Downloaded from aim.bmj.com on September 9, 2014 - Published by group.bmj.com Metatarsalgia: Treatment by Acupuncture Thispaper waspresentedat the BMASSpringScientificMeetingheld in Chesterin April 1997 Summary A course of acupuncturetreatmentwas perlomed on fourteenconsecutivepatientswith metatatsalSia. Thirteen (93%) patients respondedto acupuncture treatment.The effect appearedlong-lasting.as only two patientshad a relapseof symptomsover a one yearfollow up period. Key words Acupuncture, Metatarsalgia. I I I I I I I I I I | I I I I I f I | I I I I I II lntroduction is a generalterm usedto describepain MetatarsalBia over the ball of the foot and is usuallya resultof nerves,or due to a chronictraumato the interdigital d i s o r d e ro f t h e m e t a t a r s o - p h a l a n S jeoai n l ts. pad Conservative treatment,usinSa soft metatarsal drug togetherwith a non-steroidal anti-inflammatory (NSAID),is usuallyrecommended as the treatr.ent for this disorderf7),but sur8efymay be indicatedin that havefailedwith certaintypesof metatarsalgia conservativemanagement.Acupunctureis one torrn of treatmentwhich has been usedfor both neuralBic a n da r t i c u l ap r a i n s ,a n d i n p a r i i c u l airt h a s b e e n in chronicfoot pain (2).This preliminary successful study was performed to see whether Jocal d , u p u n ,l u r e r e a l m e n r\ ^ d ca n e f l e c t i r em e t h o do [ a l l e v i a t Lm n ge t a t a r : aal g. fi9ute 1.Ihe footshowingthe acupunctureneedlesin posilion. Needle t is insened haizontally into the foot from ke nedial ta lateralside,alang theplantarsoiace ofthe jutction of the headand shaftof the 1stmetata5al. phalanqealjaint Needle2 is insenedarcund the 1stmetatatsal an the fle\ot aspecl at points of Endeness. needlewas insertedonto the periosteumat the point of tenderness,leit for 30-60 secondsand removed without further stimulation-Treatmentwas repeated a t 1 - 2 w e e k l y i n t e r v a l s b, u t w a s s t o p p e di f n o uethod l o u t " . n , o n \ e ( L r t \ ep d t r e n l sd 8 e d l l 8 2 v c a r . .5 improvementoccurredafterthe third treatment. m r l " . u h o p e s e r t e d \ i r l ' m e t d t a r s d l S i\d, 1 c r p The durationof the patients'symptomsvariedfrom s t u d i e dA . l l p a , i e n l .p r e . e r L e dw i t h p a r n r a n d 3 daysto 16 months(median2 weeks).Fourpatients of the proximal , r o u n d l h e b i E l o e o r r r I h e f o r e f o o td r e d . had visuallyobviousosteoarthritis joint, two had had previoussurgeryfor T e n d e r n e u. .a s r s u a l r r, o ( a l e od r o u n dt h e b d l l o l metatarsal t h o r o o r a n d o c , " s i o r a l l r o n a n d a r o u n dt h e hammertoes and eight patientshad no pathology e \ ' t . n . o r . u r r d (oer l h e l < l m e l a l a r s o - p h a l a n Bdeedtle c t a b l eb y e x a m i n a t i o n .N o r a d i o l o g yw a s t o i n ' N o o d t i c n lw i t h a ' e d d n d p a i r f u Ji o r n l performedto detectjoint disease. cu8Be.ti\o p f S o L lw d s i n (l J d e d .A o n e i r c h , J 2 The amountof pain presentpriorto and duringthe gaugereedle vras in\Frlcdrully arrosslhe forelool courseof acupuncturetreatmentwas determined Lrsing a s i m p l e1 0 0 p o i n t v i s u a la n a l o g u es c a l e . at the ba.eof tl'e pro\imal lsl '"reldldrso-phaldngeal patientwas Sivena non-steroidalanti\ L n d r e p a ' a l l e l l o l h c p l r n l d ' I Only one n t . o r l h e l o o l , l e ,o j0-b0 'ilu !1ilhoul i n f l a m m a t o r yd r u g d u r i n g t h e s t u d y ,a f t e r t w o for rnd ll^en rFmovcd .n secondr , i m u l a l r o nt l i l u r e l . A . e ( o n d p o i n lo f n c e d l i n S a c u p u n c t u r e t r e a t m e n t s h a d f a i l e d t o S i v e wa- o( (asiondllvuredon Lhee\rensorsurfa,c of the appreciableimprovement.This same patientwas wds pliciledrround w i t h d r a w n a f t e r t h e t h i r d t r e a t m e n tg a v e n o b8 loe. if a poirl of lenderness p f o x i m a l in his painscalethe l s t m e t a t a r s o - p h a l a n gj o e ianl t . T h e improvement Mav 1997vol 15 No.t 17 Acupuncturcin Medicine Downloaded from aim.bmj.com on September 9, 2014 - Published by group.bmj.com Results o{ pain in the foot, but no descriptionwas given of Thirteen (93%) patientsbenefitedfrom treatmentby their efficacyor durationof effectfor the painful acupuncturc. Thiswas shownby a reductionof the conditionsdescribed. The acupuncture methodused v i s u a l a n a l o B u es c o r e sd u r i n g t h e c o u r s eo { wasbotheasyand quickto perform,and well within treatrnent(F€ure 2). One patient required a single the remit of a busy Ceneral Practitioner's lirnited treatment,4 requiredtwo treatments,6 patients consultation time.A furtherconsideration shouldbe t h r