Foot Pain/ Plantar Faciaiitis

 

 

APMA & APWA (The American Podiatric Medical Association, American Public Works Asso.)  A Survey of 1000 adult over 18 years old in May 2014 resulted: 77% has foot pain, 83% has chronic foot pain and 1/3 of population seeks medical care.

 

Plantar fasciitis, also known as jogger's heel. It is more prevalent to whose who prone to running more specially athletes and runners. It is a disorder that results in pain in the heel and bottom of the foot. The pain is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin and may be worsened by a tight Achilles tendon. The condition typically comes on slowly. In about a third of people both legs are affected.

 

Tradition view of plantar fasciitis is caused by long term excessive tractions and overuse, inflammation reaction of plantar fascia attachment is therefore generated. In fact, repetitive studies have shown that the occurrence of the plantar fascia pain and produce no inflammation, but tissue degenerative changes. Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring. As inflammation plays a lesser role many feel the condition should be renamed plantar fasciosis and so the use of anti-inflammatory drugs in the treatment proved to be ineffective. The diagnosis is typically based on signs and symptoms with ultrasound sometimes used to help. Other conditions with similar symptoms include osteoarthritis, ankylosing spondylitis, heel pad syndrome, bone spur and reactive arthritis should be differentiated with plantar fasciitis.

 

Risk factors are obesity or rapid weight gain, improper choices of shoes, flat foot, high arches, injury, tight calf muscles, extreme sports, prolonged standing and an increase in exercise.It is also associated with inward rolling of the foot and a lifestyle that involves little exercise.

 

While heel spurs are frequently found it is unclear if they have a role in causing the disease. Risk factors for Plantar fasciitis Between 4% and 7% of people have heel pain at any given time and about 80% of these cases are due to plantar fasciitis. Approximately 10% of people have the disorder at some point during their life. It becomes more common with age. It is unclear if one sex is more affected than the other. Differential diagnosis The differential diagnosis for heel pain is extensive and includes pathological entities including, but not limited to the following: calcaneal stress fracture, calcaneal bursitis, osteoarthritis, spinal stenosis involving the nerve roots of lumbar spinal nerve 5 (L5) or sacral spinal nerve 1 (S1), calcaneal fat pad syndrome, seronegative spondyloparthopathies such as reactive arthritis, ankylosing spondylitis, or rheumatoid arthritis (more likely if pain is present in both heels), plantar fascia rupture, and compression neuropathies such as tarsal tunnel syndrome or impingement of the medial calcaneal nerve. A determination about a diagnosis of plantar fasciitis can usually be made based on a person's medical history and physical examination. In cases in which the physician suspects fracture, infection, or some other serious underlying condition, an x-ray may be used to make a differential diagnosis. However, and especially for people who stand or walk a lot at work, x-rays should not be used to screen for plantar fasciitis unless imaging is otherwise indicated as using it outside of medical guidelines is unnecessary health care.

 

Is pain induced by plantar fasciitis only surrounded around heel? A study in 2013 showed patients with diagnostic ultrasound found degenerative changes in the plantar parts are scattered, not confined to the heel around. Distinguish pain caused by bone spur The pain induced by calcanea spur occurs when the heel contacts with he ground. Pain is more severe at night. Pain caused by plantar fasciitis occurs when the foot pedal off the ground. The pain is more severe in the morning instead. Most overweight people prone to heel spurs and changing the mechanical structure of the foot is likely to cause plantar fasciitis.

 

Treatment and Prevention: 

Usually for the first few weeks people are advised to rest, change their activities, take pain medications, and stretch. If this is not sufficient physiotherapy, orthotics, splinting, or steroid injections may be options.

 

Prevention (The American Podiatric Medical Association offers):

  • Don't ignore foot pain -- it's not normal. If the pain persists, see a doctor who   specializes in podiatry.

    • Inspect feet regularly, color,temperature, thick or discolored nails, cracks or cuts, peeling or scaling and any abnormal growth.

    • Wash feet regularly.

    • Trim toenails straight across, but not too short.

