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Ask an expert - muscles and bones - feet

30 questions

Q  I have no upward movement in my big toe joint following an operation to remove a lump in the base of my foot. Can acupuncture help with muscles and nerves? 

A: A great deal depends on the extent of the damage caused by the operation.

 We do not intend any criticism of your surgeon or podiatrist, but any operations to remove lumps or growths carry a small but real risk of interfering with both the nerves which supply the foot 'downstream' and also the muscles which sometimes have to be cut slightly, or may even have become fused to the lump and become collateral damage when the lump was taken out. It would only be fair to say that if the damage is permanent then acupuncture treatment will not make a difference.

 However, traditional Chinese acupuncture operates on an entirely different theoretical basis from western or conventional medicine. The basic premise is that the body, mind and emotions are all one interconnected flow of energy, which the Chinese call 'qi' and which does not translate well into English. Health, vitality and proper function all depend on a good flow, rhythm and balance of energy. When someone has an operation involving cutting through tissue there is always likely to be some break in the flow. In severe cases, especially when someone has a great deal of keloid scar tissue, the blockage this creates can cause significant trouble. In more confined areas it can result in symptoms such as you describe, loss of sensation or loss of movement.

 

Of course, if everything in life were that simple it would be an easy thing to fix; just pop into an acupuncturist's clinic, have a few needles and all should be well. In reality, some cases respond well and others don't respond at all. There are all sorts of factors which influence this, not least of which the overall balance of energies in the person in whom the problem occurs. This will mean that some people will heal faster anyway, and others will struggles. A skilled practitioner would take this into account when making an assessment.

 In any event, where the outcome is rather uncertain it is vital to set a limit to the number of treatments which someone has before drawing a conclusion about whether it is working. Having a measurable outcome makes life much easier because progress will be visible, not just based on how someone feels on the day. We tend to suggest that four or five sessions at most are a good chance to tell whether treatment will work. If there has been no change at this point it may be good to look at other options.

 The best advice, which we invariably give, is that someone visits a local BAcC member for an informal assessment of what may be possible. Actually seeing a problem is a far better basis for offering advice, and most members are happy to spare a short time without charge to see if it is something they think they could help with.

A:  We tend to stay away from words like 'cure' but there is no doubt that acupuncture treatment may be worth trying and will certainly not do any harm.

 As you may have read from our website the theories of acupuncture are based on a flow of energy, called 'qi', in the body, mind and emotions. How well this energy flows, its balance and rhythms, can have a profound effect on the effective functioning and health of the body. Where there is excess, or deficiency, or blockage, the resulting change in the flow will generate symptoms like pain or stiffness.

 Clearly a broken ankle may well have had a considerable impact on the channels of energy which flow through the region. Not only will the break itself have disrupted the flow but the attendant swelling and immobility of the joint will have probably added layers of further restriction to the flow. Reinstating this by using acupuncture and the other modalities we often use may well have a beneficial impact on the restoration of better function.

 There is always the caveat, of course, that if the bone has not set as it should, or if there has been some arthritic change because of the break, then there may be more challenges to get things to work better again. This might require a level of pain reduction, which is a well researched aspect of all forms of acupuncture, but this can often be a continuing treatment based on how much relief someone gets from the pain and how sustainable the changes are.

 The important thing to do, however, is to try to set measurable outcomes for improvement, things which will demonstrate without a doubt that there has been a positive change. We are always wary of getting into a 'treatment habit' where dealing with a long standing problem can often mean that a patient can clock up a dozen treatments without realising how much of an investment they are making. It is vital to review progress on a regular basis, and to make this work you really need to have something tangible to make that assessment - less painkillers, more freedom or range of movement, and so on.

 With all problems like this, though, where the heading 'broken ankle' could mean anything from a slight crack to a massive fracture, the unique nature of each instance means that it is best to seek the advice of a local BAcC member face to face. Someone who can actually look at what is going on and also see what is happening in the system as a whole which may be impeding your healing process is going to be able to give you a far better idea of what may be possible than we can at this remove. Most members are happy to give up a small amount of time to prospective patients without charge, and this also has the advantage that you can meet them and see where they work before committing to treatment.

