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Ask an expert - muscles and bones - feet

12 questions

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.      

A: There are a number of case studies, relatively small in terms of the numbers of participants, which seem to show positive and encouraging results for the use of acupuncture for foot drop after strokes. However, the evidence is by no means comprehensive or conclusive enough for us to give a positive recommendation for treatment.
 
However, a great deal depends on what else is going on in your system. Foot drop as an isolated symptom is unusual, and very often there is a more complex neurlogical picture within which this sits.  If there isn't, then from a Chinese medicine perspective the weakness would be understood in terms of a blockage or weakness in the flow of energy, or 'qi' as it is called. The  practitioner would probably use a combination of local and distal points to try to restore proper function in the tendons and muscles affected by or causing the condition.
 
If there is a wider pattern of dysfunction, however, then the chances are that this will bea a neurological problem whose treatment with acupuncture wouldm be less likely to be successful.
 
However, there is no substitute for a face to face assessment in cases like yours and we believe that it would be worthwhile visiting a BAcCc member local to you to benefit from their advice. If they feel that acupuncture will not be of use, we are confident that they may have other suggestions about what forms of treatment may be best for you.
 
 

Q:  I have numbness in my feet (not 100%)which prevents me from falling asleep and is generally most uncomfortable. It is apparently not related to diabetes - according to medical tests - nor to a neurological condition. Can acupuncture help?

A: The short answer is that it is difficult to say! Had you gone to one of our members before seeking any other treatment they would have referred you back to your GP for tests for diabetes and for further neurological assessment. Given that both of these have been done and nothing has been found, the next question would be whether the condition developed slowly or whether it had a sudden onset. This might point to an injury or set of circumstances which might explain its occurrence.
 
In broad terms Chinese medicine is based on a theory of energy, called 'qi', the flow, balance and rhythms of which maintain the body, mind and spirit in healthy function. There are a number of internal and external causes which can disturb the flow, and also a number of constitutional factors which predispose people to certain types of symptom. The practitioner will cover a great deal of ground trying to understand the unique balance of each patient to find the most effective means to try to address the problems.
 
In the case of symptoms such as numbness, there are functional reasons why this can occur, and it is a recognised part of several syndromes. If this were the case the practitioner would expect to find other parts of the same pattern in someone's health, not necessarily as symptoms, but just as features of daily living which they have come to accept as 'normal', like bruising easily. There may be more localised reasons for the symptoms, although the fact that both feet are involved tends to suggest otherwise - an identical bilateral local blockage would be unusual.
 
There is such a wide range of possible interpretations based on diagnostic evidence which we do not have that realistically the only way you are likely to get an informed answer to whether acupuncture treatment will help would be to see a BAcC member local to you for face to face advice. It is the kind of condition which we often find ourselves treating when conventional explanations have yielded no answers, but not every condition is necessarily treatable by acupuncture, and a responsible practitioner will want to see how the problem manifests before committing you to treatment. 
 

 

Q:  I have suffered from numbness and pain in the balls of my feet for 2 years. After many tests and MRI scans, I have been informed that the condition is neurological and defined as a 'painful sensory neuropathy' possibly originating from prolapsed discs in my lumbar region. I have been advised that it's not curable without surgery. Do you think that the condition could be improved by acupuncture?

 

A:  If the condition has been clearly defined as arising from prolapsed discs in the lumbar region, then we would be very cautious about making claims for what acupuncture could or could not achieve. If the condition arose from the prolapse itself, i.e. the protrusion of the disc material causing pressure on one of the nerves descending to the foot, we would expect the prognosis to have been a little more positive than this. Prolapsed material eventually tends to be cleared by the system itself, and patients are often told to expect to have a three to six month period during which things return to normal. If you've been told to have surgery as the only way to correct the problem it suggests that the compression of the vertebrae is causing the problem, in which case an operation may make a difference.
 
However, we have to remind ourselves sometimes that the system of medicine we practise has been around for 2500 years and well before the advent of X-rays, so a Chinese practitioner in ancient times, faced with the same symptom, would try to make sense of it within a system of understanding the body which has remained largely unchanged for the whole of that time. When there are areas of numbness the immediate conclusion is that there is weakness and blockage, and at a very simplistic level all we do with needles is to increase, decrease or unblock flows of energy, called 'qi', in the body. The practitioner will want to establish whether this is a local disturbance, or whether there is a blockage 'higher upstream' which is causing the problem, or whether there are systemic reasons for the problem, or even a mixture of all three.
 
This is really a matter for someone to take a look at face to face, though, to be able to give you the advice you need. It should take an experienced practitioner only a short while to determine whether they think they can help. It occurs to us that there might also be some mileage in considering cranial osteopathy as another possible modality, and if the practitioner you see thinks it may be beyond their capacity to help this is something that they may also recommend with the advantage of being able to make a personal referral. 
 

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