Stimulated by Wang et al 2026.[1]
PF – plantar fasciitis
PHP – plantar heal pain
IF – impact factor
CACMS – China Academy of Chinese Medical Sciences
RCT – randomised controlled trial
EA – electroacupuncture
MA – manual acupuncture
CI – confidence interval– key to acronyms
It has been almost 6 years to the day that plantar fasciitis (PF) appeared in the title of this blog – see Plantar fasciitis 2020. Plantar heal pain (PHP) came up later that same year – see Plantar heel pain 2020.
I recognised the last author on this paper in the journal Complementary Therapies in Medicine (IF 3.5). Liu Zhishun is based at CACMS in Beijing and has been involved in a number of the large RCTs of acupuncture published in high impact journals over the last decade. I have mentioned him before here – see EA for IOC, and the first of his big trials (n=1075) I picked up was published in Annals of Internal Medicine in 2016 – see EA for chronic severe functional constipation.
PF is a bit of a departure from constipation, urinary incontinence, and chronic prostatitis (some of the topics of previous RCTs from this group), but MSK topics have come up before – for example, see Acupuncture for DLSS, and PF has actually come up before too.[2] That paper was published in Acupuncture in Medicine (IF 2.6) but I did not highlight it at the time. It was a head-to-head trial of EA and MA in PF (n=92). Both groups improved but there was no significant difference between them.
The current trial (n=120) used the same protocol as the MA group above, which consisted of 2 tender points over the heel plus KI3, BL60, and BL57, but in this trial there were 3 arms. The MA arm was called high-intensity acupuncture. The non-penetrating sham was called low-intensity acupuncture, and the third group was a waiting-list control. Randomisation was in the ratio 2:1:1 respectively.
The labelling of high-intensity and low-intensity was clearly added following editorial and peer review, since the published protocol refers to acupuncture and sham acupuncture,[3] although the latter does mention combining acupuncture and sham acupuncture groups and comparing them to the waiting-list control.
The points were covered by sterile adhesive pads in both the real needling group (n=60) and the smaller sham group (n=30). The waiting-list group (n=30) was offered free acupuncture after the 16-week follow-up. Treatment was 3 times a week for the first 4 weeks and the patients were followed up at at week 8 and week 16.
The primary outcome was the proportion of responders at 4 weeks, where a responder was defined by at least a 50% reduction in the worst pain on first steps in the morning. In order to get onto the trial, the patients had to rate this pain at 50 or more on a 0 to 100 VAS.
The MCID for worst first step pain in PF is -19mm and -8mm for average PF pain.[4] The former was exceeded at 4 weeks in all 3 groups, although the 95% CI crossed below this figure in the waiting-list group. The non-penetrating sham group achieved a clinically relevant reduction in pain in the majority of subjects, but the effect in the real acupuncture group was about 30% bigger.
The primary outcome, which was the combined acupuncture groups (real and sham) versus the waiting-list group, was significant at 4 weeks (p=0.02), and the difference increased over the follow-up period.
The difference between real and sham, although substantial, did not reach statistical significance at any time point, principally due to the wide CIs in the smaller group. The real acupuncture group reached a statistically significant benefit over waiting-list at 4, 8, and 16 weeks. The non-penetrating sham did not demonstrate a significant improvement over waiting-list at any time point.
References
1 Wang W, Kang J, Wang X, et al. Efficacy of Acupuncture for Chronic Recalcitrant Plantar Fasciitis: A Randomized Trial. Complement Ther Med. 2026;103329. doi: 10.1016/j.ctim.2026.103329
2 Wang W, Liu Y, Jiao R, et al. Comparison of electroacupuncture and manual acupuncture for patients with plantar heel pain syndrome: a randomized controlled trial. Acupunct Med. 2021;39:272–82. doi: 10.1177/0964528420947739
3 Wang W, Liu S, Liu Y, et al. Efficacy of acupuncture versus sham acupuncture or waitlist control for patients with chronic plantar fasciitis: study protocol for a two-centre randomised controlled trial. BMJ Open. 2020;10:e036773. doi: 10.1136/bmjopen-2020-036773
4 Landorf KB, Radford JA, Hudson S. Minimal Important Difference (MID) of two commonly used outcome measures for foot problems. J Foot Ankle Res. 2010;3:7. doi: 10.1186/1757-1146-3-7
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