“A STUDY TO ASSESS THE EFFECTIVENESS OF TOE WALKING EXERCISE VERSUS CALOTROPIS GIGANTEA LEAVES WITH HONEY IN
HEEL PAIN AMONG DHOBIS IN
SELECTED AREAS
OF RAICHUR”
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
D.GNANAKSHI
NAVODAYA COLLEGE OF NURSING
RAICHUR, DECEMBER -2009
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DESSERTATION
- Name of the candidate: Miss.D.Gnanakshi
and address M.Sc Nursing Ist Year,
Navodaya College of Nursing,
NavodayaNagar, P.B.No.26,
Mantralayam Road,
Raichur – 584103.
- Name of the Institution: Navodaya College of Nursing
Raichur
- Course of study : M.Sc Nursing Ist Year
and subject Community Health Nursing
- Date of admission in to: 17/06/2009
the course
- Title of the Topic:
“A STUDY TO ASSESS THE EFFECTIVENESS OF TOE WALKING EXERCISE VERSUS CALOTROPIS
GIGANTEA LEAVES WITH HONEY IN
HEEL PAIN AMONG DHOBIS IN
SELECTED AREAS
OF RAICHUR”
- BRIEF RESUME OF THE INTENDED WORK:
6.1NEED FOR THE STUDY:
The intense pain after rest, like a bruise in the heel, confirms the oldage saying “when your feet hurt, your whole body hurts”.
People tend to forget the importance of their feet-how far they travel, how long they stand and how much punishment they absorb. While walking, the stresses placed on your feet can be one-and a quarter times of your body weight. So it is not surprising that heel pain is common. Plantar fasciitis is a powerful wake-up call to many individuals who have never experienced foot problems.
Pain in heels is a major cause for physical disability causing economical burden in terms of medical cost, work related sickness, payment, time lost from the work. Heel pain affects nearly 2 million Americans each year and can be responsible for mild discomfort or even debilitating pain. Eighty percentage of people suffering with osteoarthritis are showing clear radiographic evidence of heel spur and 25% have symptoms. In India, 10 million people are suffering with the same, 0.8% of population.
Foot pain is very common and an estimated 75% of people will suffer from some type of foot pain at some point in their life. The foot is complex structure made of 26 bones, 33 joints and layered with an intertwining web of more than 120 muscles, ligaments and nerves with each step we take , a force of 2-3 of our body weight is placed on our feet and during a typical day, people take 8,000 – 10,000 steps.
Heel pain accounts for a large number of patients visits to foot and ankle specialists. The most common of this heel pain is “plantar fasciitis” ( also known in some circles as “heel spur”). Patients classically complain of intense heel pain after periods of rest that improves with activity. Fortunately , plantar fasciitis is treatable. Sixty five percent to 95% of patients suffering from plantar fasciitis respond to conservative (non-surgical) therapies. When conservative measures fail, surgery may be the necessary alternative to alleviate the pain.
The onset of heel pain can sometimes be a sudden discomfort, but many times it can be a progressive aching that gets worse over time. Heel pain is amore general term given to specific ailments that effect the foot, most commonly plantar fasciitis and heel spurs. If pain is ignored and treatment is avoided , conditions that affect the heel usually worsen and can significantly impact a person’s daily routines and life style. Luckily, you can relieve and even heal most cases of heel pain through relatively conservative treatment.
Pain in heel can arise due to a number of factors. Most often, it does not result from a single injury, such as or injured ankle. Instead, heel pain usually occurs as result of excessive or continuous stress or repetitive pounding on the heel. In addition to the feeling of pain around the ball of the foot, swelling and bruising may also be present.
The risk factors of heel pain are prolonged standing, repetitive trauma or injury, calcium deficiency, heel spur and obesity. The contributing factors include walking on soft-terrain (sand or gravel), sudden weight increase, sudden increase in activity, poor shoe support, tight calf muscles, leg length discrepancy, anything that can increase the strain and stretch placed on the inelastic plantar fascia, bowleg and knock knees.
Symptoms may be exacerbated by a nerve around the heel becoming trapped due to the inflammatory process and /or resulting scar tissue. When this occurs, patients generally experience a more intense pain that is burning and tingling in nature that may radiate into the arch or the ankle and complain of “My feet are killing me!”. The complaint is common but the cause is often elusive.
Conservative Treatment ( Non surgical)
Because plantar fasciitis is so common, many physicians have developed their own protocols of conservative treatment for plantar fasciitis. The following are the most commonly prescribed conservative therapies.
Ice: Ice is a mainstay anti-inflammatory of acute injuries. Applying an ice compress for 15-20 minutes, several times a day can reduce the inflammation and pain of plantar fasciitis.
Stretching: Daily stretching of the calf muscles can improve motion at their ankle joint and reduce stress on the plantar fascia.
Physical Therapy:Range of motion exercise, ultrasound (with or without therapeutic additives), toe walking exercise and deep massage of the affected area can all relieve the pain associated with plantar fasciitis.
