January 2009

Acupuncture for Heel Pain, Bone Spurs, and Plantar Fasciitis

By Elliot Wagner, O.M.D., L.Ac., Doctor of Oriental Medicine

The plantar fascia is a band of tough, tendinous tissue that supports the sole of the foot, acts as a "bowstring" to keep the structure of the bottom of the foot taut and springy. In walking or running the fascia provides shock absorption, and is normally in tension. This renders it vulnerable to strains in the fascia caused by overuse, insufficient stretching, and metabolic imbalances. Sometimes, micro-tears can occur, and cause the fascial tissues to become inflamed. This may initiate a gradual breakdown of the collagen (the structural protein that makes up many tissues) of the foot. Eventually, this degenerative process causes stiffness, sensitivity, and pain, and is given a name: plantar fasciitis.

Bone spurs form on the heels of some patients with plantar fasciitis. They are the body's effort to strengthen the weakest part of the sole of the foot, the point of attachment of the fascia on the heel bone. These bony overgrowths are the result of additional tension on the heel caused by the deterioration (drying) and subsequent tightening of the fascia. They are not generally the source of pain themselves.

Overuse is a common factor in many cases of plantar fasciitis, particularly when it includes an increase in weight-bearing activities, such as running. The problem can be compounded by tightness and weakness in the Achilles tendon, calf or intrinsic foot muscles. Plantar fasciitis also occurs in older patients with poor intrinsic muscle strength due to lack of activity, or lower extremity circulatory problems.

How do you know if you have plantar fasciitis? Most plantar fasciitis pain is centered in the middle, or just forward of the middle, of the bottom of the heel. However, many people have pain on other parts of the heel, or in the center of the sole of the foot, or on either side. Another sign of plantar fasciitis is the classic one of pain that occurs with the first few steps in the morning — but not every patient has this symptom, nor does every person with this problem have plantar fasciitis.

What should you do if you have plantar fasciitis? Traditional treatments include fitted splints or boots worn at night to keep the bottom of the foot stretched, physical therapy-prescribed foot strengthening exercises, well-cushioned shoes and soft orthotic inserts, changing running shoes every 400 miles, and replacing hard floors with carpeting. Each of these has been found helpful by some patients.

As a practitioner of Oriental medicine, I have found that acupuncture helps many patients with plantar fasciitis, including those who have found that other treatments did not provide relief. Acupuncture treatments are directed toward improving circulation in the foot, which reduces inflammation, repairs tissue, builds collagen, softens stiffness, and relieves pain. Medicinal herbal formulas increase lower extremity circulation and further improve recovery, and provide an effective partner with acupuncture toward the restoration of normal activity. I have found that many patients improve with this regimen.