Plantar fasciitis (PF) is a common cause of heel pain,
although from a Western perspective, the pathogenesis of PF is not well
understood. PF involves the fibrous band
of connective tissue that connects the calcaneus (heel) to the toes. Micro-tears can form in the fascia where it
connects to the bone, and causes inflammation in the fibers. Degenerative changes can also occur with or
without the presence of inflammatory processes.
In some patients, a bone spur may develop, but this is not the
etiological cause of plantar fasciitis.
From a Western point of view, the pathogenesis of PF isn't well understood, and there is much debate over the manifestation of PF. Some believe that it is more of a chronic degenerative process instead of an acute inflammatory presentation.(1) Needless to say, there can be many causative factors or risks for PF. Some of the most common are:
long periods of time
Overuse in the form of excessive sports training / improper training
Wearing shoes with improper support or cushioning
soles, flat feet or high arches
Other less obvious
factors that may be contributing behind the scenes are vascular or metabolic
issues, or even congenital deficiencies.(1)
Sharp – stabbing pain on the bottom of the foot, usually near the heel that is worse in the morning, especially after getting up and taking the first few steps. Pain can also occur after standing for long periods of time or right after getting-up from a seated position; and pain can also increase in the evening hours.
In Eastern medicine PF is the result of various patterns which can occur on their own or in combination. Instead of listing every pattern, Below are the most commonly seen presentations in our clinic.
Most patients present with a combination of these patterns
along with complications from underlying conditions involving Liver &
Spleen disharmony, and Kidney & Essence deficiency. Liver & Spleen disharmony normally comes about from an improper diet, stress and frustration. These cause those organs to dysfunction leading to inhibited metabolism, deficiencies in Qi and blood, lack of nourishment to sinews, tendons and other tissues, and stagnation of Qi and fluids; all of which are pathologies that contribute to foot pain. The kidney meridians run across the bottom of the foot, arch and heel, and up the inside of the leg. This meridian can become obstructed or deficient from overwork or congenital deficiencies leading to foot and heel pain.
A typical treatment involves the use of acupuncture with some of the points being connected to a low-frequency current (electro-acupuncture). Many studies have shown acupuncture to decrease pain (3) and inflammation both locally and systemically. Both Tan's and Tung's style acupuncture are used to address energetic imbalances, which can impede blood flow, and cause pain.
In most cases, an herbal formula is given to decrease the pain and inflammation, increase blood flow to the effected area in order to nourish the fascia, to break-up micro-stasis in the plantar tissue, and invigorate circulation in the periphery. It's also very common that the patient is given an herbal compress or herbal foot soak for home care. The herbs, both internal and external, help continue the treatment while you're not in the clinic receiving acupuncture.
The patient is also recommended to rest, and refrain from any activities that may aggravate the condition. They're also shown stretches that they can perform at home to speed the recovery process. Most patients will recover in just a few months with conservative treatments. Although, there are some cases that can take much longer, sometimes 6 or more months. If this is the case, a more aggressive treatment may be called for. If a patient has recurring plantar fasciitis, then there is most likely an underlying condition that is the cause.
What ever the case may be, if your doctor is recommending surgery please come see us before making that decision, because acupuncture can often correct the problem without having to submit to such an invasive procedure.
1. Emily N Schwartz, MD and John Su, MD. Plantar Fasciitis: A Concise Review. Perm J. 2014 Winter; 18(1): e105–e107. doi: 10.7812/TPP/13-113.
2. JAMES D. GOFF, DO, and ROBERT CRAWFORD, MD. Diagnosis and Treatment of Plantar Fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-682.
3. Andrew J. Vickers, DPhil; Angel M. Cronin, MS; Alexandra C. Maschino, BS; George Lewith, MD; Hugh MacPherson, PhD; Nadine E. Foster, DPhil; Karen J. Sherman, PhD; Claudia M. Witt, MD; Klaus Linde, MD. Acupuncture for Chronic PainIndividual Patient Data Meta-analysis. Arch Intern Med. 2012;172(19):1444-1453. doi:10.1001/archinternmed.2012.3654.