Abstract
Plantar fasciitis is a commonly seen outpatient condition with numerous treatment modalities of varying degrees of efficacy. This plantar fasciitis systematic review aimed to determine the effectiveness of acupuncture in reducing pain caused by plantar fasciitis.
Methods
Investigators performed online literature searches on the PubMed and Cochrane Library databases for studies on acupuncture for pain caused by plantar fasciitis. They selected randomized controlled trials that compared acupuncture with standard treatments or had real versus sham acupuncture arms. In addition, they utilized the Delphi list to assess the methodological quality of the studies retrieved.
Results
They found three studies that compared acupuncture with standard treatment and one on real versus sham acupuncture. They all concluded that acupuncture significantly reduced pain levels in patients with plantar fasciitis, as measured on the visual analog scale and the Plantar Fasciitis Pain/Disability Scale. Researchers noted these benefits between four and eight weeks of treatment.
Plantar Fasciitis Introduction
Plantar fasciitis is a common condition considered a biomechanical overuse injury due to running or prolonged standing, which creates microtears at the calcaneal enthesis. More than one million patients in the United States suffer from this condition annually, with two-thirds visiting their family physicians.
The diagnosis of plantar fasciitis is clinical; most patients report heel pain after a period of rest, such as when sleeping or sitting. The pain is reduced after a few steps but can worsen if the patient persists with walking or prolonged standing. Physical examination usually reveals tenderness over the medial plantar calcaneal region. The condition is self-limiting, and Western treatment focuses on reducing pain rather than curing the condition. Plantar fasciitis may improve over time, but most patients seek medical attention for pain relief, as it affects their activities of daily living.
This plantar fasciitis systematic review found that after 4–8 weeks of acupuncture treatment, all four studies showed significant improvement in pain among patients with plantar fasciitis.
Discussion
The four studies reviewed in this plantar fasciitis systematic review had varying methods of applying acupuncture therapy. Two studies (Ebrahim et al. and Kumnerddee et al.) used electro-acupuncture, which applies electrical current to acupuncture needles. The other two studies used standard acupuncture with sterile needles without electrical current. Both of these studies involved manual manipulation of the needles in obtaining the ‘Deqi’ sensation, characterized as a dull ache, numbness, or heaviness.
Zhang et al. compared acupuncture at real versus sham sites. Both types of sites were distal and contralateral to the area of plantar fasciitis. Participants in the treatment group received needling at the acupoint Daling (PC7), located on the palmar side of the forearm at the midpoint of the wrist crease. Participants in the sham group received needling at the acupoint Hegu (LI4), located between the first and second metacarpal bones. Practitioners used identical methods of needling at both PC7 and LI4.
The remaining two studies used acupuncture at the affected plantar fascia sites without any distal acupoints; Kumnerddee et al. used 2–6 needles, while Ebrahim et al. did not mention the number of needles used. Karagounis et al. used plantar fascia and distal acupoints (up to 12 from a list of 20 acupoints) in their treatment arm. Practitioners used this first combination of acupoints for six consecutive sessions.
How Does Acupuncture Relieve Plantar Pain?
Investigators preparing this plantar fasciitis systematic review proposed several mechanisms to explain acupuncture’s pain-relieving effects. These mechanisms include central opioid pain inhibition, the diffuse noxious inhibitory control (DNIC) system, and anti-inflammation. In addition, the process of needle insertion in any part of the body may alleviate pain through the mechanisms of opioids or DNIC.
Furthermore, prolonged or repeated stimulation habituates neurons in the thalamus to a state of hyperexcitability, leading to chronic pain. Under these circumstances, the stimulation of specific acupoints may alter the excitability of hyperexcitable neurons in the thalamic focus. Interestingly, the center of the wrist crease on the palmar aspect, the location of PC7, is an anatomical mirror site of the heel.
