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Acupuncture can be helpful for heel pain

Analysis by Dr. Joseph Mercola Fact Checked

acupuncture benefits

Story at-a-glance -

  • Plantar fasciitis is a common condition for which definitive treatment guidelines vary depending on what triggered the condition. Acupuncture offers pain relief and in some studies has shown to provide long-term relief
  • Those who spend long hours on their feet, engage in long-distance running, ballistic jumping or aerobic dancing and who are overweight have a higher risk of developing plantar fasciitis, experiencing stabbing pain in the heel, midfoot or near the toes, especially when taking their first steps after sleeping or sitting
  • Spontaneous resolution occurs in 80% of people in the first year, but if unresolved, the condition may become chronic and lead to progressive pain, limping and secondary injuries to your knee, hip or back
  • Begin treatment at home using an anti-inflammatory diet, including foods high in healthy fats, low in sugars and non-vegetable carbohydrates, balanced omega-3 and omega-6 fats and liberal use of anti-inflammatory herbs and spices such as cloves, rosemary and turmeric
  • Consider incorporating adequate rest for your feet, icing, taping, stretching and/or a night splint to keep your fascia elongated as it heals

Feet are a common source of pain. According to the American Podiatric Association, 81% of obese Americans experience some type of foot pain,1 and those who are obese may experience multiple foot and ankle conditions. In one study, 1% of U.S. adults2 experienced plantar fasciitis in the past 30 days, and as many as 41% used prescription pain medications.

Data from the 2013 National Health and Wellness survey used self-administered questionnaires completed by 75,000 participants. The participants were asked about pain in the last year and in the last month. They were asked to select the types of diagnosis they received from a list that included plantar fasciitis. The researchers discovered:3

  • Approximately 1% of U.S. adults reported a diagnosis of plantar fasciitis in the last year, and more than 75% reported pain in the past month.
  • The prevalence of plantar fasciitis was lowest in those aged 18 to 44 and highest in those aged 45 to 64; women were 2.5 times more likely to have plantar fasciitis than men.
  • Body mass index (BMI) was strongly associated with plantar fasciitis; those with a BMI of 30 or more were five times more likely to have plantar fasciitis than those with a BMI below 25.
  • 25% reported having severe pain, 45% reported moderate pain and 28% had mild pain.
  • More than 61% reported having pain every day, and 54% reported their pain interfered at least moderately with normal work activities.

Heel pain may be relieved by acupuncture

Plantar fasciitis is a common condition for which definitive treatment guidelines vary depending upon what triggered the condition. The evidence acupuncture may cure plantar heel pain is not conclusive, but it does offer pain relief as you work through the reason the condition was triggered and correct the problem.

Acupuncture is increasingly being considered by podiatrists. In one study, researchers evaluated the effectiveness using a systematic review of past research. They found five randomized control trials and three nonrandomized comparative studies that met their quality standards.4

Overall, the studies reported significant benefits for the patient. One associated acupuncture with significant improvement in pain and function when combined with standard treatment protocols. The researchers concluded there was enough evidence to support the effectiveness of acupuncture in the treatment of plantar heel pain.

In a second meta-analysis5 to determine the effectiveness in reducing pain caused by plantar fasciitis, researchers selected studies designed as randomized control trials comparing acupuncture against other standard treatments, or those using a real versus placebo treatment.

They included four studies and determined that while acupuncture reduced plantar fasciitis pain immediately, there appeared to be insufficient evidence to draw a definitive conclusion it would be effective in the long-term.

Other studies found acupuncture was an effective treatment when compared to other commonly used interventions, such as night splints and steroids. According to the U.S. Department of Veterans Affairs6 and the Acupuncture Evidence Project,7 acupuncture has a potentially positive effect on the treatment of heel pain.

Evidence Based Acupuncture8 describes improvement using acupuncture through several pathways. As the needles are inserted it reportedly triggers a local effect on nerve endings, releasing neuropeptides to help eliminate pain. Adenosine may be released to relieve pain, with anti-inflammatory effects as well. Acupuncture also stimulates blood flow to promote tissue healing.

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Symptoms of plantar fasciitis

Symptoms of plantar fasciitis are caused by inflammation in the thick band of tissue running from the heel of your foot to the base of your toes. This thick band of tissue is called fascia.9 If you have plantar fasciitis you'll experience pain in the bottom of your foot, which may occur in the front, the center or at the heel.