    • Make sure shoes fit properly.

    • Avoid walking barefoot.

    • Be cautious when using home remedies for foot ailments. Self-treatment can often turn a minor problem into a major one.

    • People with diabetes see a podiatric physician at least once a year for a checkup. People with diabetes, poor circulation, or heart problems should not treat their own feet, including toenails, because they are more prone to infection.

 

Foot, Heel & Toe Pain Convernational Medicine Diagnosis

Imaging and Tests:

  • bone scan, 

  • x-ray 

  • MRI

  • blood test, 

  • joint fluid test 

  • or other lab test can help your doctor confirm that your foot pain is arthritis. 

 

Treatment: Non-surgical & surgical

  • rest, 

  • change their activities, 

  • take pain medications, 

  • and stretch. 

  • physiotherapy, 

  • orthotics, 

  • splinting, 

  • steroid injections 

 

Pattern differentiation and diagnosis in Chinese medicine:

1. Wind Cold Damp Obstruction Intense activity, overuse, trauma with weak constitution; all weaken the channels and involve a deficiency of qi and blood or impair the circulation of qi and blood from the invasion of exterior wind, cold, and damp. Many outdoor sports are played regardless of the weather condition and can expose athletes to wind, cold, and damp. Intense activity, pre-existing injury and open pores from sweating are possible openings for the invasion of wind, cold, and damp. Intense or excessive activity or sport leads to strain; standing for prolonged periods without proper rest or footwear; inactivity; certain, unvarying recurring movements.

 

2. Qi and Blood stagnation Trauma to the plantar fascia may reduce the flow of qi and blood to the foot and allow external wind, cold, and damp to invade the area. Poor diet and stress can also lead to qi and blood deficiencies which will impact upon the flow of qi and blood in the vessels.

 

Principle of Acupuncture Treatment: Relax surrounding soft tissues, repair breakdown of collagen, soften and reduce scarring. Improve body constitution, balance body qi and blood, and improve local qi and blood circulation.

 

The following is a list of mechanisms that acupuncture have been identified so far: 

 

  1. Acupuncture promotes blood flow. This is significant because everything the body needs to heal is in the blood, including oxygen, nutrients we absorb from food, immune substances, hormones, analgesics (painkillers) and anti-inflammatories.

  2. Restoring proper blood flow is vital to promoting and maintaining health.

  3. Acupuncture relaxes shortened muscles. This in turn releases pressure on joint structures and nerves, and promotes blood flow.

  4. Acupuncture stimulates the body’s built-in healing mechanisms. Acupuncture creates “micro traumas” that stimulate the body’s ability to spontaneously heal injuries to the tissue through nervous, immune and endocrine system activation.

  5. As the body heals the micro traumas induced by acupuncture, it also heals any surrounding tissue damage left over from old injuries.

  6. Acupuncture releases natural painkillers. Inserting a needle sends a signal through the nervous system to the brain, where chemicals such as endorphins, norepinephrine and enkephalin are released.

  7. Some of these substances are 10-200 times more potent than morphine.

  8. Acupuncture reduces stress. Recent research suggests that acupuncture stimulates the release of oxytocin, a hormone and signaling substance that regulates the parasympathetic nervous system. Recent research has implicated impaired parasympathetic function in a wide range of autoimmune diseases, including arthritis, lupus, rheumatoid arthritis and inflammatory bowel disease.

We welcome all different opinions and improvement that can benefit patients.

 

What can acupuncture do?

Studies have shown acupuncture to be effective in relieving certain types of foot pain. A study published in the journal Acupuncture in Medicine in 1996 found acupuncture to be effective in relieving otherwise unresponsive chronic foot pain. A 1999 study, meanwhile, found that electrical stimulation of acupoints on the feet could increase blood flow to the foot and lower leg. There have also been anecdotal reports of individual acupuncturists using different techniques to relieve pain associated with the ankle, heel, and ball of the foot.

As with any other form of care, however, remember that not all patients will respond to all forms of treatment. Make sure to discuss the situation thoroughly with your acupuncturist before undergoing treatment for foot pain.

