The Effectiveness of Acupuncture for Plantar Heel Pain: A Systematic Review

Abstract

Introduction Plantar heel pain (PHP) is a common complaint, yet there are no definitive guidelines for its treatment. Acupuncture is increasingly used by podiatrists, and there is a need for evidence to validate this practice. It is acknowledged that PHP and acupuncture are both complex phenomena. Method A systematic review (PROSPERO no. CRD42012001881) of the effectiveness of acupuncture for PHP is presented. Quality of the studies was assessed by independent assessors with reference to Quality Index (QI), ‘STandards for Reporting Interventions in Controlled Trials of Acupuncture’ (STRICTA) and ‘CONsolidated Standards Of Reporting Trials’ (CONSORT) criteria. Pooling of data, or even close comparison of studies, was not performed. Results Five randomised controlled trials and three non-randomised comparative studies were included. High quality studies report significant benefits. In one, acupuncture was associated with significant improvement in pain and function when combined with standard treatment (including non-steroidal anti-inflammatory drugs). In another, acupuncture point PC7 improved pain and pressure pain threshold significantly more than LI4. Other papers were of lower quality but suggest benefits from other acupuncture approaches. Conclusions There is evidence supporting the effectiveness of acupuncture for PHP. This is comparable to the evidence available for conventionally used interventions, such as stretching, night splints or dexamethasone. Therefore acupuncture should be considered in recommendations for the management of patients with PHP. Future research should recognise the complexity of PHP, of acupuncture and of the relationship between them, to explore the optimum use and integration of this approach. There is a need for more uniformity in carrying out and reporting such work and the use of STRICTA is recommended.

Two Cases of Plantar Fasciitis Treated with Magnetic Acupuncture

“…Its specific effects on health, and its effectiveness against various kind of pain, have been confirmed in a great number of studies, including those focusing on plantar fasciitis 6) .…”

“…With regards to treatment, research is actively being carried out into electroacupuncture, pharmacopuncture, and catgut-embedding acupuncture 7,19) . Among these treatments, studies on acupuncture have been published steadily, and acupuncture is now recommended for the management of patients with plantar heel pain 6,20) . However, no study has used magnetic acupuncture in plantar fasciitis patients.…”

Rationales and Treatment Approaches Underpinning the Use of Acupuncture and Related Techniques for Plantar Heel Pain: A Critical Interpretive Synthesis

“…The aetiology of PHP is complex, involving the interplay of tissue, biomechanical, psychological and other factors. [1] Furthermore, although often considered to be a single 'condition' PHP is conceptualised differently in different professional contexts such as medicine, podiatry, physical/sports therapy and acupuncture.…”

“…Although not mentioned in current guidelines,[w4, w10] there is growing evidence to support its use. Our earlier systematic review (SR) [1] rigorously appraised the quality of eight comparative studies and showed that acupuncture can be effective for the treatment of PHP. However, it was not possible to make strong recommendations because of the heterogeneity of the interventions reported.…”

“…[w15 -16] Hence while it is desirable to assess the effectiveness of acupuncture for PHP, the question of whether or not acupuncture is efficacious for heel pain' is oversimplified. [1] Some have called for Whole Systems Research (WSR)[w17 -18] with 'model validity' and a 'paradigm fit' to embrace approaches such as Traditional Chinese Medicine (TCM) but even this is problematic because delimiting a 'whole system' is not straightforward (and many acupuncturists embrace multiple models).…”