April 2014

Patient Perspective: Taking an alternative path to chronic foot pain relief

9_FA_patient_perspBy Barbara Boughton

After a year in a fracture boot with a broken foot, I thought my ordeal was over. I was wrong.

The broken bone in my foot, sustained after a fall down a staircase in my home, had occurred midway down the fifth metatarsal bone below my little toe—a site that is notoriously difficult to heal, according to my podiatrist. When a computed tomography scan revealed the bone had only partially healed after a year in the cast, my podiatrist and I agreed surgery would be the best option.

The surgery, in which a screw was placed lengthwise through the bone to knit it together, went well. The last thing I remember was the anesthesiologist saying, “I’m going to give you a little happy juice,” as she injected a sedative into the catheter line in my hand. I slept through the whole surgery. Then came six more weeks in a plaster cast and several more months in that achingly familiar heavy fracture boot (see “Patient Perspective: Communication takes edge off pain of recovery,” September 2012, page 23).

I thought I was home free. I couldn’t wait for the boot to be removed, and to be free of the foot pain that had hounded me for a year. Little did I know that it would be another year before the ache in my foot would lessen. And freeing myself of that pain would mean trying an array of alternative therapies.

Healed, but still in pain

When I was able to remove the fracture boot after the surgery, x-rays revealed the bone had healed nicely. On one of my visits, my podiatrist pointed to an x-ray on a wall-mounted light screen that showed the now-mended broken bone, and to my fascination, the screw that now held the bone together.

Yet, I complained to my podiatrist on a follow-up visit that I was still experiencing pain in the area of the broken bone. The pain centered around the thin red scar left from surgery that I could now see on the right side of my right foot. The pain was not severe, but cropped up often enough that I was hampered in daily activities. Climbing stairs caused pain, as did standing for longer than half an hour. Any significant pressure, or even walking more than a few blocks, was uncomfortable. So I eventually gave up two things I loved—walking in my neighborhood parks on weekends and the standing yoga poses and stances I enjoyed doing at home. I tried a local anesthetic cream, but it didn’t provide much lasting relief. Gabapentin—which addresses nerve pain—was helpful, but did not get rid of my foot ache entirely.

My podiatrist, who I like because he has a good sense of humor, said, “Yeah, after all that surgery, doc, my foot still hurts, and it’s worse than before!” He was exaggerating, of course. But the pain was actually very similar to the ache I had felt before the surgery whenever I removed the walking boot.

My podiatrist told me that pain after foot surgery for a broken bone is not uncommon. The nerve near the bone is sometimes irritated by the surgery, or the nerve can become entrapped in the scar tissue created by the surgery, he told me. It often resolves within a few months, he said. I was reassured.

But the pain didn’t resolve after a few months, and I was back in my podiatrist’s office again. He took another x-ray to make sure nothing was wrong with the bone. But again, the bone looked fine. The x-ray revealed it had healed completely and there were no new broken bones.

Alternatives

Several days after her first acupuncture treatment, the author’s foot pain had decreased by about half.

Several days after her first acupuncture treatment, the author’s foot pain had decreased by about half.

“Sometimes people get resolution of this kind of nerve pain with acupuncture,” my podiatrist said. “It interferes with the pain signals to and from the brain.”

I also asked about physical therapy. I wondered whether the long period in a cast might have weakened the foot and that weakness might be contributing toward the pain, which I experienced only when I walked or put pressure on the foot.

“Physical therapy could help,” my podiatrist said. “It’s worth a try.”

I made my first trip to a physical therapist that next week. The therapist I visited was part of a physical therapy group well known for treating athletic teams in the San Francisco Bay Area, where I live. The physical therapist there recommended massage and some home exercise—mainly heel raises. She also tried something called “cupping.”

“There isn’t much scientific evidence to support it, but many of our clients find it helps,” she said.

She then placed what looked like small plastic suction cups, each a little bigger than a quarter in diameter, on and near the scar on my foot. The cups grabbed what little skin there was around the scar, and, man, did those suction cups hurt. They were applied for about 15 minutes at that visit and several visits afterward. The cupping was used to loosen the scar tissue and free the nerve, the physical therapist told me.

What I didn’t know at the time is that cupping is an alternative therapy developed in Chinese medicine. However, it’s rarely used on the feet because there’s very little skin there to grab.

After a few sessions, the home exercises didn’t seem to be helping, and the cupping seemed to only make the pain in my foot worse. So I decided to seek a solution elsewhere.

The author’s acupuncturist, Carol Lourie, ND, LAc.

The author’s acupuncturist, Carol Lourie, ND, LAc.

I then paid a visit to a woman who practiced Korean acupressure in San Francisco. A friend who also suffered from nerve pain in her feet enthusiastically recommended her, and I had high hopes for the visit as I drove toward her office. During our session, the acupressure practitioner told me she had studied with a local master in Korean acupressure who is now retired. As she kneaded and applied pressure on my feet while I lay on a massage table, I could feel a tingling pins-and-needles sensation in my right foot, particularly near the area of the scar.

I knew a little bit about alternative therapies since I had used them before, including acupuncture for food allergies and homeopathy for the flu. I asked if the pins-and-needles sensation meant that the pressure of the massage had made contact with my body’s “qi” (pronounced chee). (Qi in Oriental medicine is considered the life force, and is thought to flow through the body in a number of meridians.)

“Yes,” the acupressure practitioner replied, as she continued to massage my foot in a series of light up-and-down strokes. All through the session I could feel this ting­ling—a not unpleasant sensation—in my foot, along with the soothing touch of the practitioner’s hands.

