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Has anyone any experience of using trigger point techniques in treating foot conditions? Was it useful?

thanks
Ian

I use Trigger Point acupuncture sometimes in combination with traditional podiatry, sometimes as 1st line treatment. I haven't been using this technique for long, approx. 2 years, so it is difficult to give an accurate success rate but so far TP acupuncture has proved between 70-80% successful.

Am presently treating a lady in her mid 60's with pain between 3rd and 4th mets. Pressure applied to the trigger point creates a shooting pain along dorsum of both of 3rd and 4th toes followed by a dull ache at the trigger point and tingling in 3rd and 4th toes. Patient has a history of pustular psoraisis and suspected psoriatic arthropathy. In the time it will take for confirmed dx of arthropathy and probable neuroma, TP acupuncture has reduced pain in week 1 from a VAS score 10 to VAS score 1 in week 3. Pt's life quality improved and now time to plan for long term podiatric management.

George

It should be part of the ddx for any soft tissue/musculoskeletal symptom.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Hi George,

I hope you don't mind me asking, but is your treatment with needles/pressure/electric?

Always interested in treatments and training from the Chiropodists stand point!

Regards,

Colin. (Not trained in it myself, missed the opportunity during my training in chiropody?).

I use serin acupuncture needles.

Thank you George!!!

Regards,

Colin.

Thanks george, craig etc.

Didn't get this skill in my training and a few years ago did a short introductory course (using massage finger pressure) but have had little chance to use the skill. Would be interested in any UK based training on it.

Cheers
Ian

We teach it to our students....
http://www.latrobe.edu.au/podiatry/myofasc/cover.html

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Hi Craig

Thank you for the info. It's very much appreciated.

Regards

Ian

Craig,

Have had time to go through the web site this evening. Fascinating. Cannot understand why this technique isn't taught in Universities within the UK.

This is basically the tecnique I use within my clinic whilst dodging the flak from the traditional Chinese trained acupuncturists. Maybe it is time I marketed myself as the only Podiatrist within the NW Uk using dry needling techniques to relieve myofascial pain. There are others but we are dominated by those that have invested large amounts of money and can shout louder.

At the end of the day, results speak volumes.

George

One really interestig trigger point issue starting to do some work on is the ones that occur in quadratus plantae and mimick plantar fasicitis.

I had one physiotherapist, who uses and teaches this, tell me the number one reason for foot orthoses failing in plantar fasciitis, is that they did not fail, but the change in muscle mechanics caused a trigger point(s) to develop (ie the plantar fasciitis got better, but the symptoms still there due to triggers points) - I have no idea if he is right, just have not had time to pursue it.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

I did everything I could for a patient that had suffered plantar fasciitis. NSAIDS, orthotics, ice etc.

I did the TP acupuncture course.

1 needle straight into the TP she got 50% better

1 week later another needle and she got better 100%

I got told off for not doing the course sooner.

I will be intested in the research results.

George

I should have also added, and this is not specific to trigger points, all podiatry courses are under pressure to teach more. We are frequently accused of "why do you not teach more of X" - to which I usually respond "what should we drop to fit it in?" - in reality, there will be less content and more process in the future in academic courses.

Trigger points are covered with our students in one lecture and one tutorial. All other modalities get the same. It then becomes a matter of the student pursuing it if they want to and having a patient when on a clinic and a clinician with interset .....same with every method.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Hi George and Craig

George. Where did you gain your training for dry needling techniques? Do you also use the finger pressure approaches?

Craig. I have to agree with you about PF response failure to orthoses. I have often referred a PF patient after orthoses fitting to a physio for soft tissue work. The two approaches together appears to gain good results.

Reminded of a quote:

" he who treats the site of pain is lost"

Thanks for the input

cheers
Ian

www.acupuncturecourse.org.uk www.acampbell.org.uk

Ian,

Try the above sites. He was my tutor.

Very enlightening and stimulating

Hi George

Will do and thank you very much. :)

Ian

I'm with George on this. I've just attended a course run by Anthony Campbell in South Shield, UK. Great fun and Anthony has a very pragmatic and relaxed approach. Go for it!

I'm really interested in trying firm finger pressure over TPs and 'treatment areas' (to treat diabetic neuropathy thus avoiding needling). Anyone tried this? Any good anecdotal results?

