Ask an expert - muscles and bones - feet

36 questions

Q. Do you treat Mortons Neuroma?

A. We have certainly tried to treat Morton's Neuroma, and not always with success as a rather downbeat answer from last year indicates:

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

http://acuroots.com/mortons-neuroma-treatment-plan-with-acupuncture-and-tui-na/


(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.

This still represents the best that we can say. We have looked at the research databases to see whether any further case studies have appeared, but the cupboard is remarkably bare.

There is an interesting case study about the use of therapeutic massagehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390214/which is useful for the background information, but nothing new involving acupuncture treatment.

However, we have since heard anecdotal accounts of people committing to lengthy spells of treatment which have seen significant changes, and when you consider that surgery is probably one of the few other options available, this may not be a bad thing to try.As always in cases where the evidence base is a little thin and where the stories of success are not that frequent we advise prospective patients to set or find measurable targets for change, and also to insist on regular review periods if they do go ahead. The measurable target is essential; problems like Morton's neuroma can lead to good days and bad days, and asking how things are on either won't really help to decide whether to carry on. Walking further and with less pain is something which is more difficult to argue about, and this really helps where changes can sometimes be too small to recognise day by day.Reviews are equally essential. Where there may be a long haul it is very easy to rack up a very large bill for treatment without realising it, and it always pays to know where you are, both in terms of progress and expense. As above, an initial informal chat with a local BAcC member is a great place to start.

We don't think that there is a great deal that we can add to this. Some cases respond well, others don't but we have never found anything with predictive value to see which is which before starting to treat. That is why we are very cautious, review regularly and make sure that a patient is happy to continue in the absence of immediate change. 'Treatment habit's can become expensive very quickly and don't play well when someone realises that nothing much has happened.

Q. I have been suffering from intense heel pain in both feet now for 6 years. I've been through years of physio/insoles/MRI/surgery etc in attempts to find the cause. Research now leads me to consider peripheral neuropathy. 15 years ago I suffered an almost terminating attack of Guillain-Barré Syndrome and I wonder whether this may be involved. I live on Hampshire/Surrey border. Could I get some recommendations for expert acupucture in this area, specialising in Peripheral Neuropathy.

A. The first thing to say is that there are only a couple of areas where we take specialism seriously - paediatrics and obstetrics - and where are are eventually likely to recognise expert training. Chinese medicine is by its very nature generalist because we treat people with conditions, not the condition itself. In that sense we are all qualified to treat everything, although we have to be very careful how we say this because treat implies cure, and treating people with, for example, cancer is not about curing so much as maximising the body's balance. It's an easy misunderstanding to foster.

That said, many problems present locally against a backdrop of systemic weakness, so some protocols emerge which can be applied within the overall context which we would primarily treat. We have been asked about peripheral neuropathy on a number of occasions, and a typical answer has been



There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html


shows but this is not yet compelling enough for us make a firm recommendation. If you google for results from the US National Centre for Biotechnology Information, a very useful research resource, as 'ncbi acupuncture peripheral neuropathy' you will find references to a number of studies, some of which seem to show very positive results, others less so. Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.
Chinese acupuncture is based on a theory of energy, called 'qi', and its flow and balance in the body. This can often mean that the needles used in conditions like peripheral neuropathy are often local to the problem and seen as a blockage in the flow of qi, but Chinese medicine has an elaborate understanding of the functional nature of the internal organs, understood entirely differently from in the West, and will often look at how the problem may also be a manifestation of a wider functional disturbance in the system. Then, of course, you have the underlying premise of the original Chinese medical systems which were largely asymptomatic, regarding the achievement of overall balance as the primary aim in the belief that this would deal with symptoms wherever they manifested.
The important element in treating peripheral neuropathy is understanding the physiological basis for its appearance in western terms and being realistic about what may be achieved. If this amounts to maintaining the status quo, or even as one very wise patient expressed it 'getting worse slower', then as long as this is the agreed basis for treatment, that is fine. Our members are trained to avoid raising unreal and unreasonable expectations in people with degenerative conditions or permanent physical damage. Talking to a BAcC member local to you face to face may be the best advice if you are considering treatment. They should be able to assess relatively quickly whether acupuncture was a worthwhile option for you.

From a conventional/western perspective it is quite possible that the Guillain Barre episode has resulted in nerve damage, and to that extent there may be a limit to what is achievable. We do come across cases, though, where the disruption in the flow of energy as we see it produces a pain which is assumed to arise from a broader condition someone has. Once people get a disease label it seems quite common to refer everything back to it. This is why we always recommend in cases like yours that a chat with a local BAcC member is always worthwhile. It is sometimes possible to see signs of blockage which would encourage the view that treatment may help.

We always have to be realistic, though, and after 15 years of unrelenting pain it would be a long shot for acupuncture to do the trick quickly. This does leave you open to the possibility of running up a large bill in the attempt which achieves nothing significant, so if you do decide after talking to someone to go ahead we would recommend that you try to find as objective as possible an outcome measure of progress and agree regular review periods before you start.

Good luck!

We have usually taken a rather downbeat view of how successful treatment can be, as this 'nested' response last October shows. Our personal experience is that by the time people come to acupuncture treatment there is often not enough evidence to underpin a commitment to a long course of treatment which may be necessary. Hence we wrote back then:

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 practitionerhttp://acuroots.com/mortons-neuroma-treatment-plan-with-acupuncture-and-tui-na/(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 powerfulThis still represents the best that we can say. We have looked at the research databases to see whether any further case studies have appeared, but the cupboard is remarkably bare.  There is an interesting case study about the use of therapeutic massagehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390214/which is useful for the background information, but nothing new involving acupuncture treatment.However, we have since heard anecdotal accounts of people committing to lengthy spells of treatment which have seen significant changes, and when you consider that surgery is probably one of the few other options available, this may not be a bad thing to try.As always in cases where the evidence base is a little thin and where the stories of success are not that frequent we advise prospective patients to set or find measurable targets for change, and also to insist on regular review periods if they do go ahead. The measurable target is essential; problems like Morton's neuroma can lead to good days and bad days, and asking how things are on either won't really help to decide whether to carry on. Walking further and with less pain is something which is more difficult to argue about, and this really helps where changes can sometimes be too small to recognise day by day.Reviews are equally essential. Where there may be a long haul it is very easy to rack up a very large bill for treatment without realising it, and it always pays to know where you are, both in terms of progress and expense. As above, an initial informal chat with a local BAcC member is a great place to start. 

You will not be surprised to hear that we have been asked this question before, although not for some time. Our last answer over a year ago said:

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

http://acuroots.com/mortons-neuroma-treatment-plan-with-acupuncture-and-tui-na/

(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 gettinneuromas, 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

This still represents the best that we can say. We have looked at the research databases to see whether any further case studies have appeared, but the cupboard is remarkably bare.  There is an interesting case study about the use of therapeutic massage

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3390214/

which is useful for the background information, but nothing new involving acupuncture treatment.

Our earlier advice, to visit a local BAcC member for an informal assessment of what may be possible, is still likely to be your best option. We are confident that you will get an honest opinion before committing to treatment.

You will not be surprised to hear that we have been asked this question before, although not for some time. Our last answer over a year ago said:

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

http://acuroots.com/mortons-neuroma-treatment-plan-with-acupuncture-and-tui-na/

(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

This still represents the best that we can say. We have looked at the research databases to see whether any further case studies have appeared, but the cupboard is remarkably bare. Our earlier advice, to visit a local BAcC member for an informal assessment of what may be possible, is still likely to be your best option. We are confident that you will get an honest opinion before committing to treatment.

 

 

 

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