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Ask an expert - muscles and bones - feet

24 questions

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. 

Q:  Four years ago I had surgery for an abscess in my foot, which has left me with nerve damage. The pain has got worse recently with constant throbbing day and night in my big toe, so much so that sleeping has become a problem. I have been prescribed Gabapentin which did help with sleeping but I have had several side effects and I do not like the idea of being on medication permanently. I do take regular exercise. Do you think acupuncture would help?

A:  This is rather difficult to say. A great deal depends on what damage was actually caused during the operation, and more particularly why the pain has started to get worse four years after the event. There is quite a deal of evidence suggesting that nerves in the periphery can regenerate, and one would assume that after four years most of this has already taken place. If there is now continuing and increasing pain, it suggests that either a nerve ending has permanently severed and rather like phantom limb syndrome is sending out signals which cause considerable pain, or there is scar tissue from the operation which is now impinging on a nerve and generating pain. The latter would seem more likely on the basis that natural changes in the gait might be more likely to bring the scar tissue into increasing play, but this is speculation - the bottom line is that you have pain.

From a Chinese medicine perspective, pain results from changes in the flow of energy, either excess or weakness of flow, or more often blockages. The aim of treatment is to restore the proper flow in the simple but effective belief that improved flow means less pain. Interestingly there is evidence for the treatment of phantom limb syndrome, as we wrote recently

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97

Hecker H. -U et al (2008) Color Atlas of Acupuncture 2nd Ed. Thieme, Stuttgart

Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142

Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112

Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213

Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

The mechanism by which the treatment works is not at all clear from a Western medical point of view. From a Chinese medicine perspective it is perhaps easier to make sense of the appearance of the pain from the fact that the channels which run through the affected area spread out across the body, and even in 'conventional' Chinese medicine treatment it is not unknown to treat a problem in the lower left limb by using points in the upper right limb. The fact that the opposite limb is missing would not necessarily render the treatment useless.

and we have also written about scar tissue and its impact on health. There is little research to back this up, but many of us have had the clinical experience of using very simple treatments across scar lines to 'join the dots' as it were and often to great effect.

Since each particular instance of damage will be unique and different, though, the only really good answer we can give you is to visit a BAcC member local to you for a brief face to face assessment of what may be possible. What we would say, though, is that if your health is otherwise good, you would be well advised to limit the number of treatments you have initially to three or perhaps four. Our experience is that if something is amenable to change then there should be some signs quite rapidly. What we don't like to see is patients buying into extended courses of treatment when there is really no evidence of change.

We should also mention that acupuncture can be used as a more general systemic agent of pain relief. Indeed, after Nixon's visit to China in the 1970s and strange footage of people having operations without anaesthetic a great deal of research was done about the ability of needles to release the body's own painkillers, enkephalins and endorphins. There is substantial evidence supporting this facility, and the question is how much relief and how sustainable. Unless the relief is very long lasting, though, or the pain so intractable that any relief is worthwhile, it may not be an economically viable option for most people if the improvements are only ever short term.

Q:  I have morton neuromas on both my feet affecting the toe next door to the little toe in both cases. I have had steroid injections in the past but want to look into alternative treatments and thought acupuncture the best place to start. Can you advise me if it is affective please?

A:  We have to be honest and say that there is not a great deal of evidence for the effective treatment of Morton's neuroma with acupuncture. We published an answer through this same section three years ago to a question from a patient who was convinced, and with some justification, that treatment with one of our colleagues has been wholly responsible for a complete improvement in his condition. 

We have to say, though, that our clinical experience runs counter to this, which is why the very upbeat tone of webpages like that of this American practitioner

(informative as it is) raises a wry smile. If only... Having said that, what he describes in the formation of the tissues which cause the condition is something with which we deal elsewhere on the body, and in theory there is no reason why treatment should not be able to reduce some of the discomfort. However, we would be very surprised if this could be done without the aid of orthotics which reduce some of the pressure on the affected areas while any treatment beds in.

Each case is unique and different, however, and the only real solution is to seek face to face advice from a BAcC member who can look at exactly how the problem manifests in you, and more importantly, can see the overall context in which it is occurring. One of the great strengths of Chinese medicine is that it looks at the whole system, not simply at a symptom which is regarded as merely a warning sign. Thousands of people with identical foot structures to you will walk thousands of miles without getting neuromas, and there may be systemic problems which have predisposed this to happen.

The other recommendation we would make, and we are sure that you have done this already, is to find a good chiropodist or podiatrist who can work alongside any other treatments you try to help to maintain improvements. Working in partnership with other health professionals for problems like yours can often be extremely powerful

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