Oftentimes, the pain will be worse in the morning when you first wake up. This is because during the night your foot is often positioned pointing, called plantar flexion, which shortens the plantar fascia. When you wake, the contracted fascia is suddenly stretched as you take your first step. This may happen after you've been sitting for a long time as well.10

Most people describe a stabbing pain that is worse with the first few steps after awakening and worse after exercise. In many cases, the pain disappears during exercise as the plantar fascia warms up. However, this is not a reason to exercise through the pain.

What causes heel pain?

Your plantar fascia acts like a shock absorber, supporting the arch of your foot. When tension and stress on the fascia becomes too great, it triggers small tears, resulting in inflammation and pain. This may happen for a number of reasons.11

Improper footwear — This is typically part of the problem, and research12 by Michael Warburton, a physical therapist in Australia, found running barefoot decreases the likelihood of plantar fasciitis.

Myxoid degeneration — In this instance, degeneration occurs in the tissue turning it into a gelatinous or gum like material.13

Obesity — Excess weight places a heavier load on your plantar fascia and increases your risk for pain.14

Foot mechanics — Poor foot mechanics, including flat feet or high arches, over pronation, weak foot muscles or stiffness in the plantar fascia, increase stress on the fascia and increase the risk of micro tears and inflammation.

Being on your feet for long hours — Occupations keeping you on your feet for long hours, such as factory work and teaching, may trigger an increased risk of damaging the plantar fascia. This is especially true when the surfaces are hard, such as cement floors.

Specific exercises — Certain types of activities place a lot of stress on your heel or Achilles tendon. Sports activities involving ballistic jumping, such as basketball, ballet dancing and aerobic dancing, contribute to the onset of plantar fasciitis. Long-distance runners, those who run downhill consistently or who run on uneven surfaces are especially prone to the condition.15

Tight Achilles tendon or calf muscle — A tight Achilles tendon16 or calf muscle17 places additional stress on the plantar fascia and causes it to contract further. As this happens, walking even short distances may cause micro tears and increase inflammation.

Plantar fasciitis may lead to a chronic condition

Spontaneous resolution happens in 80% of cases within the first year.18 However, the process is often slow and the underlying reason for the injury must be addressed. Athletes in particular may experience a slower healing process, which may be frustrating and severely impact athletic performance.

Although mortality is not associated with plantar fasciitis, significant loss of function may occur. If left untreated, or if the condition does not resolve spontaneously, you may experience progressive pain leading to limping and restricted activities.

Additionally, a change in your weight-bearing pattern may lead to secondary injuries to the knee, hip and back.19 Unfortunately, the plantar fascia may also rupture and flatten the arch of your foot. Steroid injections may reduce pain but can increase weakness in the area, and fails to address the underlying problem.20

If this happens, it increases your risk of rupturing your plantar fascia. If plantar fasciitis causes pain for more than a year, it may develop into plantar fasciosis with avascular scarring in the fascia.21 This condition is painful as the scar tissue is not well vascularized and the pain is resistant to anti-inflammatory treatments.

Reduce your level of inflammation

One of the threads linking a wide variety of common health problems is chronic inflammation. Obesity, diabetes, heart disease and overuse injuries have a root in a chronic inflammatory response in your body. The key to reducing this begins with your diet.

A diet high in healthy fats and low in sugars and nonvegetable carbohydrates is the best way to start to reduce inflammation in your body. It's also important to balance your omega-3 and omega-6 fats.22 Most get a high amount of omega-6 fat from processed food and vegetable oils. Animal-based omega-3 fat is found in krill oil, wild-caught Alaskan salmon, herring, mackerel and anchovies — foods that many don't eat enough of.

Herbs and spices, such as cloves, ginger, rosemary and turmeric all have anti-inflammatory properties. Fermented vegetables and traditionally cultured foods will help reseed your gut with beneficial bacteria to optimize your immune function and reduce leaky gut syndrome, thus reducing overall inflammation in your body.

Junk foods, such as candy, soda, doughnuts and fruit juices may increase the production of inflammatory markers in your system.23 Researchers have also discovered wheat contains specific proteins called amylase trypsin inhibitors24 triggering inflammation related to chronic diseases such as asthma and rheumatoid arthritis.

Begin treatment at home

In addition to eating an anti-inflammatory diet and incorporating the exercises demonstrated in the video below, there are several nonsurgical treatments you may use to reduce pain and speed your recovery.

Adequate rest for the area — An important step to reducing plantar fasciitis related pain is to stop the actions triggering the damage, such as athletic activities, heel stressing activities or standing or running for long periods of time. While you may be able to return to these activities after healing and with proper support, you should rest the area during the acute stage.

