Pada Bhramsha: Meaning, symptoms, treatment

Article by Dr Manasa, BAMS & Dr Raghuram Y.S. MD (Ay)

Pada Bhramsha is one among the eighty types of Vata Nanatmaja Rogas. These are the special disorders caused by aggravation of only vata.

The word Pada Bhramsha is made up of two terms –

• Pada – foot / feet or ankle joint
• Bhramsha – displacement, instability, unstable   

So, Pada Bhramsha is a condition wherein the person feels as if his foot / ankle joint is unstable and has been displaced. Pain, discomfort and swelling of feet too may be present. This condition is caused by aggravated vata.

In short, pada bhramsha means ‘foot or ankle instability / instability of foot’.

Causative Factors of Pada Bhramsha

Since pada bhramsha is a vata nanatmaja roga, vata aggravation is the main event which needs to occur so as to cause this condition.

Below mentioned are the important causes of pada bhramsha –

Walking and running on uneven surfaces – Regularly walking or running on uneven surfaces will cause aggravation of vata in the foot. When done for a long time or having a habit of doing so regularly would cause instability, pain and discomfort in the ankle joint / foot.

Excess weight bearing on the foot – In those obese or overweight, the body weight will be transferred to the foot / feet. This would make the foot instable. Increase of fat in the body will deplete other tissues. This will cause asthi kshaya also i.e. depletion of bone tissue. Depletion of muscle tissue will cause instability and pain in joints. When these events happen in ankle joint / foot, it causes instability of foot or ankle.

Chronic aggravation of vata in the foot / ankle joint – Sandhigata Vata i.e. chronic aggravation of vata in the ankle joint or foot will cause pain and instability in the ankle joint.

Ankle sprain / Khalli – It is a vata disorder which causes twitching / twisting of ankle / foot joint due to walking on uneven surfaces. Repeated sprain would cause foot instability.

Injury – Injury or weakness of the ligaments around the ankle joint / foot will cause vata aggravation which would further cause instability of foot.

Pathogenesis of Pada Bhramsha

Due to one or more of the above-mentioned etiological factors, vata would get aggravated. This aggravation is either generalized or localized and limited to only foot / feet (ankle joint). Generalized aggravation of vata in the entire body may get localized in weak and susceptible region of the body and cause troublesome symptoms in due course of time. In case of pada bhramsha, it would be foot / ankle joint.

Usually in case of conditions like pada bhramsha, vata aggravation would be localized since the causative factors are also limited to ‘afflicting the ankle / foot’ most of the times.

This aggravated vata gets localized in the afflicted foot, damages the ligaments, tendons, muscles and ankle joint and causes instability of foot / ankle joint. The other symptoms mentioned in the list of symptoms mentioned below may also manifest in due course of time as the disease progresses.

The instability becomes severe when the disease gets chronic or when vata aggravation is not controlled with timely interventions.

Symptoms of Pada Bhramsha

• Instability of foot / ankle
• Pain, tenderness or swelling in the foot / ankle
• Repeated ankle sprain
• Decreased movements in the foot
• Weakness of the affected ankle joint
• Difficulty in walking or running
• Difficulty in standing for long time or maintaining a stable posture
• Need for support while walking

All these symptoms are caused by vata aggravation taking place in the ankle joint / joints (foot).

Treatment of Pada Bhramsha

Nidana Parivarjana – One should avoid the causative factors which might cause or worsen the symptoms of pada bhramsha. Mainly one should stop / avoid working, walking or running on uneven surfaces. One should take care of one’s body weight and keep it in balance. Pain, injury and chronic conditions like arthritis etc. of the ankle joint / foot should be promptly treated with effective measures.

Treating Vata – Since Pada Bhramsha is caused by aggravation of vata, it is important to control and balance vata so as to control and cure the instability of foot / ankle. All vata balancing measures should be included – including foods, lifestyle changes, medicines and therapies.

Important therapies for curing pada bhramsha

a. External

• Pada Abhyanga – herbal oil massage of foot
• Swedana – sudation
• Taila Dhara – showering of medicated oils over the afflicted foot
• Pada Avagaha – foot bath / dip in medicated vata mitigating oils
• Shashtika Shali Pinda Sweda – for strengthening the foot
• Lepa – application of pastes prepared from vata mitigating herbs – for providing relief from associated symptoms like pain, swelling, tenderness etc.

Oils used for the above-mentioned therapies should include – Sahacharadi Tailam, Dhanwantaram Tailam, Ksheerabala Tailam, Mahanarayana Tailam, Lakshadi Taila and Balashwagandha Tailam.

b. Internal

Vasti – medicated enemas prepared with vata mitigating herbs will help in managing foot instability of chronic and recurring nature. Oil and decoction enemas shall be given as and when required. Matra Basti is one of the ideal choices in foot instability.

Guggulutiktaka Ghrtam, Sahacharadi Tailam, Ksheerabala Tailam, Dhanwantara Tailam shall be used for administering basti. Erandamuladi Kashaya Basti and Dashamula Ksheera Basti are also extremely helpful.

c. Important medicines

• Sahacharadi Kashayam
• Rasnasaptakam Kashayam
• Guggulutiktakam Kashayam
• Guggulutiktakam Ghrtam
• Trayodashanga Guggulu
• Rasnadi Guggulu
• Nimbamritadi Eranda Tailam

Other principles

Pada Bhramsha shall be treated on the lines of treating

• sandhigata vata – osteoarthritis
• bhagna and chyuti – fractures and dislocations
• khalli – foot sprain
• snayugata vata – ligaments and tendons afflicted by aggravated vata

Modern Correlation of Pada Bhramsha

A condition called as ‘Foot Instability or Ankle Instability’ can be compared to pada bhramsha.

The most common causes for instability of foot and its symptoms are same as those of pada bhramsha. The causes of foot instability are those which tend to aggravate vata. The symptoms of foot instability are also similar to the symptoms caused by aggravated vata. Therefore foot / ankle instability shall be managed on the lines of treating pada bhramsha and on lines of managing ‘aggravation of vata’.

Related Reading – “Foot instability or ankle instability – causes, symptoms, treatment, prevention, Ayurveda Understanding”