 

Q: I suddenly developed heel pain after a long walk four months ago and I was diagnosed with plantar fasciitis. I was told to stretch for a few weeks. I duly did this with no effect so booked myself in to see a physio. On the first session she gave me ultrasound, massage and acupuncture in three points on my heel which was incredibly painful. The heel remained painful for a couple of days but on my next visit to her I agreed to let her use the needles again. Once again the treatment was very painful particularly when she moved the needles. My heel was very sore after this at the points where the needles were inserted and it has remained sore and got progressively worse over the past five weeks. It is much more painful now than before the treatment and I can only walk short distance in hugely padded shoes. It doesn't appear to be infected although is slightly swollen at the end of each day. I have since been referred to a consultant who said he didn't think I had plantar fasciitis and ordered an ultrasound which showed no evidence of plantar fasciitis. There was therefore no treatment he could recommend for it.  I have not returned to the physio because I don't want to be hurt more.  Is it possible that the tips of the needles broke off or the plantar fasciitis has been damaged when she moved the needles?

A:  Let us say straight away that it is highly unlikely that you have a small piece of broken needle or needle tip in your foot. The manufacturing standards of needles are now governed by an ISO and BSI guideline which means that you can be pretty much assured that they will not be susceptible to damage or breakage. With needles being used only once, and with them being disposed of straight away, the causes of breakage in the distant past - repeated sterilisation at temperature - no longer apply. Even when needles were re-used we know of no instance in the UK for the last forty years of any such occurrence.

 Plantar fasciitis is unmistakable as a condition, both to the sufferer and also to the person using ultrasound. US normally provides a highly accurate diagnosis, and if the consultant reports that there is no trace, then either it was never plantar fasciitis or the treatment worked. If it is the latter, then the only possible explanation is that the treatment itself has caused some internal bruising which is being exacerbated whenever you bear weight. If this is the case it will resolve within a few weeks. 

 If it wasn't plantar fasciitis then it all depends on what it was. We wrote an answer to a similar question a little while ago in which we said:

 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 that we 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.

We think you can rule out calcaneal spur; the US would have picked it up and it is very focused and obvious.  As far as the pain of needling is concerned, that is not unusual when needling points on the base of the foot, and is especially uncomfortable on the heel itself. There is a very powerful point in the mid point of the sole which many patients have once and refuse again (me included!), so even well-aimed treatment on a sound diagnosis could be unpleasant. However, if there is a residual effect, it is most likely to be bruising and inflammation caused by the needling and will subside with time.

 The main difference between traditional acupuncturists and medical professionals who use acupuncture is that medical acupuncture tends to be a little more 'point and shoot' whereas we generally use lighter techniques and can work at a distance to try to move stagnant or blocked energy. This makes our approaches a little more versatile, especially if we are able to make sense of the presentation as a part of a more general systemic weakness against the backdrop of which the local problem is generated.

 The advice we gave before, to see a local BAcC member, may be a valid option if you need someone to take a look and assess what is happening.  

 

Q:  I had been treated for plantar fibroma in my foot and the needle was inserted on inside of my ankle.  Every time my foot jumped and I felt like electricity goes thru my foot into my toes. After 10 treatments I have pain in my foot feels like my nerves are inflamed or something. I stopped my treatments but the pain is still there. Please tell me do I need to see the doctor or the pain will go away.

A: Without seeing exactly what is happening we would probably expect the pain to start diminishing soon. It may well be that the practitioner caused a small bruise during one of the sessions which repeated needling of the same point has caused to stay 'active', causing a mild impingement which will go over time.

 However, the feeling of electricity in the foot does raise the less possibility that there has been some damage to the nerves themselves. The inner aspect of the ankle is a very densely packed area with many nerves and blood vessels, and it is possible to hit a nerve directly if the needle is used too vigorously or too deeply. Again this should diminish with time, but may take a little longer.

 The key thing, difficult as it is to judge, is that the pain or discomfort starts to diminish. If this is the case then the problem will resolve itself. If the pain continue at the same level or whenever you move in a certain way, then it may be a wise move to see your GP and arrange for some neurological testing. This may even be a good idea anyway to reassure you that there has been no permanent damage.

 Acupuncture treatment rarely causes actual permanent damage, and most adverse events, as these sorts of outcomes are described, are transient and go away within days. Occasionally, where there has been bruising near nerves or a nerve has been touched directly by a needle the effects can last for a few weeks, but permanent damage is rare.

 We are very sorry to hear that this has happened to you and hope that it all resolves well.

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.

 

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