot and inserts onto the bases of the proximal phalanges12.

 Risk & etiological factors12

  • Abnormal posture and gait
  • Anatomical deformities such as pes planus or flat foot.
  • Obesity
  • Excessive pronation of the subtalar joint
  • Diabetes mellitus
  • Weak musculature
  • Plantar fat pad atropy

The pathophysiology of plantar fasciitis can be either inflammatory due to vasodilation and immune system activation or non-inflammatory involving fibroblastic hypertrophy12. In latest studies authors found that patients with plantar fasciitis were more likely to have increased plantar fascia thickness, hypoechogenicity, and subcalcaneal spurs primarily identified on ultrasound and X-ray13.


  • Patients usually complain of pain at the anteromedial prominence of the calcaneum.
  • The pain is exacerbated by passive dorsiflexion of the toes.
  • The pain is worse when first standing after rest, typically early in the morning.
  • Once the patient starts walking, the pain tends to recede.
  • The pain eases but never fully resolves throughout the course of the day and is exacerbated by activities such as prolonged walking or exercise, particularly on hard surfaces.

 Examination & evaluation8

The laboratory tests include acute phase reactants, Rheumatoid factor, Anti-Cyclic Citrullinated Peptide Antibodies, HLA-B27 For systemic causes of the plantar heel pain.

Plain Radiographs and Computed Tomography

Clinicians can order them to diagnose stress fractures and plantar calcaneal spurs.

Musculoskeletal Ultrasound
In patients with plantar fasciitis, the investigators may find thickening of the plantar fascia (greater than 4 mm) on the medial tuberosity of the calcaneus. An increase in vascularity under power Doppler ultrasound is not a common finding in plantar fasciitis.


  • Weight reduction
  • Shoe modification
  • Foot flexion and extension using hands
  • Exercises on the foot flexion and extension under the controlled load
  • Exercises with a massage ball
  • Lifting and lowering to the tiptoes when sitting and standing.

Related rubrics in various repertories
Some of the rubrics related to Plantar fasciitis and Plantar Calcaneal Spur from “Boenninghausen’s Therapeutic Pocket Book” (BTPB)16.

parts of the body and organs lower extremities Heels 138
parts of the body and organs lower extremities back of foot 138
parts of the body and organs lower extremities soles 138
parts of the body and organs lower extremities Tendo achilles 138
sensations and complaints bones painfulness in general of periosteum 202
sensations and complaints bones swelling of periosteum 203
sensation and complaints bones inflammation of periosteum 201
Aggravation and amelioration amelioration motion in general continued 316
Aggravation and amelioration Aggravation motion at the beginning of after 292
Aggravation and amelioration Aggravation walking walking, beginning of 307

B) Some of the rubrics from Kent’s “Repertory of the Homoeopathic Materia Medica” with respect to Plantar Fasciitis and Plantar Calcaneal Spur17.

Extremities PAIN, foot morning, rising on 1079
Extremities PAIN, foot walking while 1079
Extremities PAIN, foot sole 1080
Extremities PAIN, foot sole, walking while 1080
Extremities PAIN, foot heel, walking 1080
Extremities PAIN, foot heel, morning 1080
Extremities PAIN, foot heel, bone 1081
Extremities PAIN, foot sole, stepping when 1080
Extremities PAIN, foot heel, splinter as if 1081

C) Some of the rubrics from “Boger Boenninghausen’s Characteristics & Repertory” (BBCR) with respect to plantar fasciitis and plantar calcaneal spur18.

lower extremities heels 547
lower extremities soles 548
lower extremities bones 549
lower extremities boring foot, heels 551
lower extremities bruised pain foot, heels 551
lower extremities cutting foot, heels 553
lower extremities darting foot, heels 554
lower extremities pain, simple feet, heels 559
lower extremities sensitiveness feet, heels 561

D) Some of the rubrics from William Boericke’s “Pocket Manual of Homoeopathic Materia Medica & Repertory”19

Locomotor system heels Os calcis , pain
Locomotor system heels burning
Locomotor system heels pains, aching, bruised
Locomotor system heels pains, soreness
Locomotor system heels pains, tendo Achilles, pain
Locomotor system heels pains, ulcerative

E) Some of the rubrics from “A Concise Repertory of Homoeopathic Medicines by DR. S R. Phatak”20

Heels bone would push through as if
Heels Os calcis painful
Heels painful
Heels painful standing long after
Heels painful walking, amel
Heels stand can not on
Heels tearing
Heels piercing

F) Some of the rubrics from “Synthesis 1.3 Android app” created by Archibel SA based on Synthesis Repertory version 2009, Editor: Dr Frederick Schroyens21.

Extremities feet, complaints of heels
Extremities pain, feet, Os calcis, motion continued, amel
Extremities pain feet, heel, stitching pain
Extremities pain feet, heel, excoriated as if
Extremities pain feet, heel, putting it down when
Extremities pain feet, heel, stepping agg
Extremities pain feet, heels, walking, agg
Extremities pain feet, heels, extending to, foot
Extremities pain feet, heels, shooting pain
Extremities pain feet, heels, pressure, amel
Extremities pain feet, heels, pressure, slightest, agg

A retrospective study was conducted at Dr Anjali Chatterjee Regional Research Institute (H), Kolkata, West Bengal,  to evaluate the extent of Calcaneal Spur in heel pain and to study the correlation of Calcaneal Spur with some socio-demographic and health related factors. It was found that out of 92 patients who undergone X-ray for heel pain, 76 (82.6%) had calcaneal spur. Extent of Calcaneal spur was highest in females, older age, overweight and profession of housemaid or manual labor. Homoeopathic treatment showed positive response in nearly 75% of cases and the most useful medicines were Calcarea flourica, Rhus toxicodendron, Ledum palustre and Aranea diadema.5

 In a double blind randomised placebo controlled trial conducted at Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, patients with Plantar Fasciitis were randomized to receive either Individualised Homeopathic Medicines or identical-looking placebo in the mutual context of conservative non-medicinal management. The Foot Function Index (FFI) questionnaire, as an outcome measure, was administered at baseline, and every month, up to 3 months. Significant results were also observed on three FFI sub-scales (pain%, disability%, and activity limitation %). Natrum muriaticum, Rhus toxicodendron and Ruta graveolens were the most frequently prescribed medicines.7

An unrandomized, prospective, open, controlled, comparative, observational study was carried out at two centres, the Centre Hospitalier, Troyes, and Institut Godinot, Reims, France. This preliminary observational study suggests that joint pain linked to the treatment of hormone-receptor positive breast cancer with aromatase inhibitor can be prevented or improved by concomitant homeopathic treatment combining Ruta graveolens 5CH and Rhus toxicodendron 9CH 22 . Though following drugs are found to be useful in the treatment of PHP associated with PF and PCS, efficacy of these drugs and other drugs indicated under the related rubrics in different homoeopathic repertories has to be explored.

Thus homeopathic management with reportorial approach has a wider scope in the treatment of heel pain associated with Plantar Fasciitis and Plantar Calcaneal Spur, which can be widely made use of to treat the sufferings of the patient based on his or her individuality of symptoms.


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Dr Sowgandhika K N
PG Scholar
MD Part 1- Repertory
Under the guidance of
Dr Munir Ahmed R
Professor, Department of Repertory
Government Homoeopathic Medical College and Hospital, Bengaluru

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