Afterward, I was ecstatic. I was sure my foot pain was at an end. The next day I felt no pain, and was envisioning taking up hiking again. But several days later, the pain set in, and so I returned for another session of acupressure.

“If the acupressure doesn’t work this time, we may need to use acupuncture needles. They go deeper and can have more of an effect,” the practitioner told me.

Next up: Needles

Unfortunately, that second session of acupressure did not significantly change the pain in my foot. I was also driving 45 minutes each way to see the practitioner. So I decided to look for a medical professional who practiced acupuncture, but was closer to home. The woman who had treated me for food allergies with a combination of herbs and acupuncture years before, Carol Lourie, ND, LAc, had an office in Berkeley, CA, about 20 minutes from my apartment. So I gave her a call, and went in for my first appointment.

Lourie is trained as a naturopath—a doctor of alternative medicine—and also is trained to practice homeopathy and is a licensed acupuncturist. On our first visit, when she took my medical history, she noted she had treated a number of patients with symptoms similar to mine.

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The exam room where the author received her acupuncture treatments.

“When you’ve had surgery and experience numbness, tingling, and paresthesia afterward, it’s often because the nerves have become inflamed due to the trauma of the surgery, or the tissue actually became injured during the surgery,” she said. She explained that as well as putting acupuncture needles throughout my body, she would be treating the painful area on my foot with one or more needles.

“When you treat the specific area that has symptoms, you are addressing an inflammatory process in the tissue that’s irritating to the nerve,” she said.

Usually acupuncture needles are placed throughout the body to redistribute the qi and heal the patient’s illness. But, in my case, she’d also be placing a needle locally on my foot, near to and at the site of the scar, to address a specific symptom there—a process called placing an “extra” or “Ashi point” in Chinese medicine, she said.

“It brings energy, or qi, to the tissue, helping to heal it,” she said.

When I told Lourie that my podiatrist had said that acupuncture can interfere with the pain signals to and from the brain, she agreed the needles might have this effect. But the most important contributor to the healing of the foot tissue would be the needle’s effect on the qi, she noted.

Then it was time for my first treatment. I lay on my stomach first. Each needle Lourie placed felt like a small pinprick in my skin. The sensation was momentary, and after she placed the needles, I had no pain at the needle sites at all. The room was pleasantly warm and I began to feel slightly drowsy. During the 15 minutes or so I was treated on my stomach I almost fell asleep.

Then it was time to roll over, and Lourie repeated the same process on the front of my body. This time, she paid special attention to my right foot and applied needles there. Again, the acupuncture treatment made me feel drowsy—which is not an uncommon effect, Lourie told me. Lourie left the room and I fell asleep for the next 15 minutes of the treatment.

Several days later, I noticed the acupuncture treatment did seem to have had an effect. The pain in my foot had decreased by about half. And after several treatments—each spaced two weeks apart—the pain in my foot was quite noticeably better. I was able to climb up and down stairs with no ache in my foot. I barely noticed the area on my foot that had given me pain.

After one session, I asked Lourie about the other alternative therapies I had tried—the acupressure and the cupping from the physical therapist: Why had they not worked?

“Acupressure is sometimes helpful, but it’s not always able to get deep enough to affect the qi,” Lourie said.

She was also familiar with the Chinese medicine practice of placing suction cups around a scar.

“It’s thought that this practice breaks up stagnation beneath the area that you are cupping,” she said. The theory is that cupping helps rid the body of this stagnation, enabling the qi to flow.

“But I would never cup on a foot. There just isn’t enough area, enough skin to grab onto. That’s why the cupping on your foot was painful,” she said.

I wondered whether there were patients with nerve pain that Lourie had treated who weren’t helped by acupuncture and Chinese medicine. Lourie told me some of her patients have experienced serious nerve pain, and sometimes, their treatment isn’t as successful as mine.

One example was a man she treated had severe pain in his toe after surgery.

“I was able to address the pain, but not completely eliminate it. The treatments just turned the volume down,” she said.

Progress

As for me, my encounter with acupuncture for my foot pain had been a positive one. I continue to have treatments, although they are now spaced about one month apart. Soon, I hope, I won’t need the acupuncture at all. The treatment is not cheap—more than $100 a session—and my medical insurance pays only for a small part of that fee.

“It is really unfortunate that health insurance in the US often doesn’t pay for alternative therapies, so people have to be willing to pay out of pocket for it,” Lourie said.

When I started this journey toward finding a solution to the nerve pain in my foot, I never anticipated I would find the answer in the office of an acupuncturist.

Yet, as it turns out, there is evidence in the medical literature to support the beneficial effects of acupuncture on nerve pain.

One study, done with functional magnetic resonance imaging, showed acupuncture treatments reduce the stimulation of areas in the brain involved in neural pain,1 and a recent review of basic and clinical research found that acupuncture’s modulating effects on nerve pain may result from its effects on neurotrophin expression.2,3

I suppose some people might be doubtful of the power of acupuncture, and say I experienced only a placebo effect. But my pain was very real, and so was the relief I experienced.

Barbara Boughton is a freelance medical writer based in the San Francisco Bay Area.

REFERENCES
  1. Yeo S, Choe IH, van den Noort M, et al. Consecutive acupuncture stimulations leads to significantly decreased neural response. J Altern Complement Med 2010;16(4):481-487.
  2. Soligo M, Nori SL, Protto V, et al. Acupuncture and neurotrophin modulation. Int Rev Neurobiol 2013;111:91-124.
  3. Da Silva MA, Dorsher PT. Neuroanatomic and clinical correspondences: Acupuncture and vagus nerve stimulation. J Altern Complement Med 2013 December 20 [Epub ahead of print]

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