Plantar fasciitis is often covered under an umbrella term called heel pain along with other conditions such as heel spur syndrome, fat pad atrophy and tarsal tunnel syndrome.

This patient complained of heel pain. He is a hairdresser and put his heelpain quite correctly in my view down to wearing flat designer shoes on hard surfaces. His pain was aggravated when he played 5 a side football on Astra Turf. In my examination I looked at the following relevant muscles and found trigger points: quadratus plantae, soleus and gastrocnemius. I often examine and needle in gastrocnemius and soleus TPTs as this can significantly reduce the tension on the Plantar fascia or the Achilles tendon. The patient needed a total of 10 treatments.

Most patients will have severe pain first thing in the morning since inflammation may accumulate when the rest. Weight bearing increases pressure from this built up inflammation. This pressure will get better after the first few steps as the muscle activity enables to reduce the swelling and then the pain decreases for ordinary walking. The patients pain was causing him to limp especially when he was playing football therefore affecting gait and stride length.

In my practice I will treat Plantar Fasciitis with heelpads, orthotics, ice massage, Kinesiotaping, stretching and using either manual or electroacupuncture.

There are a limited number of studies looking at the use of acupuncture in the management of foot disorders (Bailey, 2009). Most studies indicate that electro-acupuncture is suggested to be more effective than manual acupuncture: results can be more rapid and longer lasting. They are more readily controlled, standardised as well as objectively measurable with manual acupuncture (Mayor, 2007). There are a number of studies that have shown that EA is both safe and effective in the management of Plantar Fasciitis (Perez-Millan and Foster, 2001).

In a small study (eleven patients) Perez-Millan et al. (2001) investigated EA in the management of chronic plantar fasciitis. Furthermore, these patients had had no response to conventional treatment. Patients received six weekly treatments or until they improved.

Vrchota et al. (1991) had slightly larger number of n=43 patients randomly assigned to three groups investigating EA effects compared to Sham and compared to conventional sports medicine treatment. In the EA group electro acupuncture was given as well as local Ah Shi (Oh Yes) points. The second group received sham EA with superficial needling (however, there was needling which will cause physiological effects) at base of digits 1-5 and the last group received sports medicine treatment. All groups improved but only the EA group had significant pain relief at three week follow-up (Vrchota et al., 1991). An interesting study was done by Zhang et al. (2009). The treatment group received needling at PC-7 which is said to be specifically effective for heel pain and the control group was needled at LI-4. The pain was measured using a VAS scale. Morning pain was significantly reduced in the treatment group. They conclude that acupuncture is effective for pain relief and that PC-7 is a specific point that can be used in  heel pain.

 

There is a real lack of systematic reviews when it comes to evaluating the effectiveness of acupuncture in cases of plantar fasciitis. There is no systematic Cochrane Database covering this topic. In fact there is a Cochrane review on plantar pain which was withdrawn. Cotchett et al. (2010) published a systematic review investigating dry needling and plantar fasciitis and comment that the lack of adequate studies prohibited a Meta-analysis and there are not enough studies confirming as to whether dry needling is effective in the treatment of plantar fasciitis pain.

The research in this case has shown me that acupuncture and EA are safe interventions in plantar fasciitis. I have been encouraged to use more EA in plantar fasciitis and also to try an alternative point PC-7 which I would have not considered in the management of this disabling condition.

 

 

 

References:

Bailey, S. (2009). Acupuncture management of a case with chronic heel pain. Podiatry. 21-23.

Cotchett, MP., Landorf, KB., Munteanu, SE. 2010. Effectiveness of dry needling and injections of myofascial TPTs associated with plantar heel pain: a systematic review. Journal of Foot and Ankle Research, 3:18.