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.