Browsing articles tagged with " Plantar Fasciitis"

67. Dr. Jun Xu’s calling from West Africa

Mar 5, 2017   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

Dr. Jun Xu went to Leprosy village in 2013, 2014 and 2016, soon he will go to the leprosy village on March 31, 2017.

In 2013, there was no a single room being used for treatment in the leprosy village, Dr. Xu and his team had to use a tent. The temperature was around 125 Fahrenheit degrees.

The leprosy patients were waiting for their turn to be attended. Dr. Jun Xu saw about 200 patients a day.

Typical leprosy patient:
Early Stages
Spots of hypopigmented skin- discolored spots which develop on the skin
Anaesthesia(loss of sensation) in hypthese opigmented spots can occur as well as hair loss
“Skin lesions that do not heal within several weeks of and injury are a typical sign of leprosy.” (Sehgal 24)

Progression of disease

“Enlarged peripheral nerves, usually near joints, such as the wrist, elbow and knees.”(Sehgal 24)
Nerves in the body can be affected causing numbess and muscle paralysis
Claw hand- the curling of the fingers and thumb caused by muscle paralysis
Blinking reflex lost due to leprosy’s affect on one’s facial nerves; loss of blinking reflex can eventually lead to dryness, ulceration, and blindness
“Bacilli entering the mucous lining of the nose can lead to internal damage and scarring that, in time, causes the nose to collapse.”(Sehgal 27)
“Muscles get weaker, resulting in signs such as foot drop (the toe drags when the foot is lifted to take a step)”(Sehgal 27)

Long-term Effects
“If left untreated, leprosy can cause deformity, crippling, and blindness. Because the bacteria attack nerve ending, the terminal body parts (hands and feet) lose all sensations and cannot feel heat, touch, or pain, and can be easily injured…. Left unattended, these wounds can then get further infected and cause tissue damage.” (Sehgal 27)
As a result to the tissue damage, “fingers and toes can become shortened, as the cartilage is absorbed into the body…Contrary to popular belief, the disease does not cause body parts to ‘fall off’.” (Sehgal 27)

Every year, Dr. Jun Xu and his team bring around $300,000 worth of medicine donated from his team members and Americares in Stamford, CT to treat the leprosy and other patients in Senegal and Guinea Bissau. http://www.americares.org/, in 2017, his team also received medicine donation from Direct Relief in California, https://www.directrelief.org/.
Dr. Jun Xu and his team finally established a clinic in the leprosy village, one building for the clinic, and another building for the living of doctors and nurses.

Leprosy village people were celebrating the opening of the clinic.

There are 8 wards, which could hospitalize the patients if it is medically necessary.

Dr. Jun Xu’s team usually stay in Senegal for 10 to 14 days, these are the foods his team brought from US in order to keep them health and safe. They do not dare to eat street food.

The above are the coolants contained food Dr. Jun Xu’s team brought from US

Dr. Jun Xu and his team from US in 2006.
If you are interested in joining Dr. Jun Xu’s team or donating to his work in Senegal, please address your check payable to AGWV, and send to
Jun Xu, MD, 1171 E Putnam Avenue, Riverside, CT 06878, USA.
Dr. Xu promises that all your donation 100% will go to Senegal and his team will nerve use a penny from your donation. You will receive the tax deductible receipt. Any amount is a great help for Africa patients.
For more info, please visit our websites at
http://www.drxuacupuncture.co/ and http://www.africacriesout.org/

34. Acupuncture and Heel and Foot Pain

Oct 13, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  No Comments

News Letter, Vol. 3 (10), October, 2011, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

Heel and Foot Pain


literunner.com

Jennifer is a 55 year-old, moderately obese woman. She runs every morning for about 4 to 5 miles, who complains of right heel and plantar foot pain, difficulty walking, especially in the morning after waking up from sleep for 2 years. She went to the podiatrist, who gave her an x-ray, which showed a mild heel spur at her heel. She was given orthotics for the right foot, but she still feels pain, therefore, she comes to me for evaluation and treatment.

