Plantar fasciitis is the most common cause of heel pain, affecting about 10% of the population over their lifetime and being particularly prevalent in runners, workers who spend long periods standing, and people with excess weight. Despite the diversity of available treatments — from physical therapy and insoles to corticosteroid injections and extracorporeal shock waves — until recently there had been no consensus based on indirect comparisons on which intervention offers the greatest analgesic benefit. A network meta-analysis published in Cureus in September 2024 fills this gap, pooling 32 clinical trials and 2,390 participants to systematically rank the main interventions for plantar fasciitis.
The study compared acupuncture (including conventional acupuncture, electroacupuncture, and trigger-point acupuncture), extracorporeal shock wave therapy (ESWT), therapeutic ultrasound (US), corticosteroid injection (CSI), platelet-rich plasma (PRP), and stretching exercises (active control), in addition to placebo/inactive control. The primary outcome was pain intensity (VAS), assessed at different time points: immediately after treatment, 1 month, and 3 months. SUCRA ranking was calculated for each intervention at each follow-up period.
MAIN RESULTS — 32 TRIALS, 2,390 PARTICIPANTS
Results by follow-up period
The network meta-analysis revealed an important temporal pattern: the benefit of different interventions varies depending on the time of evaluation. At 1 month, acupuncture showed the largest analgesic effect, with MD=−1.33 points on the VAS compared with placebo — surpassing corticosteroid injection (stronger immediate effect, but without sustained advantage), PRP, and shock waves. This leadership position at 1 month is clinically relevant because it corresponds to the period of greatest functional impact of plantar fasciitis — the first morning steps with intense pain and restriction of daily activities.
Comparison with corticosteroid and PRP: the time factor
Temporal analysis revealed that corticosteroid injection produces more immediate relief (weeks 1–2), but loses efficacy over time — with risk of plantar fascia rupture from repeated injections. PRP shows a crescent effect over time (greatest efficacy at 3–6 months), while acupuncture demonstrates consistent efficacy at 1 month with potential for maintenance in the following months. Extracorporeal shock wave therapy (ESWT) showed a more favorable efficacy profile in chronic cases (more than 6 months of evolution), where calcification and fascial degeneration may respond better to controlled mechanical trauma. These findings suggest that the choice of intervention should be individualized based on chronicity of the case and patient characteristics.
Frequently Asked Questions
Plantar fasciitis tends to resolve naturally in 12–18 months in most cases, but it may persist or recur without correction of causal factors (inadequate footwear, altered biomechanics, muscle shortening). Acupuncture accelerates symptom resolution and, by treating trigger points in the muscles that overload the fascia, may help prevent recurrences — but it does not replace correction of predisposing factors. Patients who combine acupuncture with regular stretching, custom insole, and strengthening of the foot intrinsics have the best rates of lasting resolution.
Not necessarily. Absolute restriction of physical activity is rarely necessary and can be counterproductive for athletes. The physician should advise modification of the training load — reduction of volume and intensity, temporary substitution with low-impact activities (swimming, cycling), and gradual progression with pain monitoring. Acupuncture can be initiated even during the training-reduction phase, and many runners are able to maintain moderate activity throughout treatment. The decision should be individualized based on symptom severity and the patient’s activity level.
Acupuncture is preferable for acute and subacute cases (less than 6 months of evolution), for patients with intense pain that limits tolerance of shock waves (which are uncomfortable), for those with contraindications to shock waves (pregnancy, pacemaker, coagulopathies), and when an approach that also treats associated muscle trigger points is desired. Shock waves have recognized advantage in chronic cases with calcaneal calcification, where controlled mechanical trauma promotes calcification remodeling. In complex cases, the combination of the two approaches can be discussed with the attending physician.
Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).