Acupuncture of Different Treatment Frequency in Chronic Plantar Fasciitis

Overview

Plantar fasciitis (PF) is one of the most common causes of heel pain, typically characterized by a sharp pain in the plantar aponeurosis, specifically near the insertion site close to the medial process of the calcaneal tuberosity. It has been reported that 1 in 10 people are expected to be affected by PF in their lifetime. A comprehensive internet-panel survey conducted among the adult United States population revealed the population-based prevalence of self-reported PF with pain in the last month was 0.85 percent. Approximately 1 million patients are diagnosed with this disease each year in the United States. PF was believed to be an acute inflammatory disease, but patient samples show it is actually a chronic degenerative process caused by various factors such as repetitive stresses, vascular and metabolic disorders, excess free radicals, high temperatures, genetic factors, and conditions like rheumatoid arthritis and spondyloarthropathies. PF may be associated with impaired health-related quality of life, including reduced life functioning, poor perceived health status and social isolation. Additionally, a recent study indicates that the annual cost associated with PF is $284 million. The first-line treatments recommended by guidelines for PF encompass physical therapy (including manual therapy, stretching, and others), pharmacological therapy (involving corticosteroids or platelet-rich plasma), and surgical treatment. However, the definite effects of physical therapy still require confirmation. Pharmacological treatments, such as local corticosteroid injections, exhibit a short maintenance period. Some studies indicate that the relief provided by corticosteroid injections lasts up to one month, yet its efficacy diminishes after 6 months. Surgical treatment is generally advised 6 to 12 months after unsuccessful conservative treatment, albeit with the drawback of higher costs, post-surgery recovery time, and patient apprehension. Acupuncture is one of the most common complementary alternative therapy for the treatment of pain-related diseases such as musculoskeletal muscle, and recent guidelines recommend dry needling as a treatment for relief of plantar fasciitis, with a level of evidence of B. Dry acupuncture is different from acupuncture in terms of theoretical basis, therapeutic apparatus, technical operation and scope of indications, however, the American Alliance for Professional Acupuncture Safety also believes that dry needling falls under the umbrella of acupuncture, but under a different name. In addition, there are systematic evaluations that suggest acupuncture can be a safe and effective treatment for PF, and most of the trials in the systematic evaluations used 4-week treatment courses. Our prior study demonstrated that a 4-week intervention of both electroacupuncture and manual acupuncture resulted in improved pain outcomes among patients with PF. The frequency of acupuncture stands as a crucial factor influencing its efficacy. A study revealed that needling trials with negative results had a significantly lower frequency compared to those yielding positive results. Furthermore, several studies indicate that acupuncture once a week can be help in conditions such as simple obesity, functional dyspepsia, and overactive bladder in women. There is no universally accepted standard of frequency of treatment for many conditions, including PF. In China, patients with chronic diseases usually receive 3-5 acupuncture treatments per week. However, in most previous trials, individuals with chronic diseases received 1-2 needling sessions per week. An increase in the frequency of acupuncture means an increase in the pain, time, and financial investment associated with the acupuncture process. Therefore, it is critical to optimize the frequency of acupuncture to ensure the effectiveness and feasibility of the treatment while avoiding increasing the burden on the patient. Accordingly, the investigators designed the current trial to compare the effects of different acupuncture sessions (1 session per week versus 3 sessions per week) in a randomized controlled trial (RCT) of chronic PF. The hypothesis is that 1 session per week compared with 3 sessions per week of electroacupuncture treatment over a total of 4 weeks of treatment will provide a similar effect on pain relief in chronic PF.

Interventions

• Procedure electroacupuncture(more frequent)
  With the patient in a prone position, the local skin will be routinely sterilized, Ashi points will be perpendicularly inserted into the plantar fascia layer with a depth of approximately 15-20 mm depending on the location. BL57, KI3, and BL60 will be punched perpendicularly 10-15 mm deep into the skin. All needles except the Ashi points will be manually stimulated with small, equal manipulations of lifting, thrusting, twirling, and rotating to achieve De qi (a sensation including soreness, numb
• Procedure electroacupuncture(less frequent)
  The intervention is the same as Group M except that the frequency of acupuncture will be once per week acupuncture. During the treatment period, in addition to acupuncture, patients will be visited twice a week for a total of 8 visits by telephone or in person. If the content of the visit aligns with the established efficacy evaluation visit in the program, it will be carried out as planned. If not, the patient will be inquired about the progress of their condition since the previous treatment,

Primary outcome measures

• The response rate [Time frame: At the end of weeks 4]

Secondary outcome measures (8)

• The response rate [Time frame: At the end of weeks 8, and 16]
• Change from baseline in the VAS score for worst pain intensity during the first morning steps [Time frame: At the end of weeks 4, 8, and 16]
• Change from baseline in the VAS score for mean pain intensity during the day [Time frame: At the end of weeks 4, 8, and 16]
• Change from baseline in the duration of heel pain during the day [Time frame: At the end of weeks 4, 8, and 16]
• Change from baseline in heel pressure pain threshold (PPT) [Time frame: At the end of weeks 4, 8, and 16]
• Change from baseline in ankle range of motion (AROM) [Time frame: At the end of weeks 4, 8, and 16]
• Change from baseline in Foot and Ankle Ability Measure (FAAM) total score and subscale scores [Time frame: At the end of weeks 4, 8, and 16]
• Participant global assessment of improvement [Time frame: At the end of weeks 4, 8 and 16]

Eligibility criteria

Inclusion criteria

• Patients with a diagnosis of chronic PF with a disease course of ≥ 6 months;
• The most painful heel pain in the morning is Visual Analogue Scale (VAS; 0 indicating no pain and 100 indicating maximal pain) ≥ 40 mm on a 100 mm VAS;
• Patients between the ages of 18 and 75 years;
• Patients should be conscious, free from mental disorders, and without serious heart, liver, or kidney diseases; and
• Willing to sign the informed consent form.

Exclusion criteria

• History of calcaneal tuberosity fracture/calcaneal stress fracture/calcaneal contusion/plantar fascia rupture;
• History of ankle or foot surgery;
• Achilles tendon enthesis lesion/tarsal tunnel syndrome/medial calcaneal nerve entrapment/nerve injury;
• Systemic or local infection, severe cracked heel, foot deformity (e.g., high arched feet, flat feet, foot valgus);
• Systemic diseases (e.g., obligatory spondylitis, rheumatoid arthritis, seronegative arthritis, autoimmune system diseases, tumors, diabetes ) and other situations judged by the investigators not to be suitable for the clinical trial;
• Pregnant women; patients with severe combined cardiac, hepatic, renal, hematopoietic, and patients with cardiac pacemakers , and patients with severe poor general nutritional status;
• Cognitive impairment, inability to understand the content of the scale evaluation;
• Topical steroid injection or oral use in the past 6 months;
• Patients with a known fear of acupuncture or who have been treated with acupuncture in the past 8 weeks.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

China · 1 center

• Department of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences Guang — Beijing

Publications

• Shi J, Jiao R, Liu Y, Liu X, Sun Y, Shi H, Gao N, Liu Z, Liang J, Wang W. Comparing different session regimens of electroacupuncture for chronic plantar fasciitis: Study protocol for a randomized clinical trial. Contemp Clin Trials Commun. 2024 Aug 24;41:101355. doi: 10.1016/j.conctc.2024.101355. eCollection 2024 Oct. PMID 39280785

Identifiers

NCT: NCT06284993 · 2023-214-KY

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