Acupuncture for Metatarsalgia

Last week (before our snow all melted), I went X-C skiing with my brand new skis on four days. Some aerobic cross training with a less weight bearing exercise does me good. The snow was cold and fast; it was great.

However, my orthotics wouldn't quite fit into my ski boots so I left them out.

By the weekend, I started having pain in ball of my right foot, particularly under the 2nd, 3rd and 4th metatarsal heads. It was painful to walk on. I didn't want to start running again for fear of exacerbating it. After a few days, the pain hadn't improved.

As a runner, I have experienced almost every type of injury that you can imagine: iliotibial band syndrome, shin splints, plantar fasciitis, stress fractures and many others. These have kept me from running for as short as only a few days to as long as a few months. The fear of injury keeps many of us observant and self-aware of our bodies.  I know that I am not alone in worrying  about the occasional little tweaks I feel: is that just a minor ache that will be gone to tomorrow or is that the beginning of yet another injury? The line between optimum fitness and overtrained is a fine one indeed. One never knows when another injury may occur that keeps you out of a race or from following your training program. Fortunately, I do not have any races planned for months and am still in my off-season. 

I had never had pain quite like this before. After doing some reading, I learned that what I had was metatarsalgia. Apparently the repetitive push-off when skiing had caused an injury that I had never gotten from running.

What was I to do?

Some recommend metatarsal pads, which I promptly ordered from Hapad, Inc. In the meantime, I also tried some NSAIDs and ice. This helped a bit, but not enough to allow me to run pain-free.

While I was doing a search of the medical literature on another topic, I decided to do a quick search for metatarsalgia. I was surprised to find an article: Metatarsalgia: Treatment with Acupuncture. I was intrigued because among other things, I know how to perform acupuncture. 

As a physician, I have been trained to have a natural skepticism of new or emerging therapies. However, several years ago a physician friend who knew acupuncture offered to give me my first treatment. Even though I am skeptical, I am also open-minded. I always try to learn as much as I can about new treatment modalities before passing any judgement one way or the other.

After that first treatment, I was a believer! There were tenderpoints and areas of muscle stiffness that I had had for years which had disappeared completely.  I had thought they were simply chronic annoying little aches and pains that I was going to have to live with for the rest of my life. Now they were gone!

I received several other treatments after that. However, shortly thereafter we moved away.  I didn't know of any acupuncturists locally from whom I could receive treament. So I learned how to do acupuncture. I don't provide this service to my patients because it is not really a part of my specialty. Rather, I learned how to do acupuncture primarily so that I would always have an acupuncturist readily at hand, no matter where I was. I don't believe that acupuncture can do everything (there is no treatment that can do that) but it does seem to work very well for managing pain as well as musculoskeletal overuse injuries.   

The article on metatarsalgia suggested a 93% response rate (but the number of participants was very small and there was no placebo group) so decided to try the treatment for myself. I modified the needling locations to over the 3rd metatarsal head where the maximum area of tenderness was. I used Seirin L No. 3's and left them in for about 15 minutes which was longer than suggested in the article. From personal experience I have found that I get a better response if I leave the needles in until the body is no longer "grabbing" them and they are almost ready of fall out on their own.

If you have never received acupuncture, the best I can describe the sensation of being needled is like a dull but pleasant ache. It is almost like the kind of pleasant pain you feel during a good massage. Other times, instead of an ache, the feeling is more of a spreading warmth. Sometimes the muscles twitch. The needles are so fine and sharp, that it doesn't hurt like when getting an injection.

I felt the ache immediately and  knew that I had found some good points to needle. The next morning, my metatarsal pain had disappeared completely!   I waited another day before running and was surprised that it did not return.

Amazing! Usually I get improvement but not complete resolution of symptoms after the first treatment.  

The metatarsal pads finally came in the mail today. I am still going to put them in my ski boots to hopefully prevent any future recurrence.

If the pain returns I will certainly get out my acupuncture needles again.

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9 responses

  1. Wow, sounds pretty neat!
    I've actually been considering accupuncture for the chronic pain in my left calf…it seems to be muscular or tendon related, and while deep tissue massage helped, it hurt so much that I could only have it done once in a while…
    but of course, in my recent move, I have not been running too much, so lots less pain anyway!
    I admire you the courage to stick yourself…I cannot even do it to test blood sugar….

    January 11, 2008 at 3:45 pm

  2. In reality, I am a chicken when it comes to blood. That is why I could never work in an ER. I am even more of a chicken when the blood happens to be coming from me! However, acupuncture feels so good afterwards that I was able to get over the apprehension I initially had about poking myself.
    Once, I did have to place sutures into a lower extremity laceration that I received when I was riding horses up in the mountains. The guys who were with me were non-medical people. We were so far out into the wilderness that there was no way that I could put my boots on and ride my horse out to civilization for medical care.
    I always try to bring medical and wound care supplies with me when going for prolonged trips so I had all of the supplies necessary. I attempted to talk one or another of my friends into suturing the wound but I was unable to convince any of them, even with me offering to supervise and talk them through it.
    So I ended up suturing myself up. I am proud that I did so without fainting even though I did feel very lightheaded when I first injected the lidocaine.
    My friends, the supportive good ole boy redneck cowboy-types that they were, did offer me a swig from a whiskey bottle they had. I admit that I took two plus one more afterwards for good measure.
    When we got back to civilization, of course, my friends told everyone they knew. They bragged about how doc just sewed himself up. Before you know it the story became larger than what really happened. I only placed a few sutures on myself but after that story was told and retold, some folks were under the impression that I had practically re-attached a lost limb! It's really funny how stories can change so much with time.
    Though I chuckle at my memory of this story, I hope that I never ever have to suture myself up again!

    January 11, 2008 at 4:47 pm

  3. May 26, 2010 at 11:49 am

  4. May 26, 2010 at 11:52 am

  5. I don't have a video and haven't yet had to repeat the treatment… maybe I will when winter returns and it is cross country skiing season again?
    I found that acupuncture insertion points are sometimes more easily found by palpation rather than visualization only, after all we're all built a little differently and the skin can move over other tissue. Thus a video would probably be less helpful than actually seeing it done in person. I don't think I could describe the anatomic locations any better than as described in the captions in the photo or in the article.
    Sorry I can't be more helpful- but thank you for reading and commenting!

    May 30, 2010 at 9:22 am

  6. tziporah Newman

    whats the link to the article about foot accupuncture?
    the link said not available
    thanks

    February 5, 2012 at 11:53 pm

    • Sorry, I don’t know what happened to it. I’ll have to see if I can track it down.

      April 22, 2012 at 11:34 am

  7. The acupuncture metatarsalgia article is located here: http://aim.bmj.com/content/15/1/17.full.pdf+html?sid=1dee96b8-7d14-4feb-9929-cfaab1d2eb9f. Thanks for blogging about this. I hadn’t considered acupuncture for my chronic metarsalgia caused by bad foot biomechanics. It’s something I’m working on, but in the meantime acupuncture might allow me to enjoy hiking and running more!

    June 10, 2012 at 10:01 am

    • Thanks for finding this older post of mine and commenting. I haven’t had any further problems with metatarsalgia since. Of course there are alway other overuse injuries and pains lurking… good luck with your hiking and running!

      June 17, 2012 at 12:07 pm

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