– THOMAS E,SPORTS MEDICINE
Rest
Rest is the most important component of treatment for all stress fractures, and that rest must be total. In other conditions I have recommended that the athlete should continue to exercise. When one has suffered a stress fracture the temptation to ‘try out’ the injury is great. Training should not be resumed until the athlete or dancer has been free of pain for a minimum of ten days, and when training restarts it must stop again if pain recurs.
Return to Activity
The return to activity must be gradual, progressive and – through varied exercises – well monitored and careful, especially for dance and running. Non-weight bearing exercise such as swimming or cycling should be used to maintain cardiovascular and pulmonary fitness.
Homoeopathic Treatment for Stress Fractures
Homoeopathic treatment for stress fractures should be given in three stages:
Phase 1:
Arnica
Arnica should be given immediately the pain is felt, and rest from high impact activity is essential, if the pain is sore and there is bruising, touch is painful and the person insists he is well enough to continue performing.
Dosage: One Arnica 30c, repeated hourly for three or four doses.
Phase 2:
Bryonia
If any movement is painful. The pain increases as activity continues, and decreases with rest. Pressing or firm bandaging the area eases the pain.
Dosage: Bryonia 30c three times a day can make movement and weight-bearing easier. This should be continued as necessary until the pain begins to ease, but not longer than a week.
Rhus Toxicondendron
If the pain is typically worse for first movement, better with continued movement. It is difficult to find a comfortable position to rest and the person moves the foot constantly. Pain is worse at night.
Dosage: Rhus Tox. 30c, one tablet twice a day for three days, or until the pain eases.
Rhododendron
Rhododendron has a bruised, drawing and tearing pain in the bone. The feet feel cold, even in a warm room and in bed. There is weakness after even slight exertion, and the person is sensitive to windy, stormy weather. Heat reduces the discomfort.
Dosage: Rhododendron 30c, three times a day for three days, or until the pain eases.
Phase 3:
Symphytum
One tablet of Symphytum 6c, three times daily for two weeks will help the bones to heal. Then stop the remedy for a week and start again for another two weeks.
See also below for general foot pain remedies.
Hallux Rigidus and Osteochondritis
Stiffness of the big toe joint is a gradual process, often the result of earlier injury to the big toe and its joint with the head of the metatarsal during growth in adolescence. The pain is worse during forceful bending such as when sprinting or lunging. Osteochondritis is inflammation of the big toe joint following the deterioration of the bone ends as the result of childhood or adolescent trauma to the toe. Both of these conditions produce pain and tenderness between the toe and the head of the metatarsal.
Bryonia
In hallux rigidus the pain is felt with the least movement, especially dorsiflexion. Bryonia will help to make movement and walking less painful. It may be taken orally for as long as necessary to relieve the pain and this may eliminate the necessity for surgery.
Dosage: One Bryonia 30c, as necessary until the pain eases, but not longer than a week.
Ledum Palustre
In osteochondritis when pain is felt behind the toes and movement is not only painful but actually makes the pain worse. Cold applications ease the pain and warmth makes it worse. There may also be swelling and tenderness
Dosage: One Ledum 30c, until the pain ceases, but not longer than a week.
Gradually-developing Foot Pain
Gradually developing foot pain can be caused by an inflammatory joint condition such as gout or ankylosing spondylitis, or it could be referred pain from a back problem. Although these conditions can be treated successfully with homoeopathic medicine, one should refer the patient for a diagnosis by a doctor and treatment by a qualified homoeopath.
Ligament Injuries and Conditions
Ligaments bind the foot bones together and act as springs, giving the foot resilience and strength. The two ligaments most likely to cause trouble are the plantar fascia and the spring ligament.
Any of the many ligaments in the foot may be strained by trauma or overuse. If a sudden tearing pain is felt Arnica should be taken as soon as possible. Once ligament damage is suspected Ruta 30c should be taken three times a day until an improvement is felt, but for no longer than a week.
Plantar Fasciitis and Tears
Inflammation of the plantar fascia may occur in sports which involve repeated jumping, or forced dorsiflexion of the foot, such as in long uphill walks. Wearing shoes with lower than usual heels, or running and walking in thin soled shoes or bare feet may also cause this condition. It is the most common cause of heel pain in runners and is a common cause of foot pain in dancers.