By physical examination, there is tender point at right heel and arch. There is no ankle pain, no numbness nor tingling sensation at right leg.  Based on my examination and clinical information, the patient most likely has right plantar fasciitis with possible heel spur.

There are two different concepts of plantar foot pain:

  1. Plantar Fasciitis: Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot, i.e. the plantar fascia. It connects the heel bone to the toes and covers and supports the arch of the foot. The pain is located at the medial heel, however, if the pain is severe, it will spread out to entire foot arch.
  2. Heel Spur: A heel spur is a hook of bone that can form on the heel bone (calcaneus). A calcaneal spur (or heel spur) is a radiological (X-ray) finding, and when it is located on the inferior aspect of the calcaneus, is often associated with plantar fasciitis. However, sometimes, people may have heel spur without any pain, some people may have severe heel pain and the pain may mixed with plantar fasciitis to cause the entire plantar foot pain. An inferior calcaneal spur consists of a calcification of bone, which lies superior to the plantar fascia at the insertion of the plantar fascia, most common in the medial side heel of the foot.

Fig 10.1

Causes, incidence, and risk factors:

The most important key part of plantar fasciitis is overstretched or overused of the thick band of tissue on the bottom. This can be painful and make walking or running more difficult.

Risk factors for plantar fasciitis include:

  1. Obesity.
  2. High arches and/or flat feet.
  3. Overwalking or running, especially running downhill or on uneven surfaces
  4. Tight Achilles tendon, which is the tendon connecting the heel to the calf muscles.
  5. Hard surface of the shoes, especially tight and hard shoes without any arch support or Cushing function.
  6. Men ages 40 to 70.

Symptoms:

The pain in the bottom of the foot usually is sudden onset with most often sharp or burning sensation, sometimes you may feel dull pain.

The pain is usually worse:

  • In the morning when you take your first steps
  • After sitting or standing for a while
  • When climbing stairs or walking on uneven surfaces
  • After intense activity

The pain usually feels better after you warm up with first steps or take hot shower.  The pain may develop slowly over time, or suddenly after intense activity.

Signs and Tests:

The doctor will perform a physical exam. This may show:

  • Tenderness on the bottom of your foot, usually at the medial heel and entire arch.
  • Flat feet or high arches
  • Mild foot swelling or redness
  • Stiffness or tightness of the arch in the bottom of your foot.

X-rays may be taken to rule out other problems, but having a heel spur is not significant.

Fig 10.2

http://spinalphysio.kornberg.net/heel_spurs.gif

Treatment:

  1. Anti-inflammatory medications: Acetaminophen (Tylenol), or ibuprofen (Advil, Motrin) to reduce pain and inflammation.
  2. Rest- At least rest for one week or more, no running, no long walking.
  3. Ice: apply ice to your bottom of the feet for at least 15 min, 2 to 3 x  per day.
  4. Wearing shoes with cushions, custom made shoe insole and heel cups. Boot cast, night splint

Arch Support

Fig 10.3

plantar-fasciitis-fix.com

Fig 10.4

the-good-doctor.net

Fig 10.5

myfootshop.com

Fig 10.6

bannertherapy.com

Fig 10.7

feetinsoles.com

Fig 10.8

foot-pain-store.com

Fig 10.9

woundblog.com

  1. Physical therapy

Fascia-specific stretching exercise by gently pulling back the toes for 10 sets of 10 seconds.  Repeat 3 times a day.

Fig 10.10

Fig 10.11

Another exercise targeted at the plantar fasciia and strengthening the small muscles of the foot is marble pick-ups.  Place a handful of marbles on the floor and pick them up using the toes and place in container.  Repeat for a total of 3-5 minutes.  If marbles are not available, the same motion can be performed using a towel.

Fig 10.12

The use of anti-inflammatory properties of ultrasound targeted to the bottom of the heel is beneficial.  A typical treatment would be around 8 minutes and can be performed by your physical therapist.