e e , o n e p a t i e n tf o u r a n d o n e p a t i e n ts i x the safetyof acupunctureto the foot, comparedto t r e a t m e n t sO . n e p a t i e n th a d n o b e n e f i tf r o m a the possibleside effectsassociatedwith NSAIDs combination of acupunctureand diclofenac,an n o r m a l l y r e c o m m e n d e da s t r e a t m e n t i o r NSAID, and was referredto an orthopaedicsurgeon metatarsalEia. who injectedthe proximalist metatarso-phalanBealT h i s s t u d y c a n n o t a n s w e rt h e q u e s t i o na s t o joint with a local steroid injection before relief was w h e t h e r a c u p u n c t u r ei s m o r e e f f e c t i v e t h a n obtained.Over a follow up periodof one year,two conseryativernanagement with a metatarsalpad and patientsdevelopeda recurrence of their symptoms, N S A I D , a s t h e t w o t r e a t m e n t sh a v e n o t b e e n a t 3 a n d 6 m o n t h s r e s p e c t i v e l ya { t e rt h e i r l a s t f o r m a l l y c o m p a r e d . H o w e v e r ,t h e r e s u l t sa r e acupuncturetreatment.The VAS figureswere 25 sufficiently encouraging to suBgest that metatarsalgia and 5 respectively and both respondedto a single may be treatedby acupuncturealone and to warrant acupuncture treatment as previously described. a trial comparingthe effectiveness of thesediffering conservative treatments, Anthony I StellonBScMRCP TheAbbey Practice 107 LondonRoad,TempleEwell Dover,Kent CTl6 3BY (UK) - l . M a n n R A { 1 9 8 4 )M e t a t a 6 a l g i aC: o m m o nc a u s e sa n d c o n s e r v a r i v el r e a l m e n t .P o s t g r a d u a t M e e di c aI l o u n a l . 7515):150-68 2. EricksonRj, Edward, B (1996)Medically unresponsiveloot pain treatedsuccessf!llywith acupuncture., cuplrctrre i/] Medicine 14(2):71-4 l . M a n n F ( 1 9 9 2 ) R e i n v e n t i n gA c u p u n c t u r e .B u t t e r w o r t h H e i n e m a n nL,o n d o n1: 7 3 4 s' 30 20 Acupunctureand Moxibustion:Formulas and Tfeatment ,r cr-sD--r, Fiqu.e2. The nean visualanalo7uescorcsl0 = na pain, lOO= worst pain) in patlents ||ith melatarsalgladuinq the cou$e of treatnent with acupLncture. Theangoinq number of patientsbeinqacupuncturedwith eachtrcatnent b shown * Discusedin detailshow qi flows,hN to manipulate speci|c points,howin sequenceone's needleinsertioN,how longto stnulaie,elc.A lery usefulclinicalbook. 120.5o+P&P Acupuncture & Related Techniquesin Discussion The study has shown that metatarsalgiamay be treatedeffectiveiyby acupuncturealone and should now be recognised as a suitable form of conservativetreatmentfor this condiiion. ln the majorityof patientstreated,a maximum oi three acupuncturetreatmentswas requiredto alleviatethe metatarsalgia and the effectseemsto be an enduring one, as only two patientshad recurrenceof pain within a one yearfollow-upperiod.This prolonged analgesiceffectoccurredeven in thosepatientswho hadobviousjoint paihology. The acupuncturepoints usedto treat metatarsalgia in this study can be describedin both traditional Chinese and modern Western acupuncture terminology. UsingtraditionalChinesenomenclature pointusedacrossthe 1stmetatarsothe acupuncture phalangealjoint is Spleen3 and the otherpointused i s e q u i v a l e ntto a n A h - s h i p o i n t . U s i n gm o d e r n Westernacupunctureterminolog, thesewould be describedas trig8erpoints,as they were tenderto p a l p a t i o n .T h e s e a c u p u n c t u r ep o r n t s h a v e previouslybeendescribedby Mann f3l for treatment Acupuncture i n Medici ne 18 Physical Therapy "r r, v H.rNoa.Mr,,64 & s Mokone This bookfocuson conditonsconnonly encounrered by physicaltherapists,pdticuldly musculoskeleralcondrhons. The texi is suppoltedby clee illustration. !24.00+P&P Acupuncture Patterns & Practice r,rr r*,", This is a pEctical,clinicallyorientedexposilionof haditjonal Chinesediaemsisandacupunclurc therdpy.Theb@k consslsor 9 s€nesof caxesl|at is comonlv s@nin theclinic t29.50+P&P TENS Clinical Applicationsand Related Theory r" a".a",'rw-r An up-lo-datetextbookon rhe theory andpEctice of TENS reliews e$ential back Foundknowledgo.appliedknowledgeand !22.50+P&P HMdredt oj book titLes ia Acupua.ture, Chinese Medicine, Shia^u anll ConpLenentarr ne.liciae are perMnentlt awilable Jrun nocks. Books list on reqaest. ++ P&P pledse a.l.l fl.50 ** fot each .op! ailercd M a y 1 9 9 7V o l 1 5 N a . l Downloaded from aim.bmj.com on September 9, 2014 - Published by group.bmj.com Metatarsalgia: treatment by acupuncture Anthony J Stellon Acupunct Med 1997 15: 17-18 doi: 10.1136/aim.15.1.17 Updated information and services can be found at: http://aim.bmj.com/content/15/1/17 These include: Email alerting service Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article. Notes To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/