If the plantar fascia partly detaches from the calcaneum it can cause local pain and tenderness. The tear may be caused by jumping, stepping down or is worse when walking, standing or an unexpected dorsiflexion of the foot such as partially stepping on a stone or kerb.
This condition may take a long time to heal. The remedies listed under the ‘Foot Pain in General’ section on page 00 may help. The person will almost certainly need a dose of Arnica if there has been trauma.
The pain may be felt on the bottom of the foot near the heel. Prolonged and repeated tension of the fascia, which extends from the calcaneum to the heads of the metatarsals, causes bleeding. A sudden increase in activity or a change of activity can be the cause of this injury. Typically the heel hurts when standing after a period of rest, and eases up after repeated or continued movement. Mechanical treatment by taping, and the provision of soft orthotics can play an important part in recovery. Healing may take up to four weeks.
Arnica
Dosage: One Arnica 6c or 30c. Two or three doses if there was trauma following unaccustomed or increased exercise or activity, or when the pain is first felt.
Graphites
If there is burning pain when in bed.
Dosage: One Graphites 30c.
Rhododendron
Rhododendron has a bruised, drawing and tearing pain in the heel. The feet feel cold, even in a warm room and in bed. There is weakness after even slight exertion, and the person is sensitive to windy, stormy weather. Heat reduces the discomfort.
Dosage: One Rhododendron 30c, three times a day for not longer than a week, or until the pain eases.
Rhus Toxicodendron
As if stepping on a stone. If the pain is typically worse for first movement, better with continued movement. It is difficult to find a comfortable position to rest and the person moves the foot constantly. Pain is worse at night.
Dosage: Rhus Tox. 30c, one tablet twice a day for a few days until the pain eases, but not longer than a week.
Ruta
Ruta has a special affinity with ligaments and tendons, and should be used when you suspect strain, damage or inflammation in the ligaments or tendons of the foot. It will often be effective when the foot pain is the result of overuse, and when there is pain from the slightest physical exertion. Bruised, sore and aching pain is felt near the heel.
Dosage: One Ruta 30c, daily for up to a week. Stop when relief is felt.
Zinc
The pain is very exhausting.
Dosage: One Zinc 30c.
Spring Ligament Strain
This ligament may also be strained by a change in normal activity or trauma. Treatment is similar to that for plantar fasciitis according to the symptoms. (See also ‘Foot Pain in General’, page 00.)
Heel Pain – Plantar Fascia Tear
A plantar fascia tear may be caused by a sudden exertion, stepping down, jumping or dorsiflexion of the foot when the agonistic and antagonistic muscles are not acting. The condition is noticed by a sudden tearing pain near the middle of the arch during exercise. The victim is usually middle-aged or elderly, and there may be some danger of an arch collapse if the injury is not treated. This painful and debilitating condition is often very slow to heal, and may prevent participation or performance for more than six weeks while the ligament heals. A further complication may arise if a bony spur grows from the calcaneum, causing further pain, and complications further up the locomotor framework.
The injury requires continued RICE (Rest, Ice, Compression and Elevation).
Contrast baths may also help healing by stimulating circulation. This treatment is simple to carry out at home using two buckets or bowls. One is filled with iced water, and the other with water as hot as can be borne without discomfort. The foot is dipped into one bowl and kept there for a few seconds. Then the foot is taken out, dried, and put in the other bowl. The sequence may be repeated for ten minutes or so, or until the skin begins to flush.
Angustura Vera
Sudden tearing pain in foot, cannot put it down. Limps badly. Much better from cold applications, especially cold hands, and worse during rest. Constant thirst.
Dosage: One Angustura 30c, every hour during pain, for up to six doses.
Arnica
Dosage: One Arnica 6c or 30c immediately and repeat for six one-hourly doses.
Kali Carbonicum
Tearing pain in the sole caused by a sudden, unguarded movement. Very sensitive to touch. Does not like cold. Pain is worse in the middle of the night, 2 to 3 a.m. , and the person is anxious and quarrelsome.
