Meet Jane, a 63-year-old woman who is an avid walker. Unfortunately, due to her condition of arthritis with both knee replacements and the development of plantar fasciitis in both feet, she is finding it increasingly difficult to continue her love for walking. Her left foot is particularly affected, with a dull pain and difficulty in movement, making it a struggle for her to keep up with her daily routine.

Jane, who has a high threshold for pain, has tried different methods to alleviate the discomfort, including ice packs, herbal remedies such as turmeric tablets and black pepper, and some ointments, but has not found significant relief.

In addition to her foot pain, Jane has a history of panic attacks and migraines. As she continues to age, she is finding that her pain threshold is decreasing, making it even more challenging for her to find relief from her foot pain.

Jane has a good appetite, but she knows she should drink more water and tries to keep at least three-quarters of a glass of water by her bedside. She has a regular bowel movement and often urinates, which is normal for her. However, she experiences episodes of diarrhoea when she travels to different countries.

Jane sweats very little and is a naturally dry person. She is struggling with insomnia and is taking an antidepressant to help her sleep. She finds it easier to fall asleep now but still experiences wakefulness at night. She feels drained of energy and finds it difficult to concentrate.

Jane has a low tolerance for hot weather, which makes her irritable and impatient. 

Pulse: 

Her pulse on the left side is thin and empty, while the right side is tight and strong, close to being wiry and tender, but weak on the rear position. 

Tongue: 

Her tongue is purple, pale, and has a thin white coat, with some orifices on the left side and no deep root marks.

What is Plantar Fasciitis?

Plantar fasciitis is a common cause of heel pain, affecting millions of people worldwide. It is caused by inflammation of the plantar fascia, a band of tissue that runs from the heel to the toes. This condition can be quite debilitating, making it difficult for people to walk, run, or engage in other physical activities. If left untreated, plantar fasciitis can lead to chronic pain and decreased mobility.

Diagnosis:

The patient is diagnosed with Qi and Blood Stagnation in the foot affecting the Kid, Bl, Gb, and Liv channels as well as Liver Qi constraint invading the Spleen.

Brief on Aetiology & Pathology:

The root cause of her foot pain is likely related to her long-standing profession as an architect and teacher, which required her to spend long hours standing and walking, and may have also been exacerbated by overuse of her feet. Her emotional state, marked by irritability, moodiness, sadness, depression, and diarrhoea, might also be indicative of Liver Qi constraint invading the Spleen. The purple coloration on the sides of her tongue and some cracks on the left side suggest long-standing emotional distress.

Acupuncture Points & Treatment Plan:

The treatment plan includes alleviating the pain in the foot by moving Qi and Blood Stagnation and calming the Shen. 

The composition of points will include local palpation and Ashi points, Ba xie points in the foot, Kid 1, Kid 2, Gb34, Ren 17, and Ying Tang.

Ba Xie points in the foot, extra points of the foot, invigorates blood and decrease swelling using Liv 3 location as guide

YongQuan (KID 1); Jinwell point of Kidney Channel, common uses for pain and swelling of the Leg

Rangu (KID 2); Ying spring and Fire point of the Kidney, swelling and restless feet

Yanglingquan (Gb34); Hea sea and Earth point, benefits the sinews and joints, spreads the Liver Qi

Shanzhong (Ren 17); Front Mu point of the Pericardium, function used to Calming Shen and unbinds Chest

Ying Tang: Extraordinary point often used to Calming the Shen

Tui Na Physiotherapeutic massage:

The treatment will also include Tui Na on the foot and plantar to alleviate the pain at the end of the session. The goal is to invigorate blood and decrease swelling, benefit the sinews and joints, spread the liver qi, and unbind the chest while calming the Shen.

The patient lies prone and fully relaxes their body. Use the pulp of your thumb to grasp, pinch, press, and knead the gastrocnemius muscle in the calf region several times, moving from top to bottom towards the calcaneus.

Next, apply pressure to the Weizhong, Chengshan, Kunlun, Shenmai, Qiuxu, Jiexi, and Taixi points. The patient should remain in the prone position as you use the pulp of your thumbs to rub and knead the plantar fascia from heel to toe, repeating the motion several times to generate heat. Then, gently pluck the plantar fascia in a perpendicular direction using the tip of your finger.

The use of AN Fa and Rou Fa techniques on the heel and plantar region has shown to effectively reduce pain and alleviate tension in the fascia. To perform AN Fa, the therapist places their thumb under the base of the patient’s large toe and strengthens their grip until a torque is created in both directions. The therapist then applies thumb pressure along the plantar fascia from the heel to the toe, repeating the motion multiple times while stabilising the patient’s foot with their other hand.

Subsequently, the therapist performs Rou Fa, a technique that involves the application of strong, stationary circular pressure, several times on the tender areas surrounding the calcaneus tuberosity. To enhance the effectiveness of the treatment, ointments may be applied to the affected area. 

This combination of AN Fa and Rou Fa and strong stationary circular pressure, several times on the tender areas surrounding the calcanea tuberosity techniques, along with the use of ointments, can offer a holistic approach in the management of pain and discomfort in the heel and plantar region.

Results: 

After five treatment sessions, the patient showed significant improvement in their condition, and had recovered their walking ability with minimal pain. Additionally, the patient made adjustments to their footwear, opting for more supportive shoes, and began warming up their feet before walking to help prevent further discomfort.

This outcome suggests that the treatment was effective in addressing the patient’s symptoms, providing relief and promoting a return to normal activities. It is important to continue monitoring the patient’s progress and providing ongoing care as needed to ensure sustained improvement in their condition.