Thinking of the foot as an archer’s bow were the bowstring is the plantar fascia and the bone is the arch. If the tips of the bone were brought closer together the bowstring would be limp. In the case of plantar fasciitis , the tips of the bow are brought further apart, thus increasing the tension on the bow string to point whereit will snap, tearing the plantar fascia from its heel bone insertion resulting in heel pain.
Plantar fasciitis is often relieved without need for surgery. The success of the treatment underlies in identifying the cause. Unfortunately, it takes time. The podiatrist will prescribe the combination of conservative therapies that have proven effective in their practice. So, the best way to protect the feet is by implementation of the intervention such as the use of calotropis gigantea leaves with honey and toe walking exercise and not to ignore the pain.
Dhobis are a group of people involved in the occupation of washing clothes. During the activity of the occupation, their feet gets damped in the water. Due to continuous exposure weight bearing, stress and low economic status the heel pain is commonly ignored.
Hence, the researcher felt the need to assess the effectiveness of toe walking exercise and calotropis gigantea leaves with honey in getting relief from heel pain among Dhobis in selected areas of Raichur.
6.2 REVIEW OF LITERATURE:
A review of literature on the research topic makes the researcher familiar with the existing studies and provides information which helps to focus on a particular problem, lays a foundation upon which to base a new knowledge. It creates accurate picture of the information found on the subject.
A case control study was conducted to determine the impact of chronic plantar heel pain on health related quality. The impact of Chronic Plantar Heel Pain on health-related to life among adults in selected hospitals at Victoria. Eighty subjects with Chronic Plantar Heel Pain (CPHP) and 80 sex and age-matched controls without CPHP were chosen for the study . Data were collected by using Foot Health Questionnaire. The results of the study showed the CPHP group demonstrated poorer general health – related quality of life with lower scores on physical activity, social capacity. Age, sex had no association with the degree of impairment in people with CPHP. The study concluded that the CPHP has a significant negative impact on foot – specific and general health-related quality of life.
A study conducted on Herbal Practices And Products by Rambhajan at Madhya Pradesh explain the uses of calotropis procera plant. He suggested that application of heated leaves of calotropis procera plant on aching joints helps to cure the pain. Jen Adley, a physical therapist from USA, swimming and USA Triathlonand author “Overcoming plantar fasciitis” suggested toe - walking for heel pain as this intervention helps to develop mobility in the muscles of the foot as well as plantar fascia.
Dr. Vijay Kumar Soni, one of the writer for “Healthy Living” suggested toe walking as one of the rehabilitation exercises for plantar fasciitis. Owen Anderson in his article on “Plantar Fasciitis and Plantar Fasciitis Stretches” suggested toe waling as one of the strengthening exercises in the prevention of plantar fasciitis.
A case –control study was conducted to determine the risk factors for heel pain among the patients in selected hospitals at Richmond. Fifty consecutive patients with unilateral plantar fasciitis were chosen or the study. Data were collected by measuring height and weight and by the hours spent by the workers in weight-bearing in a day. The results of the study showed that the individual with dorsiflexionof ankle, BMI > 30kg /m2 and those who spent majority of their work day on their feet are at risk for the development of plantar fasciitis.
A Prospective, Randomized Study was conducted to assess The Tissue – Specific Plantar Fascia – Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain in Department of Physical Therapy, Ithaca College, University Of Rochester Campus, Rochester, New York. One hundred and one patients who had plantar fasciitis for a duration for atleast 10 months were randomized into one of two treatment groups. All the patients received prefabricated soft insoles and three – week course of Celecoxibs, and they also viewed an educational video on Plantar Fascia Tissue-Stretching Programme. Eighty two patients returned for the follow up evaluation. The study concludes that, the pain subscale scores of the Foot Function Index showed significantly better results for the patients managed with the plantar fascia stretching programme with respect to item I (worst pain, P = 0.02) and item II (first steps in the morning, P = 0.006).
A case control study was conducted to assess the risk factors for Plantar Fasciitis, Department of Physical Therapy Virginia. Common wealth university, Richmond – Virginia. Fifty samples are included in this study and the data were collected through questionnaire.Individuals with less than 0o of dorsiflexion had an odds ratio of 23.3 (95% confidence interval, 4.32 to 124.4) when compared with the referent group of individual who had more than 100 of ankle dorsiflexion. Individuals who reported that they spent majority on their had an odds ratio 3.6(95% confidence interval, 1.32 – 010.1) when compared with the referent group of those who did not. The study concluded that the risk of plantar fasciitis increases as the rate of ankle dorsiflexion decreases.
