Plantar Fasciitis


Mariela P, Simi Valley, California, 2009

Mariela, a 32 years old female pharmacist, suffered constantly pain in the bottom of her feet with more in the right foot for about one year. The pain was in the bottom of the ankles extended to the toes of the feet. Plantar fasciitis was diagnosed. She had been tried to use different treatment modalities including physical therapy, local cortisone injection and cast. Not much improvement had been rewarded. She used Tylenol and Celebrex as painkillers and TENs machine to ease her pain. As a pharmacist she has to stand for long time during working that make the pain worsen. Finally she has to quit her job because of the pain. She was referred by her doctor to Acuhope Center for acupuncture and started her treatment on 10/30/2009. Before treatment the pain level was 8/10 on a 10-point scale. We treated her with electroacupuncture twice a week. At the third treatment she started to feel less pain in her feet, and stopped to use TENs. At the 4th treatment pain in the left foot was subsided, and lesser pain was felt with a level of 6/10 in her right foot. Her condition was improving by the treatment and improved progressively. At the 12th treatment all pain in both of her feet were completed gone. She returned to work afterward.

On 8/11/10, she returned to the clinic because of mild pain in her right foot for about one week due to long standing. Five treatments were provided and the condition was clear up. Follow up her condition till this writing (12/2012) she did not have foot pain recurrence.      

Plantar Fasciitis. Plantar fascia is a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes. The function of the plantar fascia is to provide static support of the longitudinal arch of the foot as well as shock absorption during gait. Plantar fasciitis (PF) is the most common cause of heel pain and occurs in all types of athletic and active individuals. Risk factors for this condition include overweight, repetitive stress in athletes, prolonged standing, walking, overpronation, lateral tibial torsion, and excessive femoral anteversion. It is commonly seen in runners, and may account for as much as 10 percent of all running injuries. However, simply walking and standing on a hard surface may also cause symptoms. PF is an inflammation and irritation of the plantar fascia possibly micro-tears in the fascia at or near its attachment to the calcaneus, and or spur formation.     

The most common symptom associated with PF is pain typically located at the anteromedial aspect of the calcaneus near the origin of the plantar fascia. The pain is exacerbated by passive dorsiflexion of the toes, standing tiptoe, palpation of the heel, and weight bearing after a period of rest. The treatment of PF is widely variable with no consensus on which modality is most effective. Recommended conservative treatment includes resting, icing, stretching, strengthening, exercising, modifications or restrictions, nonsteroidal anti-inflammatory drugs, brace, casting, night splints, iontophoresis, and injections. Surgical intervention has also been tried. Although the vast majority of those who have the condition will recover over time with conservative management, some patients will develop persistent and often disabling symptoms.

Acupuncture treatments for PF is one of the many choices of treatment and has been shown its great improving effect. The basic reactions of acupuncture treatment are to increase the local microcirculation, relieve congestion and swelling, and promote the healing process. The treatment most of the time will be combined with electric stimulation to promote the reliving of pain, swelling, and inflammation by stimulating the mid brain to increase the concentration of endorphins and enkephalins.

Literature Review

Robert Perez-Millan. Low-Frequency electroacupuncture in the management of refractory plantar fasciitis: A case series. Medical Acupuncture Vol. 13; No. 1

Eleven patients diagnosed with plantar fasciitis referred for a trial of acupuncture after failing other conservative methods of treatment. Mean age of the patients was 40, 27% male with a mean duration of symptoms of 39 months. Acupuncture with traditional points and trigger points were used with application of low frequency electric stimulation, 1 treatment weekly for 6 sessions. 82% of the treated patients reported greatly improvement in pain reduction and of them 36% were completed healed.

 

Karagounis P, et al. Treatment of plantar fasciitis in recreational athletes: two different therapeutic protocols. Foot Ankle Spec. 2011 Aug;4(4):226-34. doi: 10.1177/1938640011407320.

Plantar fasciitis (PF) commonly causes inferior heel pain and occurs in up to 10% of the US population. Treatment protocols in most studies include the use of ice therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching and strengthening protocols. The aim of the current study was to examine the effectiveness of 2 different therapeutic approaches on the treatment of PF in recreational athletes using the Pain and Disability Scale for the evaluation. A total of 38 participants with PF were randomly allocated to 2 different groups of 19 male participants in each group. Group 1 was treated with ice, non-steroidal anti-inflammatory medication, and a stretching and a strengthening program. Group 2 received the same therapeutic procedures as group 1, reinforced by acupuncture treatment. The primary outcomes, nominated a priori, were pain description and mobility-function at 1 and 2 months. Outcomes were measured with the pain scale for PF. The mean total score of the acupuncture group at the third measurement was statistically minor compared with the mean total score of the first group. Acupuncture should be considered as a major therapeutic instrument for the decrease of heel pain, combined with traditional medical approaches.

Zhang SP et al. Acupuncture treatment for plantar fasciitis: a randomized controlled trial with six months follow-up. Evid Based Complement Alternat Med. 2011;2011:154108. doi: 10.1093/ecam/nep186. Epub 2011 Feb 15.

The aim of this study was to determine the efficacy and specificity of acupuncture treatment for plantar fasciitis. Subjects were randomly assigned to the treatment group (n = 28) or control group (n = 25). The treatment group received needling at the acupoint PC 7, and the control group received needling at the acupoint LI 4. Treatment was administered five times a week for 2 weeks, with an identical method of manual needling applied to the two acupoints. Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain, overall pain and pressure pain threshold. No serious adverse event was observed in either group. The results indicate that acupuncture can provide pain relief to patient with plantar fasciitis, and that PC 7 is a relatively specific acupoint for heel pain