Plantar fasciitis, or plantar heel pain (PHP), is responsible for approximately one million patient visits to the doctor per year. Patients usually describe pain near the heel that is worse with the first steps of the day or after a period of inactivity. In acupuncture practice, a variety of strategies are used to treat PHP in the local or distal areas, standard acupuncture points, tender points, or myofascial trigger points with or without electroacupuncture. Different treatment approaches are sometimes contradictory, such as the application of moxibustion by some and ice by others, and no consensus exists as to which approach is more effective. Although such heterogeneity has undermined the demonstration of effectiveness of acupuncture for PHP.
The following is a case study in which a few different acupuncture and electroacupuncture protocols were applied to treat a patient with PHP, but significant relief came only after the use of a protocol that included a classical yuan-luo point pair. The patient was an active 41-year-old female with PHP. She experienced constant stiffness and pain on the plantar surface of her left foot, just distal to the heel, which was worse in the mornings. The pain was dull with a severity between 3 and 5 of 10 on the numeric rating scale (NRS) with 10 being the worst pain. Pain was alleviated by pressure applied to the plantar foot at the area of pain. Tender points were palpated along the left calf.
The patient had a second chief complaint of left-sided low back pain (4 to 7 of 10 on the NRS) with radiation midway down the posterior thigh lasting two years. The pain would come on after prolonged sitting and last for a couple of hours to a day. Tender points were palpated on the left side. She received no other treatments for PHP before acupuncture. The PHP was located along the kidney channel pathway at the left plantar heel. The fact that it improved with pressure indicated that pain was due to deficiency in the channel. Five acupuncture treatments were delivered at a frequency of one treatment per week with a final treatment two weeks later. Acupuncture needles (spring type stainless steel needle ) were inserted with the patient in a prone position and retained for 30 to 35 minutes. A TedingDianciboPu (TDP) lamp was placed twelve inches above the left buttock although needles were retained.
During the following week, the patient experienced occasional, mild discomfort (1 of 10 on the NRS) and stiffness in the bottom of the foot. Complete relief of pain (0 of 10 on the NRS) with only mild stiffness
in the mornings was reported after the same treatment was repeated on the fifth visit with additional acupuncture points.These same results persisted over the next two weeks, and the treatment was repeated
a final time. In this case report, the patient experienced complete relief after six acupuncture treatment. Three different acupuncture protocols were used on the foot over the course of treatment. PHP can be a complex issue for which a variety of treatment approaches are necessary. The main value of this case report lies in its presentation of at least three distinct acupuncture and electroacupuncture protocols that are used for PHP.
The author is Head of the Department of Acupuncture, Sir Ganga Ram Hospital, Delhi