A comparative study was conducted the Plantar Fasciitis: Are Pain and Fascial Thickness Associated with Arch Shape and Loading. Subjects (3 male and 7 female) with unilateral planter heel and 10 asymptomatic control subjects individually matched for age, sex and body weight participated in the study. Subjects with heel pain had tenderness, localized to the calcaneal pertaining to the calcaneus, insertion of the plantar fascia which was exacerbated with weight bearing following periods of rest. There was a significant group X limb interaction in the saggital thickness of the plantar fascia (F = 43.8 ; df = 1.9 ; p < 0.05). The plantar fascia limb (6.1 [+ or - ] 1.4 mm) was 48% thicker than that of its asymptomatic counter part(4.2[+ or -] 0.5 mm) and 75% to 79% thicker than the fascia of the matched control study and matched study.
A prevalent study was conducted to find the incidence of Plantar Fasciitis in United States Military. A query was performed with the use of the Defense Medical Epidemiology. Data Base for the International Classification of Disease. The overall unadjusted incidence rate of plantar fasciitis was 10.5 per 1,000 person – years. Compared with men woman had a significantly increase adjusted incidence rate ratio for plantar fasciitis of 1.96 (95% confidence interval, 1.94 – 1.99). The adjusted incidence rate ratio for the age group of 40 years old or more compared with the twenty –to twenty-four-year-old group was 3.42 (95% confidence interval, 3.34 – 3.51). The study concludes that female sex and increasing age are all risk factors of planter fasciitis.
6.3STATEMENT OF THE PROBLEM:
“AStudy to Assess the Effectiveness of Toe Walking Exercise Versus Calotropis GiganteaLeaves with Honey in Heel Pain among Dhobis in Selected Areas of Raichur”
6.4OBJECTIVES OF THE STUDY:
- To assess the level of the heel pain before and after the toe walking exercise.
- To assess the level of heel pain before and after the use of heated calotropis gigantea leaves with honey
- To compare the effectiveness of toe walking exercise and use of heated calotropis gigantea leaves with honey for heel pain relief.
- To find the association between the effectiveness of toe walking exercise and use of heated calotropis gigantea leaves with honey for heel pain relief with the demographic variables.
6.5OPERATIONAL DEFINITIONS:
Effectiveness : It refers to the relief from pain got from toe walking exercise or the use of heated calotropis gigantea leaves.
Toe walking exercise : It refers to barefoot, standing on the toes, balancing for a moment and then begin walking forward with slow, small 10-20 steps ( take one step every one to two seconds, with each step being about 10-12 inches in length).
Heated Calotropies Gigantean Leaves With Honey : It refers to the leaves of calotropis gigantea smeared with honey on the upper surface of leaves which are warmed up on tawa before placing them under the heels.
Heel Pain : It refers to the pain experienced when the ‘plantar fascia’ of the foot becomes irritated and inflammed, causing discomfort in the heel and arch of the foot.
Dhobis : It refers to the people involved in the occupation of washing clothes between the age of 30- 60 years.
6.6HYPOTHESIS:
On the basis of the objectives of the study the following hypothesis have been formulated:
H1 ; There will be a significant difference between pretest and posttest scores among Dhobis with toe walking exercise for heel pain relief.
H2 ; There will be a significant difference between the pretest and posttest scores among Dhobis with placing the legs on heated calotropis gigantea with honey for heel pain relief.
2H3 ; There will be a significant difference betweenthe toe walking exercise and placing the legs on the heated calotropis gigantea leaves with honey for heel pain relief.
H4 ; There will be a significant association between the demographic variables of Dhobis with toe walking exercise and calotropis gigantea leaves with honey for heel pain relief.
- MATERIALS AND METHODS:
7.1SOURCE OF DATA:
Design:
The researcher design adopted for this study is the experimentalfactorial repeated measures design.
Setting of the study:
Raichur is one of the Backward District situated in the North- Eastern Karnataka. It has an area of 6,839 sq.km and comprises of 5 towns, 830 villages and 35 wards. The study will be conducted at Kulsumbi Colony, an urban slum area of Raichur with the population of 16,82,212.
Population:
The population for the study comprises of Dhobis who are residing in selected areas of Raichur.
Sample size:
The sample consists of 60 adults(30 for toe walking exercise and 30 for heated calotropis gigantean leaves with honey).
Sampling technique:
Convenient technique will be used for selecting the sample and the study area.
Inclusion Criteria:
The study includes adults who are:
1)willing to participate in the study
2)available at the time of data collection
Exclusion Criteria:
The study excludes adults who are not:
1)willing to participate in the study
2)available at the time of data collection in treatment of heel pain
SELECTED VARIABLES:
The variables included in the present study are :
Dependent variables:
Heel pain in middle aged adults.
Independent variables:
Toe walking exercise and heated calotropis gigantea leaves with honey for heel pain.
Extraneous variables:
In the present study it refers to age, sex, martial status, number of children, educational status, type of family, sources of information and treatment exposure.
- Age:It refers to the chronological age of the adults.
For the present study age was categorized as,
a)30-40 years
b)41-50 years
c)51-60 years
- Sex: It refers to the character of being male or female.
For the present study sex was categorized as,
a)Male
b)Female
- Martial Status:It refers to the state of marriage.
For the present study martial status was categorized as,