Dosage: One Kali Carb. 30c, three times daily for three days.
Symphytum
Dosage: One Symphytum 30c, taken every day for two weeks will promote healing.
Physiotherapy, using ultrasound and friction should be provided. NSAIDs should not be necessary if Arnica and Symphytum, or the other indicated remedies as described for the foot, are used. Note that Symphytum may be given at the same time as another indicated remedy because it acts as a tissue repair agent. (See also ‘Fractures’, page 000.)
Calcaneal Apophysitis (Sever’s Disease)
Apophysitis of the calcaneum, inflammatory pain in the heel, is commonly caused by repetitive jarring on hard surfaces, which can occur in young dancers and very active children who run and jump on hard floors, for example in practising gymnastics. Pain is felt down the sides of the heel, and any pressure on the heel hurts.
Arnica
Arnica should be taken as soon as the discomfort and pain arise. Rest and non-jarring exercise are essential for recovery.
Dosage: One Arnica 30c, as necessary.
Badiago
This remedy will relieve the pain from pressure if even the slightest pressure hurts and the part cannot be touched.
Dosage: One Badiago 30c, as necessary for the pain, for not more than three days.
Conium Maculatum
For shooting pains in the heel, with a feeling that there is a lump or stone under the heel and that the bone would push out. The person may stagger when walking. This remedy is often indicated for older people.
Dosage: One Conium 30c, as necessary for the pain, for three days.
Pulsatilla
The young athlete or dancer experiences the worst pain down the sides of the heel when beginning to walk, and in the evening. Likely to forget the pain as soon as the mind is taken by another interest. May be weepy.
Dosage: One Pulsatilla 30c, three times a day for seven days.
Rhododendron
Rhododendron has a bruised, drawing and tearing pain in the heel. The feet feel cold, even in a warm room and in bed. The pain, when walking, may be felt more in the Achilles tendon. There is weakness after even slight exertion, and the person is sensitive to windy, stormy weather. Heat reduces the discomfort.
Dosage: One Rhododendron 30c, three times a day for not more than a week, or until the pain eases.
Symphytum
See page 000 above.
Tenosynovitis of Dorsiflexor Tendons
If the maintaining cause of a condition can be identified, it should be removed. If the tenosynovitis is caused by overtightening shoelaces, the laces should be loosened or padding provided. Ruta ointment or cream will help to ease pain and reduce inflammation.
Black Toenail (Subungual Haematoma)
The toenail of the big toe is particularly susceptible to bruising from walking or running downhill for long periods, wearing shoes that are too short or narrow for dance or running, or from a blow to the toe. The injury is very painful at first because of bleeding into the restricted space under the nail. If the pressure is not relieved the pain becomes unbearable and throbbing in nature, and the nail eventually becomes detached from the toe.
The best method of relieving pressure is trephining. Heat a paper clip and burn a hole in the nail. This may seem drastic but it is actually painless. Better still, one could prevent the swelling by limiting the extravasation with a dose or two of Arnica as soon as the condition becomes obvious.
Remedies for the condition of black toenail are as follows.
Arnica
As soon as the toe begins to feel bruised, Arnica will prevent bleeding under the nail and swelling. Use immediately if the swelling, pain and bruising is because of a blow to the toe.
Dosage: Just one tablet of the 30c potency should be enough.
Arsenicum Album
This remedy is specific for discoloured toenails when they have gone black. It is more painful after midnight, the person cannot bear cold in any form, is very restless and becomes very weak, even from a sore toe. In other words, the Arsenicum patient suffers out of proportion to the seriousness of his condition.
Dosage: One Arsenicum 30c, three times in one day.
Hypericum
If the pain becomes unbearable and shoots into the foot or leg after bleeding under the nail.
Dosage: One Hypericum 30, as required for the pain.
Silica
Bruised, throbbing pain in toe. Pain prevents walking, nails are rough, brittle, blue or black. Noticeably bad-smelling foot sweat. Wants to be kept warm and cannot bear cold, touch or pressure. Worse at night. May have lost confidence.
