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Ask an expert - muscles and bones - feet

26 questions

Q:  I have suffered heel pain for 3 years.  I have plantar fascitis in  both feet after running on a trend mill in flat shoes.  Now  my right foot is very troubling,  I  stopped having cortisone injections about a year ago,  I have tried all types of gel pads which have made no  difference.  The pain is crippling like having a nail inserted through the heel, does anyone have answers regarding acupuncture, 

A:  We were surprised to find that we had been asked a similar question some time ago and managed to trace some research; we didn't think that this would have been chosen as a research topic. The answer we gave then was:

There are a small number of encouraging studies, summarised in this systematic review:


http://www.ncbi.nlm.nih.gov/pubmed/23099290

We use the word 'encouraging' because the researchers used a protocol for gathering data which was partly devised by acupuncturists themselves within the framework often used to gather material, and the results reflect far more accurately than usual the probable benefits of acupuncture.

However, all reviews of this kind will conclude that more and better studies are needed. This is just a reflection of the fact that while acupuncture is regarded as a fringe activity it will never attract the levels of funding which are required for studies of sufficient size, and we shall be continually reporting that there are encouraging but inconclusive signs!

We would really like to know a little more about how the condition which you have developed. This is quite often associated with exercising or jogging, and this impacts on the possible solutions. What we can say is thatwe would want to know what had been ruled out by conventional tests before we gave a professional view of whether we could help. There are some forms of damage in this area which would not be amenable to acupuncture treatment, and might only be corrected by surgery.

However, the majority of cases involve inflammation and tightening of the tendon, and from a Chinese medicine perspective this points either to local blockage and stagnation through over-use or accident, which might be amenable to local treatment, or a much more wide-ranging systemic condition of which this is the earliest manifestation. The skill and art of the practitioner is what enables them to determine the extent to which the problem is a reflection of a wider pattern of imbalance, and this in turn ensures that the treatment is not applied just locally as a quick fix which may not last that long.

The advice in all of these cases, where we lack the specifics of the problem and cannot make a face to face assessment is to visit a BAcC member local to you and see if they are happy to give up a short amount of time without charge to give you a more balanced view of what acupuncture treatment may be able to achieve. If they think there are other and more effective options, they are likely to say so.      

This probably remains the best that one can say. We are assuming that the various investigations have ruled out a calcaneal spur, which if it were the case is not really going to shift without surgery. If it does arise from tendon problems, however, then there may well be some hope that acupuncture may be able to offer something. Even as pain relief treatment can be very beneficial, but the question then becomes how much relief and how sustainable it is. This can sometimes become a financial equation - is the expense worth the extent of relief - but for some people it is important to buy some pain-free time when they need it.

Our advice always remains the same in these cases: visit a BAcC member local to you for an informal assessment, hopefully without charge, of what acupuncture treatment may be able to offer.

 

Q:  My mother is 93 years old and has had neuropathy in both feet and lower leg area. She has no pain but numbness and walking is difficult. Very unsure and poor balance. She has had acupuncture for 9 weeks with no sign of any change and balance is worsening. What are the chances of improvement?

A:  That is very difficult to say. Your mother's age is not the primary factor here other than that it is sometimes difficult to determine whether the decline in balance and confidence is entirely related to the underlying pathology. As the son of a 96 year old mother this 'expert' has seen a gradual decline in both her confidence and her balance which is not atypical of the pattern in many of the co-residents at her home without there being any obvious pathology.

However, if it is related to her neuropathy, as a general treatment comment this can be a difficult problem to address. Most of the questions we have been asked about neuropathy have tended to be about the treatment of the problem as a product of Type-2 diabetes and involve a certain amount of pain rather than simply numbness and balance. Much of the research in this area is focused on pain reduction (chemotherapy-caused neuropathy is another common presentation), and the outcome measurements for this are much more easily documented than those for balance and numbness. Numb patches can move around, and some days balance can be better than others for all sorts of reasons.

That said, most of the research shows positive outcomes, and after nine sessions your mother should be showing some small improvements, or at least evidence of not getting worse ('getting worse slower' as one of our more witty patients remarked). When we are treating someone with neuropathy, though, we are treating them, not simply the condition, and we are looking at their symptoms in the context of their whole overall patterns of balance. This means, as we are sure you will have read, that twenty people with the same named condition might be treated twenty different ways by a Chinese medicine practitioner. This does mean that we would always be looking at all aspects of someone's health all the time, and in cases where there is a 'headline' problem we would always be looking at other outcome measures to see if there were evidence of progress. This can sometimes be in the form of better sleep or better digestion, or the improvement of a secondary problem. This sort of thing, together with encouraging changes in diagnostic signs, might be enough to make a practitioner confident that change will occur.

There does come a point, though, where it appears that nothing is happening, and it is far better to draw a halt at this point and look at other alternatives rather than plod on in what Doctor Samuel Johnson once called in another context 'the triumph of hope over experience'. This expert has sent patients on to cranial osteopaths or reflexologists when there seems to be little chance of progress, and we all work alongside other healthcare professionals whose work we know and trust and who may be a better alternative.

