Plantar fasciitis is the most common cause of heel pain, and occurs in all types of athletic and active individuals. However, simply walking and standing on a hard surface may also cause symptoms. Plantar fasciitis is an inflammation and irritation of the plantar fascia, the connective tissue that supports the arch. Some orthopedic texts suggest the possibility of micro-tears in the fascia at or near its attachment to the calcaneus. Fifty percent of patients may also have a calcaneal heel spur.
Acupuncture treatment uses the extraordinary point Shimian M-LE-5 as the “target” zone for local treatment. Numerous other secondary points may be considered on the Kidney, Bladder and other related channels. And the inclusion of complementary procedures, such as orthotics for the correction of the biomechanics of the foot, often enhance clinical results.
The extraordinary point Shimian is the “target” zone of the plantar fascia and its attachment to the calcaneus. This point is located in the centre of the plantar surface of the heel . All local needling is in relationship to Shimian. Palpation will help determine the precise site of needle insertion.
The following is a summary of several variations on this local point. The practitioner may consider from one ahshi point to as many as four needle insertions. This naturally will be determined by the signs and symptoms of the patient, and the size of the “zone of pain” on the calcaneus and the attachment of the plantar fascia.
1. Two points at Shimian
Two needles are inserted perpendicularly into the two most sensitive ashi points in the region of Shimian. The depth is about 0.5 inches, varying with each patient. Some patients have a very thin “fat pad” on the heel, making insertion depth less than 0.5 inch. Consider electrical stimulation.
2. “Medial” Shimian
Palpation often reveals point tenderness near the medial tubercle of the calcaneous. This is about one-third of the distance between Shimian and the point Kidney 6. Consider this zone to be “medial” Shimian. Insert the needle at “medial” Shimian, directed toward the centre of the heel. The depth reached should be about 1 inch. Two needles may be used at this zone, determined by palpation. Electrical stimulation may benefit.
3. Shimian + “medial” Shimian
“Medial” Shimian may be paired with Shimian in the centre of the heel. The needle inserted in the region of “medial” Shimian will be roughly a 90 degree angle to a perpendicular insertion at the text location of Shimian in the centre of the heel. In some cases, you could add a second set of needles, making four needles in total in this treatment protocol, in other word, two needles are perpendicular, in the centre of the heel and the other two are inserted from the medial side, directed towards the centre of the heel. Again, consider electrical stimulation on these four needles.
With each of these variations above, needling is directly into the plantar fascia at or near its attachment to the calcaneus – the site of qi stagnation and blood stasis. In theory, we are increasing micro-circulation through these tissues. However, with all direct needling comes the possibility of aggravation. Explain this to your patients so they can be prepared. The flaring up these tissues is often clinically beneficial.
Warm needling may also be considered in this treatment. Some practitioners avoid needling directly into the heel, and therefore use only thread moxa. While they report good results with this technique, the inclusion of the needle is recommended. Alternatively, you may follow the needle treatment with thread moxa at the site of insertion. Consider five small, rice grain-size threads on each point needled.
Whitfield Reaves, OMD, L.Ac., has been working in the field of sports medicine since he first began practice in 1981. He earned a Doctor of Oriental Medicine degree in 1983 that included a thesis entitled Acupuncture and the Treatment of Common Running Injuries.
Whitfield’s experience in sports medicine includes the 1984 Los Angeles Olympic Games, as well as numerous track and field, ski racing, and cycling events nationally over the last 30 years. He has been in the forefront of the acupuncture sports medicine field, and lectures in North America and Europe. He is the author of The Acupuncture Handbook of Sports Injuries and Pain.