Document 6475157

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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.
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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
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Metatarsalgia: treatment by acupuncture
Anthony J Stellon
Acupunct Med 1997 15: 17-18
doi: 10.1136/aim.15.1.17
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