Investigators have proposed several theories to explain the effects of electro-acupuncture. In addition to the inflammation brought about by plantar fasciitis, the condition causes myofascial pain due to the development of trigger points in the foot muscles. Researchers in this plantar fasciitis systematic review suggested that acupuncture can deactivate these points, with electrical stimulation providing an ‘additive’ effect. In addition, deactivation of trigger points could relieve the noxious stimulus, leading to central sensitization in the spinal cord and central nervous system.
Conclusion
In conclusion, acupuncture is a safe and effective treatment for managing plantar fasciitis. Four studies have shown a significant reduction in pain during 4–8 weeks of therapy compared to standard or sham acupuncture.
Next Steps
Raleigh Acupuncture has been successfully treating plantar fasciitis for nearly twenty years.
BOOK NOW to schedule an appointment online.
Watch Video About Our Plantar Fasciitis Treatment.
Learn about all the conditions we treat.
Reference
Thiagarajah A. G. (2017). How effective is acupuncture for reducing pain due to plantar fasciitis? Singapore Medical Journal, 58(2), 92–97. https://doi.org/10.11622/smedj.2016143
Focus Keyphrase: Plantar Fasciitis Systematic Review
Photo by Pixabay: https://www.pexels.com/photo/black-under-amour-sneakers-163535/
What our Clients are Saying
I came to Raleigh Acupuncture for severe plantar fasciitis and hamstring pain. They helped me with both of them. My pain was a 10 out of 10 beforehand, and now I’m barely a 1 out of 10. The process is amazing. I don’t know how it works but I KNOW it works!
I was referred to Raleigh Acupuncture a few months ago because I was having a problem with a bone spur affecting my Achilles. The bone spur caused tremendous pain in my ankle and heel. Physical therapy ordered by a doctor really did not help. My doctor said that if the physical therapy did not help he could do surgery, but it would be very painful and would have an 8-9 month recovery period. Raleigh Acupuncture was my last hope. After a few treatments it was less painful when I walked. As I continued the treatments the pain totally went away. Now surgery is not even necessary. They have also helped me with my migraine headaches and restless leg issues. Acupuncture has made a huge difference in the quality of my life.
For the past 13 years I suffered from peripheral neuropathy in my calf, ankle and foot. I tried numerous medications, therapy with lights, neuromuscular massages and back decompression. I felt like I had stones under the ball of my foot. After the first couple of sessions with Dr. Mark, feelings returned to my calf, ankle and the “stone like feeling” under the ball of my foot began subsiding. Thanks to Dr. Mark, I am able now to walk without pain and discomfort. The extraordinary care and attentiveness I am receiving from Raleigh Acupuncture in treating my neuropathy is remarkable and I recommend them without reserve!
My husband Arthur and I have used Mark and Jinmei bi-weekly for at least 4 years, for a variety of treatments, including general well-being. Both of us felt our ailments healed with the treatment. I had a sprained hip flexor which a sports doctor told me would take 6 weeks to heal… it was gone after 2 visits! Mark and Jinmei are very professional and learned, and we have every confidence in them. Even though we pay out of pocket, we obviously feel that the acupuncture is worth it. We both highly recommend Raleigh Acupuncture. You won’t regret it!
Last month when I was working out at the gym I injured my hip. It was diagnosed as sciatica. Two cortisone shots later the pain was still there, so I came to Raleigh Acupuncture. I was skeptical that it would work because the pain was so bad. But sure enough, they got rid of the pain. And it never came back. These guys are good. I highly recommend them.
I LOVE this place! I LOVE these people. Caring and professional, great at what they do. Living with foot pain for SO LONG now, and it was cleared up after just a couple of sessions. Very reasonable on the price, too. Did I mention I LOVE this place!!
My husband is a runner and came to Raleigh Acupuncture with a bad case of plantar fasciitis. He runs about 25 miles a week and does half marathons. In 3 treatments he was pain-free. And they told him he didn’t even have to stop running while they were treating him. It’s been six months and the pain has not returned.
They treated me for trigeminal neuralgia and planter fasciitis. Fabulous – I fly in from Arizona to see them!!!