Icing — Using ice may help to reduce the inflammation in the area and reduce the pain. Apply a cloth-covered ice pack to your foot for 15 to 20 minutes, three to four times a day.

However, it's important to remember ice contracts the area so you'll want to do this when you anticipate sitting or immediately before going to bed. Once you get up again, it's important to use some stretches to warm the area for movement.

Stretching — Gentle stretching exercises will help to warm your feet up before getting out of bed or getting up after sitting and helps to reduce additional tearing to the plantar fascia.

You may do this by slowly and gently pointing your toes and then pulling your toes up toward your head with your knees straight. Do this several times before getting out of bed in the morning or out of a chair after sitting.

Night splint — Many patients notice improvement in their feet after wearing a night splint.25 The splint keeps your foot in neutral position or with your ankle in slight dorsiflexion, toes pointed towards your head. Theoretically, your plantar fascia heals while in an elongated position and reduces pain first thing after waking.

Taping your foot — Taping with athletic tape helps to stabilize the affected leg and avoid abnormal movement or excessive strain on the plantar fascia.26 Consult with an athletic trainer or physical therapist to learn the proper way to tape your foot and the schedule you should follow.

Extracorporeal shock wave therapy (ESWT) — This may be used when conventional treatments fail. It entails directing sound waves at the affected area to help address the pain and promote healing. These high pitched sound waves are mechanical, and not electrical. They're designed to speed your body's natural process by increasing blood flow.

ESWT does have some caveats; for example, you should not undergo ESWT if you are pregnant, have bone cancer, are taking anticoagulants or have had a steroid injection within the past 12 weeks. You also may experience some pain or discomfort, which is usually manageable, although some doctors may administer a local anesthetic to help make you comfortable.27

Dynamic stretching and cross friction massage — As the inflammation begins to resolve, you may find dynamically stretching your plantar fascia and applying cross friction massage to the area will help to break up adhesions and encourage healing.28

Dynamic stretching may be done by rolling your foot over a tennis ball or 15-ounce food can. Cross friction massage is done with two or three fingers and gently massaging your foot from side to side and then gently up and down the length of the foot.

Footwear — It is important to use properly fitted, appropriate shoes for your activity. Shoes that are too small may exacerbate foot pain and those with thicker, well cushioned midsoles may reduce pain while standing on concrete.29

Five exercises may help reduce pain

Gentle exercises to stretch the plantar fascia, Achilles tendon and calf muscles help relieve pain caused by the condition. In this video Lulu Peele, yoga therapist and Ayurvedic counselor, demonstrates five exercises you may consider doing at home as part of your rehabilitation.30

Wall stretch — Stretching and elongating your calf muscles are the primary objectives of this move:

  1. Start standing about an arm's length from the wall.
  2. Step forward with your left leg, while moving backward with your right.
  3. Bend your left knee and press down with your right heel.
  4. Hold this position for 20 to 30 seconds and then switch legs.

Tennis ball massage — The rolling motion of a tennis ball helps loosen your plantar fascia, potentially reducing pain. Peele suggests doing this exercise on a soft surface such as a yoga mat, carpet or rug, as the ball will slide on hardwood surfaces:

  1. While sitting down, place a tennis, lacrosse or golf ball underneath the big toe of your left foot.
  2. In a backward and forward motion, gently roll the ball beneath your foot. Once you locate a tender spot, stop and flex your toes upward and downward.
  3. Continuously roll the ball for about a minute or two, then repeat on the other foot.

Picking up a sock or towel using your toes — Tone your plantar fascia and develop arch strength by doing this simple exercise any time of the day. Simply curl your toes around a washcloth, towel or sock, pick it up and then release the item.

Seated calf stretch — Peele's version of a seated calf stretch involves lifting and straightening your leg, pointing your toes forward just like a ballerina, flexing and keeping them as wide apart as possible. Repeat this step a couple more times. After this, move your ankle in circles and point and flex your toes while doing a circular motion. This encourages strength in your ankles and provides support for your feet.

Belt stretch — You may do this stretch while sitting or lying down:

  1. Take a belt, towel or yoga strap and place it under the ball of your foot. Slowly pull the belt toward you and allow the toes to come toward your body.
  2. Try to continuously release and stretch your foot, especially your plantar fascia. Hold this position for around 15 to 30 seconds to feel the stretch in your calf, while relaxing your shoulders, neck and jaw.
  3. Release the foot back to the starting position, repeat the move two to four times and then change sides.