  1. Acupuncture

The following acupuncture points are selected: experienced points (Arshi points), Ki 1 Yong Quan, Sp 9 Ying Ling Quan, GB 34 Yang Ling Quan,

Points Meridian/No. Location Function/Indication
1 Arshi Points As indicated For local pain
2 Yong Quan Ki 1 On the sole, in the depression when the foot is in plantar flexion, approximately at the junction of the anterior third and posterior two thirds of the sole Headache, blurring of vision, dizziness, sore throat, dryness of the tongue, loss of voice, dysuria, infantile convulsions, feverish sensation in the sole, loss of consciousness
3 Ying LingQuan Sp 9 On the lower border of the medial condyle of the tibia, in the depression on the medial border of the tibia Abdominal pian and distension, diarrhea, dysentery, edema, jaundice, dysuria, enuresis, incontinence of urine, pain in the external genitalia, dysmenorrheal, pain in the knee
4 Yang Ling Quan GB 34 In the depression anterior and inferior to the head of the fibula Hemiplegia, weakness, numbness and pain of the knee, beriberi, hypochondriac pain, bitter taste in the mouth, vomiting, jaundice, infantile, convulsion

Fig  10.13

  1. Steroid injection: Steroid injection sometimes may make a significant improvement. However, you should use is cautiously, because the steroid may cause necrosis of the plantar foot.
  2. Surgery: Last resort.

Jennifer’s Treatment:

Jennifer was advised to stop running immediately. In the meantime, she was given heel pad with two layers of shoe insoles, and changed to a bigger size of snickers. She was given above acupuncture treatment and physical therapy stretch exercise 3x per week for 4 weeks. She also stretch her foot and perform ice massage 3 to 4 x per day. Her plantar faciitis was completely healed. She run again after 2 months.

Tips for Patients:

  1. Early treatment, the earlier, the better.
  2. Always use two layers of shoe insoles to cushion your inflamed foot.
  3. Rest and ice massage

Tips for Acupuncturists:

  1. Arshi 1 and Arshi 2 are most important points to reduce plantar pain.
  2. Use electrical stimulation to desensitize the plantar foot pain.
  3. Encourage your patients to use shoe insoles, two layers are better than one layer.
  4. Try not to use steroid injection.

33. Acupuncture and Lateral Ankle Sprain

Sep 20, 2011   //   by drxuacupuncture   //   Blog, Case Discussions, Uncategorized  //  1 Comment

 

News Letter, Vol. 3 (9), September, 2011, © Copyright

Jun Xu, M.D. Lic. Acup., Hong Su, C.M.D., Lic. Acup.

Robert Blizzard III, DPT

www.drxuacupuncture.co

Rehabilitation Medicine and Acupuncture Center

1171 East Putnam Avenue, Building 1, 2nd Floor

Greenwich, CT 06878

Tel: (203) 637-7720

 

Lateral Ankle Sprain

Fig 9.1

Douglas is a 26 year-old male football player who has been experiencing right lateral ankle pain after a month of strenuous exercise.  He was training for the 100-meter dash when he felt a pain in his right ankle that caused him to fall.  He was immediately taken to a sports medicine doctor who found his right ankle to be moderately swollen, though because of the severe pain Douglas felt, the doctor immediately sent him for an MRI without contrast of the right ankle.  The MRI showed no fracture, no ankle bone dislocation, though showed there was a ligament sprain of the right ankle.

 

The patient was given preventative treatment known as RICE, which stands for:  R is rest; the patient was ordered to stay off the right ankle.  I is ice for ice packs to be held to the affected area to decrease both the inflammation and the swelling.  C is for compression: the patient was given an elastic sock to wear on his right ankle and E is elevation, so the patient was instructed to elevate his leg to decrease the edema and the swelling.

 

The patient gradually felt better, however he still felt pain in the right lateral ankle after a month, so he came to me for further treatment and evaluation.

 

I noted the ankle was still slightly swollen and the lateral right side of it was very tender.  The range of motion of the right ankle dorsiflexion, i.e. his right foot bend up to his nose was 0-30 degrees and the plantarflexion, i.e. his foot bend down to the ground, 0-20 degrees, though with pain.

 

The patient had suffered a lateral ankle sprain, the most common form of ankle sprains, which accounts for 80% of this type injury.  There are three small ligaments in the ankle which are very easy to sprain.

