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Ask an expert - muscles and bones - feet

15 questions

A:  As you can imagine we have been asked this question a number of times, and a typical answer was:

Can acupuncture help with plantar fasciitis?

Plantar fasciitis can be a very unpleasant and debilitating problem, as you no doubt know. There is some evidence for the use of acupuncture treatment, as this paper shows,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094706

and if you google 'acupuncture' and 'plantar fasciitis' you will find a number of other papers which suggest that there may be benefits from treatment. However, the combined weight of the various studies is not enough to be able to give an unqualified recommendation.


 

That said, the strength of Chinese medicine is that it operates from an entirely different paradigm or theoretical basis, and has different ways of making sense of the symptoms which a patient is experiencing. This can sometimes offer treatment options which would not necessarily translate into a western understanding of physiology, although there is usually an overlap. The system of medicine rests on a theory of energy, called 'qi', whose flow and balance determine how well the various systems of the body function. Many problems like plantar fasciitis point to local blockages and disturbances, often due to over-use or poor gait, which once they have become established remain a problem even after someone's habits have changed. Symptoms such as this can also point to more systemic problems, and the skill of the practitioner lies in making a clear diagnosis of the whole system before starting to correct aspects of it.

In this case, since the presentations of plantar fasciitis can be very different, we would advise you to visit a BAcC member local to you for a brief face to face assessment of the problem before committing to treatment. We are fairly sure that you will have seen a chiropodist as well as your GP, but if you have not, we would highly recommend that you do. There are a number of treatment options which can work alongside acupuncture treatment to great effect, and with these sorts of problems it is often a combined approach which pays the greatest dividends.

We believe that this remains sound advice. Our own personal experience of treating the condition is that if the treatment is going to work it begins to show evidence of change fairly promptly. The real problem with chronic conditions like this is that it can occasionally lead to a treatment habit developing where hope triumphs over experience and treatment can continue far beyond a time when it is clear that nothing is happening. If you did decide to go ahead it would be wise to identify as objective as possible outcome markers for improvement, something which can be measured, and to ensure that progress is reviewed carefully every three or four sessions.

As an additional aside we have recently heard a number of reports of osteopathy being used to good effect alongside acupuncture treatment to provide better relief, as well as reflexology often being mentioned as a worthwhile option. We mention this because if acupuncture did fail to generate results it is good to know that there are other options for treatment available.  

Q: I have been diagnosed with tendinitis of the ankle/foot . It is very disabling . The doctor told me that the only cure is rest. Would a course of acupuncture help?

A:  We have to be honest and say that this is one of the areas of treatment where the formal evidence is not that good but the evidence by word of mouth from practitioners is pretty good. We have done the usual searches of databases to see if things have changed much from the last time we answered questions about tendonitis in the Achilles tendon, and the answer is 'not much.' There are quite a few studies of tendonitis in  various areas of the body, and both these and the systematic reviews tend to conclude that evidence looks promising but that larger and better trials may be necessary. There are frequently criticisms of the trial methodologies which are often used to undermine the provenance  of their results.

However, from a Chinese medicine perspective the proper functioning of tendons, their flexibility and strength, is seen to be a part of the wider functional responsibilities of some of the Organs (these are capitalised to distinguish them from organs as we understand them in the West) . If there is a functional disturbance of an Organ which could impact on the tendons, then it is highly probable that a skilled practitioner will see further evidence of Organic failure, and by treating the system as a whole begin to restore balance and proper function. Even where this is not the case, the theories of the flow of energy in channels known as meridians means that there are sometimes local blockages, occasionally bilateral, which can impair the nourishment of local tissue and cause weakness and pain.

We think the best advice we can give is that you see if a BAcC member local to you is happy to give up a small amount of time without charge to give you a brief face to face assessment of what might be possible. Most are only too happy to do this, and if they think that they can help they will give you an idea of what might be involved in terms of frequency and cost of treatment. They may also recommend other modalities which may help. We have seen many patients benefit from reflexology either alongside or instead of acupuncture treatment, and some forms of massage can also be very helpful.

A:There is no evidence that we can find, at least not in English, that acupuncture has been successfully used to treat bunion pain. There may well be papers amongst the many thousands published in Chinese each year, but none have as yet been translated. Working on the premise that important papers often make it into English you could probably assume that this means that there are no landmark studies.

From a western perspective once a bunion, always a bunion, unless you have an operation. The thickened skin and additional bone growth are not likely to be dealt with by anything short of surgery, and the best that is usually offered is anti-inflammatory medication to reduce the secondary inflammation and management advice - wider shoes, forms of cushioning.

There is a long and well-researched tradition in Chinese medicine of the use of acupuncture to deal with chronic pain, and the question in this case is simply how much pain relief treatment may provide and how sustainable it is. If treatment offered relief for a week or so, then it may be a worthwhile continuing programme, but it would not be realistic to look for anything beyond temporary relief alongside conservative management strategies like better footwear and padding.

There may be some merit in talking to a BAcC member local to you who can give you advice on the unique presentation of your problem, but as a general rule we would have to say that the chances of radical change in an area which it is difficult not to irritate in daily life are relatively small.

Plantar fasciitis can be a very unpleasant and debilitating problem, as you no doubt know. There is some evidence for the use of acupuncture treatment, as this paper shows,

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094706

 

and if you google 'acupuncture' and 'plantar fasciitis' you will find a number of other papers which suggest that there may be benefits from treatment. However, the combined weight of the various studies is not enough to be able to give an unqualified recommendation.

That said, the strength of Chinese medicine is that it operates from an entirely different paradigm or theoretical basis, and has different ways of making sense of the symptoms which a patient is experiencing. This can sometimes offer treatment options which would not necessarily translate into a western understanding of physiology, although there is usually an overlap. The system of medicine rests on a theory of energy, called 'qi', whose flow and balance determine how well the various systems of the body function. Many problems like plantar fasciitis point to local blockages and disturbances, often due to over-use or poor gait, which once they have become established remain a problem even after someone's habits have changed. Symptoms such as this can also point to more systemic problems, and the skill of the practitioner lies in making a clear diagnosis of the whole system before starting to correct aspects of it.

In this case, since the presentations of plantar fasciitis can be very different, we would advise you to visit a BAcC member local to you for a brief face to face assessment of the problem before committing to treatment. We are fairly sure that you will have seen a chiropodist as well as your GP, but if you have not, we would highly recommend that you do. There are a number of treatment options which can work alongside acupuncture treatment to great effect, and with these sorts of problems it is often a combined approach which pays the greatest dividends.

 

Q:  Could acupunture help with pain in my heel and tight calf? I  have had a steriod injection  in my heel but it has not really helped.

A: 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 actibity 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.      

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