Cheers
John

John, try dry needling with EAP (using TENs attached to needles) of your DN / neuropathic pts; have had some success, myself, with painful neuropathic patients! Acupressure benefits are shortlived & better for other conditions such as MFS and fibromyalgia. I usually practice a more segmental approach needling bone, muscle & nerve root at the appropriate spinal level that is supplying the affected dermatomes, myotomes, sclerotome etc, however, you could needle proximal & distal points associated with affected dermatome, as well as traditional TCM points (e.g. Bl-50 with Bl-60 etc) within the affected limb.
Regards
Dyn

==================
Dyn Parry
PHYSIO & PODIATRIST
Licensed Acupuncturist

Further to the discusion on TriggerPoint therapy, I have found that acupressure ( in my case finger pressure) of Gactroc,soleus TPs very helpful in helping relieve heel pain and plantar fascial pain. This makes daily muscle stretching easier for the patient, an integral part of PL fascial therapy.
My awareness levels of the value of TP therapy are high as my partner is a physio who practices this type of therapy daily on chronic musculo-skeletal patients of all types. :)

Myofascial trigger points MFTPS) or periosteal trigger points (PTPS) are invaluable diagnostically and therapeutically.

MFTPS - as initially researched and developed by Janet Travell.
PTPS - as initially researched and by Lawrence Jones.

MFTPS - usually indicative of a soft tissue pathology or dysfunction.

PTPS - usually are indicative of trauma or dysfunctional joint / ligamentous complex - with a neural basis.

On palpation of a sensitive area one or both will usually be found. Diagnostically it is important to differentiate and form a tissue - pathology assessment.

In terms of treatment - its very simple:

1. Apply direct pressure till sensitivity decreases. (pts tend not to tolerate this in an acute)
2. Stick an acupuncture needle in (only if appropriately trained)
3. Inject with marcaine.
4. Lazer
5. Strain Counter Strain Technique - osteopathic technique - probably the most effective and most patient tolerable approach.

There are 2 books worth reading if you want to add this approach to your repetoire:

1. Positional Release Therapy by D'Ambrogio
ISDN: 0-8151-0096-5

2. Myofascial Pain and Dysfunction - The Lower Limb - by Janet Travell
ISDN: 0683 08365-1




Further training in strain counter strain can be arranged via me!

Hope this helps,



Roger Kingston

Our practice has used this technique for a long time. It has been really useful with thoses hard to fix people. We use a very patient freindly approach.
1 Stretch and spray
2 laser (no needles)
3 moist head pack

Thanks for the comment Viginia,

I have no experience of spray and stretch but know that Travell used it extensively to good effect. Lazer or heat will have an eff4ect but the best results (I have seen) are with direct pressure over the TP and positioning the part in a position that switches the pain off - hold for 90 secs (or longer - up to 10 mins in a neurological contracture) before release occurs.

It really is brilliant for the chronics!


Roger Kingston

Roger are you talking about Jones Strain- Couterstrain technique?

Ta Virginia

Yes Virginia,

Strain Counter Strain / Jones Technique - absolutely brilliant. See the book reference slightly higher up the chain.

Roger

Just curious George, (excuse me if this comes across as being a stupid question) where did you insert the needle, as traditional trigger points for the insertion of the plantar fascia is in the soleus musculature... is this where you needled? Or into the insertion? And did you put the needle in and leave it there? Just very intrigued by this technique, doing reading on it currently but this thread has been of great interest.

Cheers.

__________________
My karma ran over my dogma .....

I have just joined the site, as I wanted to ask if any one had any specific research papers on trigger point acupuncture, in particular periosteal needling. I did my podiatric acupuncture course 2 years ago with Anthony Campbell and have had excelllent results with plantar fasciitis. I am now doing a post graduate course in reasearch methodology/project management and am embarking on acupuncture research. This is proving to be quite involved, as there is little work/research with robust methodology. I would love to prove that acupuncture is an effective treatment for plantar fasciitis, as I have had such remarkable and fast results with its use. Like every thing these days you have to "prove" its efficacy. It is difficult to get a control group with sham acupuncture, as I am not sure waht to use. Do i use a different site on the foot, other than the site of greatest tenderness, or do i just use a superficial needling at the same point? the ethics are a nightmare too! Any ideas any one. I would be grateful for any pointers in any direction.

many thanks
Jo

... thats exacty the wrong approach to research that you are wanting to take (Research Methods 101).

ok, I will rephrase and say that i am setting out to prove whether acupuncture is an effective treatment for plantar fasciitis or not. I will keep my own prejudices out of it, sorry :(

Research is not about prooving anything - its about answering research questions and testing hypotheses.

Any UK pods using acupucture for trigger points encountering extra hurdles with HPC checks etc. How is your insurance cover on this modality.
Cheers
Ian