  1. Anterior talofibular ligament (ATFL):  This is the most common ligament injury
  2. Calcaneofibular ligament (CLF): This is the second most common and
  3. Posterior talofibular ligament (PTFL):  This is the last to be injured.

http://www.webmd.com/hw-popup/ankle-sprain Fig 9.2

All of these three ligaments function to stabilize the ankle during inversion, so when the ankle experiences inversion on the plantarflexed foot, this is the most vulnerable position.

 

http://www.midwestsportsfans.com Fig 9.3

Ankle Sprain Causes

The ankle pain is most often caused by injury to the ligaments, not bone. Ankle ligaments, especially as mentioned above are injured most commonly when the foot is turned inward or inverted by a force greater than the ankle ligaments can sustain. This kind of injury can happen in the following ways:

  • Sports: such as football, basketball, tennis, when the athlete landed with the plantar foot inverted and the downward force. A common example is a basketball player who goes up for a rebound and comes down on top of another player’s foot. This can cause the rebounder’s foot to roll inward.)
  • Fall while stepping on an irregular surface, such as stepping in a hole.
  • The most common ankle sprains are Inversion injuries, in which the foot rolls inward, are more common than eversion injuries (also referred to as a high ankle sprain), in which the foot twists outward.

There are three grades of lateral ankle sprains:

  1. Grade 1 is mild, which includes partial tear of the ATFL and intact CFL and PTFL.  There is no instability, mild swelling and point tenderness at the lateral aspect of the ankle.
  2. Grade 2 is moderate.  There is a complete tear of the ATLF and partial tear of the CLF.  The patient’s ankle is very unsteady and exhibits diffuse swelling and ecchymosis.
  3. Grade 3, severe. This is the complete tear of the ATFL and CFL.  The patient in this case is extremely unsteady.

 

Western medicine treatment.

  1. During the acute stage the ankle is treated with RICE, as detailed above.
  2. Nonsurgical treatment only can treat grade 1 and possibly part of grade 2; grade 3 requires surgery.
  3. Physical Therapy:

 

A rocker boot helps to promote a more natural gait while providing stability for severe ankle sprains, fractures of the foot and for post-operative use.  There are many types of rocker boots, but most feature adjustable air cells to ensure a custom snug fit to accommodate any foot.

 

Ensuring optimal pain free motion is needed to help with recovery.  Starting with Active Range of Motion perform up to 30 pain free reps of the 4-Way Ankle Movements before moving on to resistance with strengthening.  Strengthening the muscles of the ankle and lower leg is important to prevent imbalances and future weakness in the ankle.

 

1: Dorsiflexion – foot is pulled back towards the body against resistance

2: Plantarflexion – foot is pushed down away from the body against resistance

3: Inversion – foot is turned down and in against the resistance

4: Eversion – foot is turned up and out against the resistance

Fig 9.4

 

 

Fig 9.5

 

 

 

Fig 9.6

 

 

Fig 9.7

 

 

 

To continue to strengthen the stabilizing muscles of the ankle and improve proprioception work on standing balance on the ground.  After, continue to progress to balance with a foam pad for 2 sets of 30 seconds.

Fig 9.8

 

 

 

This will assist in strengthening the stabilizing muscles of the ankle and help to regain balance in circumstances where the ankle may be injured again such as in basketball when going up for rebound and coming down on another players ankle.  The wobble board once balance is achieved in standing on a flat surface and on the foam pad can be used again, this time in a standing position.

 

Traditional Chinese medicine treatment:

 

Many patients tried everything before they came to me. They usually had different treatments for years. However, they still feel pain with difficulty standing, and walking. They have extreme pain by walking a long distance, such as during vacation. Acupuncture might be their last resort.

 

My personal experience is that we first have to make a clear diagnosis by palpating the tender points to differentiate injuries of the three ligaments: the most common injured ligament is ATFL, the second most common injured ligaments are ATFL and CFL. You will see rarely the PTFL injury. After palpation, you can clearly understand the source of the problems. Then you can treat the injury accordingly.