 

References

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12 Orchard J (October 2012). "Plantar fasciitis". BMJ 10 (345): e6603. doi:10.1136/bmj.e6603. PMID 23054045.

13 Yin MC, Ye J, Yao M, Cui XJ, Xia Y, Shen QX, Tong ZY, Wu XQ, Ma JM, Mo W (March 2014). "Is Extracorporeal Shock Wave Therapy Clinical Efficacy for Relief of Chronic, Recalcitrant Plantar Fasciitis? A Systematic Review and Meta-Analysis of Randomized Placebo or Active-Treatment Controlled Trials". Arch Phys Med Rehabil. S0003-9993 (14): 00207–X. doi:10.1016/j.apmr.2014.01.033. PMID 24662810.

14 Buchbinder R (May 2004). "Plantar Fasciitis". New England Journal of Medicine 350 (21): 2159–66. doi:10.1056/NEJMcp032745. PMID 15152061.

15 Cole C, Seto C, Gazewood J (December 2005). "Plantar fasciitis: Evidence-based review of diagnosis and therapy". American Family Physician 72 (11): 2237–42. PMID 16342847.

16 American College of Occupational and Environmental Medicine (February 2014), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American College of Occupational and Environmental Medicine), retrieved 24 February 2014, which cites

• Haas, N; Beecher, P; Easly, M; et al. (2011). "Ankle and foot disorders". In Kurt T. Hegmann. Occupational medicine practice guidelines : evaluation and management of common health problems and functional recovery in workers (3rd ed.). Elk Grove Village, IL: American College of Occupational and Environmental Medicine. p. 1182. ISBN 978-0615452272.

17 "Plantar Fasciitis and Bone Spurs". American Academy of Orthopaedic Surgeons. 2010. Retrieved 24 June 2014.

18 Aqil A, Siddiqui MR, Solan M, Redfern DJ, Gulati V, Cobb JP (November 2013). "Extracorporeal shock wave therapy is effective in treating chronic plantar fasciitis: a meta-analysis of RCTs". Clin Orthop Relat Resl 471 (11): 3645–52. doi:10.1007/s11999-013-3132-2. PMID 23813184.

19 Wang CJ (March 2012). "Extracorporeal shockwave therapy in musculoskeletal disorders". J Orthop Surg Res 7 (1): 11–8. doi:10.1186/1749-799X-7-11. PMC 3342893. PMID 22433113.

20 Lee SY, McKeon P, Hertel J (February 2009). "Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis". Phys There Sport 10 (1): 12–8. doi:10.1016/j.ptsp.2008.09.002. PMID 19218074.

21 Anderson J, Stanek J (May 2013). "Effect of foot orthoses as treatment for plantar fasciitis or heel pain". J Sport Rehabil 22 (2): 130–6. PMID 23037146.

22 Thomas JL, Christensen JC, Kravitz SR, Mendicino RW, Schuberth JM, Vanore JV, Weil LS, Zlotoff HJ, Bouché R, Baker J (May–June 2010). "The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010". J Foot Ankle Surg 49 (3 Suppl): S1–19. doi:10.1053/j.jfas.2010.01.001. PMID 20439021.

23 Tweed JL, Barnes MR, Allen MJ, Campbell JA (September–October 2009). "Biomechanical consequences of total plantar fasciotomy: a review of the literature". J Am Podiatr Med Assoc 99 (5): 422–30. PMID 19767549.

24 Cotchett MP, Landorf KB, Munteanu SE, Raspovic A (January 2011). "Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial". Journal of Foot and Ankle Research 4 (1): 5. doi:10.1186/1757-1146-4-5. PMC 3035595. PMID 21255460.

25 Cotchett MP, Landorf KB, Munteanu SE (September 2010). "Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review". Journal of Foot and Ankle Research 3 (1): 18. doi:10.1186/1757-1146-3-18. PMC 2942821. PMID 20807448.

26 http://chriskresser.com/chinese-medicine-demystified-part-iv-how-acupuncture-works/

 

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