Dosage: One Silica 200c. (But first note the warning on page 00.)
Foot Pain in General
The remedies suggested below will be found effective for all foot pain as indicated by the symptoms, including plantar faciitis, metatarsalgia, sesamoiditis, intrinsic muscle strain, and spring ligament strain.
Whatever the anatomical or mechanical cause, and regardless of the diagnosis, you can prescribe for foot pain according to the homoeopathic symptoms. You may use several remedies successfully in association with physiotherapy or osteopathy and RICE if you take care to match the symptoms to the remedy. Some of the most likely remedies are listed overleaf.
Arnica
If the pain started from a fall, blow or sudden twisting, stretching, dorsiflexion or plantar flexion, or if the injury was of a traumatic nature of any sort then the first remedy must be Arnica 30c. It is especially required if there is bruising or the chance of bruising. The patient does not want treatment, says he is ‘fine’ when he obviously is not, and avoids coming close to people because he fears that if they touch him the pain will increase. He avoids putting his foot on the ground for the same reason. He may feel bruised all over, not only in the foot, and may feel weak in his knees.
Dosage: One Arnica 30c, one or two doses.
Arsenicum Album
Soreness and burning in the ball of the toe when walking (sesamoiditis), the feet feel weak and numb, soles may feel numb. Wants heat treatment. Very restless, cannot sit in one place and moves from chair to chair. Cannot bear cold in any form, may shiver, and needs to be kept warmly dressed or wrapped up. May refuse ice treatment however well indicated. Very fastidious about personal appearance, details of performance, treatment. May consult several doctors or practitioners, but is also very careful with money. May even seem stingy.
Dosage: One Arsenicum 30c, once daily until the pain is relieved, or for three days.
Aurum Metallicum
Where there is a bruised pain in the soles of the feet and they are hot at night. The pain may also be sharp and boring, and may be felt deep in the foot. The Aurum patient may be depressed and brooding about the injury, and can get angry quickly. Likes music, and moonlight.
Dosage: One Aurum 30c, twice a day for three days.
Bryonia
The pain in the feet is like pins and needles, and they are swollen and hot. The soles are painful as soon as they touch the ground, but are better when pressure is put on them. Then they are sore again when lifted. Heat is unbearable. The slightest movement is also unbearable.
Dosage: One Bryonia 30c, twice a day for three days.
Ledum Palustre
The soles are so sore that the person avoids stepping on them. Tenderness and some loose swelling in the pad behind the big toe. The pain is worse and the back of the foot itches at night, and the feet are very stiff on first rising in the morning. A strange symptom for Ledum is that the soles are most painful on walking upstairs. This person likes cold bathing and cold weather.
Dosage: One Ledum 6c, twice a day for three or four days.
Rhus Toxicodendron
Often the best remedy for sore and painful feet, especially when brought on by unusual and excessive exertion. The feet feel hot and painful, stiff and paralysed. Pain in the sole of the foot that the patient may describe as ‘stitching’ or similar. The pain could also be burning or aching. It is worse in the morning on waking and on rising, and after sitting in a chair and rising. First movement is painfully stiff, but continued movement eases the pain. The person is very restless, constantly moving the feet to ease the pain and to find a comfortable position.
Remember the basic symptoms for Rhus Tox., and bear in mind that they need not only be manifested in the injured part:
Hot, painful swelling, worse in the evening.
The pains are tearing, shooting and stitching, and the person cannot rest.
Worse at night.
Worse on first movement; better for continued movement.
Worse from exposure to wet and cold.
Worse at rest, which makes him restless.
Ailments brought on by overexertion.
Better from heat, hot bathing.
Dosage: You may find that you will use a range of potencies from 6c to 200c, and that some cases may need repeated doses.
Warning: Be careful not to repeat Rhus Tox., or indeed any remedy, too often or for too long without careful reconsideration of the case. Repeating the remedy daily for more than a week is not advisable. Always advise the person to stop taking the remedy once an improvement begins. Homoeopathic remedies continue to work for a long time even after the patient has stopped taking them. The lower potencies, i.e. 6c and 30c, can be repeated safely more often than the higher potencies such as 200c and upwards.