Electroacupuncture for Plantar Fasciopathy: A Multisite Randomized Clinical Trial

Heel pain caused by plantar fasciopathy is a condition that affects approximately 10% of the general population and is even more common in physically active individuals, such as military personnel and athletes. Commonly known as plantar fasciitis, this condition causes intense pain in the heel and sole of the foot, especially during the first steps after waking or after periods of rest. Although it usually resolves naturally within six to twelve months, symptoms can be debilitating and significantly affect quality of life, limiting physical activities and work capacity. Traditional treatment relies primarily on stretching and strengthening exercises for the plantar fascia and related muscles, but these protocols often take weeks or months to provide effective relief.

This randomized controlled trial, conducted at three U.S. Air Force medical centers, aimed to investigate whether adding acupuncture with electrical stimulation to a traditional exercise program would be more effective than exercises alone in reducing pain and improving function in patients with plantar fasciopathy. Seventy-two participants were divided into two groups: one received combined treatment of acupuncture with electrical stimulation plus home exercises, while the other group performed only home exercises. The acupuncture protocol used four specific points in the ankle and foot, with needles connected to a 30 Hz electrical stimulation device for 20 minutes.

Acupuncture treatments were performed every two weeks for six weeks, totaling four sessions, followed by an additional six weeks of follow-up. The exercises consisted of daily stretching and strengthening exercises on alternating days for five weeks. Outcome assessment used validated scales to measure foot pain and function over 12 weeks.

The results clearly demonstrated the superiority of combined treatment. In the group that received acupuncture with exercises, the pain reduction at 12 weeks was 2.17 points on the pain scale, compared with 1.62 points in the exercise-only group. Similarly, foot function improvement was greater in the acupuncture group, with a reduction of 19.5 points on the function questionnaire, versus 12.9 points in the control group. These differences were statistically significant, indicating that adding acupuncture provided real and measurable benefits.

Notably, 23 of the 25 participants who received acupuncture reported satisfaction with the treatment, demonstrating not only objective efficacy but also patient acceptance.

For patients suffering from plantar fasciopathy, these findings represent a promising new therapeutic option. Acupuncture proved capable of accelerating pain relief and functional recovery when compared with conventional treatment alone, potentially allowing a faster return to work and sports activities. For health professionals, especially those in primary care, where most of these patients first seek attention, the study offers robust evidence to consider acupuncture as a safe and effective complementary treatment. Acupuncture has advantages over other interventions such as corticosteroid injections, which may cause complications like plantar fascia rupture, or more expensive treatments such as platelet-rich plasma or onabotulinumtoxinA injections.

The studied protocol was specifically designed to be feasible in busy primary care offices, making it a viable option for implementation in routine clinical practice.

The study has several important limitations that should be considered when interpreting the results. The absence of blinding is an inherent limitation in acupuncture studies, as it is virtually impossible to conceal from participants whether they are receiving the actual treatment. There was loss of participants during follow-up, with some excluded from analysis due to incomplete data, although this loss was similar between groups. Additionally, the 12-week follow-up period, although adequate to assess short- and medium-term benefits, does not allow conclusions about long-term benefits.

Future research could explore different treatment frequencies and longer follow-up periods to optimize therapeutic protocols. Despite these limitations, this study significantly contributes to the body of scientific evidence supporting the use of acupuncture as an effective adjunctive treatment for common musculoskeletal problems, offering patients with plantar fasciopathy a less invasive and well-tolerated alternative to accelerate recovery and improve quality of life.