So, in summary, we're not sure we could even begin to quantify your mother's chances of improvement, but we think it may be time to have a serious discussion with the practitioner about the value of carrying on and whether there is anything in the clinical picture which encourages them to believe that change is nigh.

Q:  I have been having  acupuncture treatment for ankle swelling and pain mostly on the outside of the foot but after three treatments I have been noticing pain on the inside of the foot more than out. Is this possible?

A:  This is always possible, although without knowing a great deal more about what caused the ankle swelling and pain we are not able to be too precise.

It is not uncommon, when treating patients with a problem on one limb, or even one side of the body, to find that as the body restores normal function and with it normal structure, the side which has not been troubled now starts to play up, This can often happen when a limb or foot is rotated and the muscles are slightly less stretched than they should be. When they are stretched into normal shape this can hurt. Osteopaths and chiropractors routinely warn their patients that they may get some unusual reactions in the body as normal structure is re-asserted, and our work, which encourages better structure through regaining best function, is no different.

However, sight unseen it is really difficult to say, and we think that your own practitioner is the best resource you have at your disposal. He or she will know exactly what they have on the basis of exactly what they found, and this will enable them to make better sense of what you describe than we are able to at a distance.


Q: I have had a tendon reconstruction in my ankle and my ankle swells I have had physio but I was told it was the fluid is not draining as I was not very mobile for a long time will acupuncture help with the swelling . It swells so  I have trouble bending it.

A:  Sight unseen it would be quite difficult to say with any certainty that acupuncture treatment might do the trick.

A great deal depends on the damage caused by the operation. There is often collateral damage from reconstruction surgery in the form of scar tissue and from a Chinese medicine perspective even the most beautifully executed surgery can disturb the flow of energy in the channels. This can in turn affect the flow of body fluids in the area and lead to the kind of blockage and stagnation from which you appear to be suffering.

Recovery also depends on your overall balance and state of health. We are always at pains to point out that treatment is always of the individual, not simply the presenting symptom. A large part of our diagnostic process calls for skilled judgement about why some problems fail to heal in the context of someone's overall health. Sometimes a problem is self-contained in an otherwise perfectly healthy person, sometimes the problem is exacerbated and prevented from healing because of the person's overall condition.

That's the disclaimers out of the way! We suspect that acupuncture treatment might well be able to help the problem and enable you to do some of the physio exercises slightly better, which in turn will help to resolve the problem. The best advice is that you visit a BAcC member local to you for an informal assessment. Most are happy to do this without charge, and it enables someone to offer a much better idea of what is possible than we can offer here.

 

Q: I have seen my GP about hot feet which stop me sleeping. It's a perception of heat because the feet feel cool. They also get puffy by the end of the day. My GP has eliminated thyroid problems, diabetes, Vit B12 deficiency. She has changed my statins and my blood pressure tablets. So far I am not responding to treatment. Do you think acupuncture might help?

A:  One of the great strengths of Chinese medicine, aside from its entirely different grasp of what is happening in the body, is that it is rooted in the lived experience of the people it treats. With no elaborate tests and only the diagnostic tools of the practitioner to see, hear and feel what is going on in the body's energies, a great deal depends on what people actually report by way of symptoms. Over two thousand years of practice has meant that odd sounding conditions like 'feet are cold to touch but feel hot on the inside' have found their way into the syndromes, the regularly occurring patterns which are common enough to get generic diagnoses and treatments.

However, although the symptom may appear in a number of commonly recognised syndromes that does not mean that a practitioner will go straight ahead and treat according to a text book. Using formula treatments sidesteps one of the most important aspects of Chinese medicine, which is that it is the person we treat, not simply the condition. Our question to ourselves is not 'why has this symptom occurred' but 'why has this symptom occurred in this particular person.' There is a huge difference in the impact of treatment based on this distinction; formula treatments may work but may also only have short term effects because another underlying problem may be the real driver of the hot feet, and just treating the symptom is like turning off an alarm because it is too noisy. A skilled practitioner will want to make sure that a symptom is understood in its overall context in order to ensure that if it does go it stays gone.

This also means that things may not be as simple as they appear, which is why we always recommend that a prospective patient pops along to see a BAcC member for an informal assessment of what is going on. This will give them a much better chance to find out what may be involved, and it also gives the person a chance to meet the practitioner and see where they work before committing to treatment. Most members are happy to do this without charge.

In summary, though, this is a symptom we see regularly, and we can in most cases make sense of it. This is not a guarantee of success, but it does mean that a practitioner will have some immediate lines of enquiry to follow. What we always recommend, though, is that if you decide to have treatment, make sure that progress is reviewed frequently. It is all too easy to find that treatment can stretch out to over a dozen sessions without any discernible change, and this can eventually become a source of discontent. Finding an objective measure of change really helps, and can guide both practitioner and patient in whether the treatment continues to be worthwhile. 

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