By Shihan Mary Bolz
Master of Science Oriental Medicine
Doctoral Fellow, FBU
Master Martial Arts Instructor
Many people have painful feet due to a variety of conditions. Foot pain can be caused by overuse, such as standing for prolonged periods of time without variety of movement, too much time in total spent on the feet without rest, poor posture, poor weight distribution due to a person’s gait and even certain deformities of the foot.
Many people also have surgery far too often for conditions that can be greatly helped or cured by proper care and treatments other than surgery. An overlooked method for treatment is acupuncture. Acupuncture can be highly successful in treating painful feet for such conditions as plantar fasciitis, Morton’s neuroma, Hammer toes, heel spurs, Achilles tendonitis, bursitis, sprained and strained ligaments and a variety of other conditions
What is plantar fasciitis? First of all, what is the fascia? The plantar (bottom of the foot) fascia or aponeurosis, as it is also called, are strong bands of connective tissue which originate at the inside bony structures of the heel, splay out over the sole, and insert near the metatarsal heads (the bony joints connecting the foot and the toes) in the forefoot, into ligamentous structures there. Superficial fascia is immediately deep to the skin, is composed of fat and other connective tissue and has four important functions: 1) it stores water and fat. 2) It forms a layer of insulation that protects the body from heat loss. 3) It provides mechanical protection against wear and tear and other outside forces. 4) It provides a pathway for nerves and blood vessels to enter and exit muscles. The plantar aponeurosis (fascia) is deep fascia that supports the longitudinal arch of the foot and encloses the flexor tendons of the foot. You may think of the plantar fascia as the tiebeam for the support of the medial longitudinal arch. There are four layers of plantar muscles which, along with their tendons control the actions of the foot. As you already may know, anytime you see the suffix, -itis, you know this means an inflammation. So we have, inflammation of the fascia on the bottom of the foot.
We, as practitioners can palpate the plantar surface of the foot. It should feel smooth, nontender, and nonnodular. Point tenderness may indicate plantar fasciitis, while discrete palpable nodules in the fascia indicate Duputyren’s contracture ( a condition which we will not go into here). Most often, nodules found on the skin of the sole, especially on the ball of the foot are plantar warts, which are tenderer when pinched than when under direct pressure. Upon palpation of the soft tissues between each of the metatarsal heads of the foot, we look for tenderness and swelling. It is not uncommon to find painful neuromas in the space between the third and fourth metatarsal heads. Callosities on the plantar surface, are tender to pressure but not to pinching. These symptoms and signs are a good indication of what is going wrong with the feet.
The term neuroma is simply a tumor on or around a nerve. The suffix -oma means tumor, while neuro refers to nerve. A very common condition in foot problems is Morton’s neuroma. In Morton’s neuroma, a digital nerve is affected, usually the one between the third and fourth toes, although it could occur on others. While walking, the person is suddenly seized with an agonizing pain on the outer border of the forefoot. The pain is often intermittent, like a cramp, shooting up the side of and to the tip of the toes or the adjacent two toes. If the metatarsal bones are squeezed together, pain will be elicited because of the pressure on the digital nerve. The condition tends to be more frequent in women than in men.
There is also a condition known as Morton’s foot, Atavistic or Grecian foot. In this condition, the second toe is longer than the first. Increased stress is put on this longer toe, and the big toe tends to be hypo mobile. There is often hypertrophy ( enlargement) of the second metatarsal bone because there is more stress put through the second toes. Acupuncture can help to improve these conditions and other related conditions contributing to painful feet.
A recent study from the journal, Acupuncture Today, relates the following for plantar fasciitis: Traditional allopathic therapies for plantar fasciitis vary depending on the degree of the condition and the person being treated. The most common forms of treatment include rest, ice, orthotics and anti-inflammatory drugs. More severe cases can require injections or even surgery. However, none of these modalities is considered more effective than another, and occasionally, patients will develop chronic, disabling symptoms despite the best efforts.
Recent studies using the scientific method have shown that acupuncture – with or without electrical stimulation – can be an effective form of pain relief for a variety of musculoskeletal conditions, but research regarding its use for plantar fasciitis is scant. In an article in a recent issue of Medical Acupuncture, researchers from Walter Reed Army Medical Center in Washington, D.C. examined the role of electro acupuncture in the management of this condition. The results of their study suggest that electro acupuncture is an effective form of care for plantar fasciitis, producing marked reductions in foot pain and improved function in a relatively short amount of time.
A total of 11 patients (73% female, average age 40) participated in the trial. All of the patients had been suffering from plantar fasciitis for a minimum of two months and were referred for acupuncture after other conservative methods of treatment had failed. Acupuncture treatment was carried out on the affected side at the rate of one treatment per week for a maximum of six sessions, or until a maximum favorable response was attained. Point selection consisted of traditional acupuncture points KI 1, 3 and 6; BL 60 and 67; GB 44; and local a-shi or trigger points on the plantar region of the foot. Once the needles were in place, an electro stimulator was connected between KI 1 to a local trigger point near the insertion of the plantar fascia to the calcaneus, and to two other points in the medial arch area. Electro stimulation was applied for 20-30 minutes per session. Two surveys were used by the scientists to measure the level and severity of heel pain. In the first, patients were asked to assess their level of heel pain before the start of treatment and at the completion of the program using a 10-point visual analog scale (VAS), with 10 representing severe pain.
The researchers also used an 11-question foot function index questionnaire that addressed how the pain affected different functions and activities. Pain severity for the questionnaire was measured using a similar scale as the patient assessment, with 10 representing severe pain or inability to function.
Results Of the 11 patients included in the study, nine reported an improvement in pain reduction of greater than 50%; two patients reported a complete resolution of heel pain. Only one patient stated that the heel pain had been reduced by less than 25%. VAS pain scores fell an average of 46% per patient, from 5.7 at the start of the study to 3.0 at the end of the program. Post-treatment foot function scores closely followed those of the pain reduction scores. Foot function scores improved an average of 3.5 points per category, with the greatest improvement seen in the areas of walking, walking inside the house, pain severity at the end of the day, and greatest level of pain.
This is only one study. However, the greatest study of all is the millions of people, and billions over the centuries that have used acupuncture for this in China and other parts of Asia, and recently also some people in the Western countries and the United States; with great results. Empirical evidence IS evidence. Not everything can be measured in a few clinical trials of scientific research methods. In fact, in the large view, over the centuries, and even in the last decade, all the clinical scientific trials are a drop in the bucket compared to empirical evidence. And, what is wrong with what works? If you have foot pain that is not getting better; before invasive methods of surgery, such as cutting the tendons; check out and try acupuncture. You have nothing to lose. But once you have surgery, there is always scar tissue and there is no return to the original condition again.
Think more than once before surgery, and pharmaceutical prescriptions, which are very unbalanced and subject you to the possibility of many ill side effects. You can always try those more drastic methods after you have exhausted all other natural means.