 

The following acupuncture points are usually selected: Sp 6 San Ying Jiao, UB 62 Sheng Mai, GB 40 Qiu Xu, UB 60 Kun Lun,  PC 6 Nei Guan, and St 36 Zu San Li.

Sp 6 is the crossing points for three Ying Meridians, therefore, it can adjust all three meridians energy, and smooth the blood and qi. UB62 is located at the ATFL, therefore, it is very important to use for the ATFL injury. GB41 coincident at CFL, it will help UB62, both UB 62 and GB 41 will bring blood flow to the injured ATFL and CFL ligaments to facilitate healing. PC 6 and St 36 helps adjust the entire energy flow in the body.

Points Meridian/No. Location Function/Indication
1 San Yin Jiao Sp 6 3 inches directly above the tip of the medial malleolus, on the posterior border of the medial aspect of the tibiaFigure 24.22 Abdominal pain, distension, diarrhea, dysmenorrheal, irregular menstruation, uterine bleeding, morbid leucorrhea, prolapse of the  uterus, sterility, delayed labor, night bed wet, impotence, enuresis, dysuria, edema, hernia, pain in the external genitalia, muscular atrophy, motor impairment, paralysis and leg pain, headache, dizziness and vertigo, insomnia
2 Shen Mai UB 62 In the depression directly below the external malleolus Epilepsy, mania, headache, dizziness, insomnia, backache, aching of the leg
3 Qiu Xu GB 40 Anterior and inferior to the external malleolus, in the depression on the lateral side of the tendon of extensor digitorum longus Pain in the neck, swelling in the axillary region, pain in the hypochondriac region, vomiting, acid regurgitation, muscular atrophy of the lower limbs, pain and swelling of the external malleolus, malaria.
4 Kun Lun UB 60 In the depression between the external malleolus and archillus tendon Headache, blurring of vision, neck rigidity, epistaxis, pain in the shoulder, back and arm, swelling and heel pain, difficult labor, epilepsy
5 Nei Guan PC 6 2 inch above the transverse crease of the wrist, between the tendons of m. palmaris longus and m. flexor radialis. Cardiac pain, palpitation, stuffy chest, pain in the hypochondriac region, stomachache, nausea, vomiting, hiccup, mental disorders, epilepsy, insomnia, febrile diseases, irritability, malaria, contracture and pain of the elbow and arm.
6 Zu San Li St 36 3 inch below St. 35 Du Bi, one finger below the anterior crest of the tibia, in the muscle of tibialis anterior Gastric pain, vomiting hiccup, abdominal distension, borborygmus, diarrhea, dysentery, constipation, mastitis, enteritis, aching of the knee joint and leg, beriberi, edema, cough, asthma, emaciation due to general deficiency, indigestion, apoplexy, hemiplegia, dizziness, insomnia,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig 9.9

 

 

 

 

Treatment course for Douglas:

Douglas underwent my treatment 2-3 x per week for about 5 weeks, besides acupuncture treatment, he also was guided to have strengthening exercise for his right ankle.  I realized that acupuncture treatment only might take a longer time to recover, however, if we combine acupuncture with physical therapy and ankle brace, the patient will have much less pain and resume their regular walk sooner. After 5 weeks treatment, Douglas started his regular walk with mild tenderness; he can sustain much longer ambulation without pain.

 

Tips for Acupuncturist:

 

    1. Acupuncture and physical therapy can treat only the grade 1 ankle sprain.  If grade 2 or 3 is concerned, you should encourage the patient to consult an orthopedic physician.
    2. Acupuncture is a good treatment for long-term ankle pain, you may need to treat the patient for a few months in order to get better results.
    3. You should encourage your patients to use ankle brace to protect ankle joint.
    4. Electrical stimulation with UB 60, UB 62 and GB40 for 30 min are very important.

 

Tips for Patients:

 

  1. For grade 3 sprain, you may consider surgery for reparation. However, if you have grade 1 or 2, be very cautious to have surgery. I have patients who went through many surgeries, have had long term pain for many years.
  2. You should always massage the three points, UB 60, UB 62 and GB40 5-10 min in the morning and evening everyday. If you have anti-inflammatory cream for massage, you will get better results.

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