Efficacy of acupuncture for chronic recalcitrant plantar fasciitis: A randomized trial

Plantar fasciitis is one of the leading causes of heel pain, affecting millions of people annually. This condition is characterized by pain and tenderness in the plantar region of the foot, especially during weight-bearing activities. Although often considered a self-limiting condition, studies show that up to 80% of patients still feel pain after one year of treatment, and 44% report discomfort even after 15 years. When heel pain persists for more than six months despite conservative treatment, the condition is classified as chronic recalcitrant plantar fasciitis, which may require more invasive interventions.

This chronic form of the disease significantly limits patients' daily activities and is associated with falls, reduced quality of life, and functional disability.

The primary aim of this study was to evaluate whether acupuncture would be effective in reducing pain in patients with chronic recalcitrant plantar fasciitis. The researchers conducted a randomized controlled clinical trial at two Chinese hospitals, comparing different intensities of acupuncture with a waiting-list control group. A total of 120 participants were randomized into three groups: high-intensity acupuncture (60 patients), low-intensity acupuncture (30 patients), and waiting-list control (30 patients). The primary endpoint was the proportion of patients who achieved at least 50% reduction in morning pain intensity after four weeks of treatment.

Participants were 18 to 75 years of age, with plantar fasciitis for at least six months, and had already tried conservative treatments such as anti-inflammatory drugs, stretching exercises, or shock-wave therapy without success. Treatment consisted of three weekly sessions for four weeks, with follow-up to 16 weeks.

The results demonstrated that acupuncture was significantly more effective than waiting-list control. After four weeks, 56.7% of patients who received acupuncture (combined groups) showed clinically significant pain improvement, compared with only 33.3% in the control group, a difference of 23.3%. Even more impressive was the dose-response gradient related to treatment intensity: high-intensity acupuncture showed superior results at all assessments. At week 16, 76.7% of patients in the high-intensity group were considered treatment responders, compared with 56.7% in the low-intensity group and 36.7% in the control group.

The difference between high intensity and control was 40% at week 16, while the difference between low intensity and control was only 20% and did not reach statistical significance. The benefits remained stable throughout the 16-week follow-up period, suggesting durable treatment effects.

For patients suffering from chronic plantar fasciitis, these findings offer a promising therapeutic alternative, especially when conventional treatments have failed. High-intensity acupuncture proved particularly effective, providing significant and lasting pain relief. For healthcare professionals, the study provides robust evidence that acupuncture treatment intensity is a crucial factor for therapeutic success. Acupuncture proved safe, with only mild adverse events such as small subcutaneous hematomas or transient acute pain.

In addition to pain reduction, patients also showed improvement in activities of daily living and reduced need for rescue analgesic medication. These results suggest that acupuncture, especially at high intensity, should be considered a valid treatment option for patients with chronic plantar fasciitis who do not respond to conventional care.

The study has some important limitations that should be considered. First, the 12-week follow-up period may be insufficient to assess the long-term sustainability of acupuncture effects in a chronic and potentially recurrent condition. Second, a fixed acupuncture protocol was used, which differs from usual clinical practice where treatment is often individualized. Third, the inclusion of participants from only two Chinese hospitals may limit the generalizability of the results to other populations.

In addition, the study was powered to compare combined acupuncture groups versus control, not direct comparisons between high and low intensity, limiting definitive conclusions about the relative superiority of the two approaches. Despite these limitations, the results provide compelling evidence that acupuncture, particularly at high intensity, represents a valuable therapeutic option for patients with chronic recalcitrant plantar fasciitis, offering significant pain relief with effects maintained for at least four months after treatment initiation.