to the editor: I found this article very helpful; however, I would like to add one treatment option for plantar fasciitis that was not discussed. Acupuncture has been shown to be effective for the alleviation of plantar fasciitis pain in one small trial.¹ This trial randomized 28 persons to the treatment group and 25 persons to the control group. The participants received five treatments per week for two weeks. The end points were improvement of morning pain, pain on activity, overall pain, and pain with pressure threshold as measured by a visual analog scale and algometry (a pain pressure threshold measure). At one month, the treatment group had more pain relief compared with the control group. This preliminary study seems to support that acupuncture might be helpful for some patients with plantar fasciitis.

in reply: I appreciate Dr. Solomon’s interest in our article. Although we did not find much literature on the use of acupuncture in the treatment of plantar fasciitis, its use has shown positive results in treating other musculoskeletal conditions.

The study Dr. Solomon mentioned was a randomized controlled trial of acupuncture for treating plantar fasciitis that used two treatment groups: a control group (n = 25)that received acupuncture to the heel acupoint Hegu (LI 4), and a treatment group(n = 28) that received acupuncture to the heel acupoint PC 7.¹ Both groups showed gradual improvement in symptoms over six months. The treatment group showed a 40 percent improvement in morning pain at one month compared with the control group. Overall, there was little difference in clinically significant symptom reduction between the two groups over six months. This study would have been more convincing if it had included an additional placebo group that received no treatment.

Another study on acupuncture compared two groups of patients with plantar fasciitis: a control group (n = 19) treated with ice, nonsteroidal anti-inflammatory drugs (NSAIDs), and a stretch/strengthening program; and a treatment group (n = 19) treated with ice, NSAIDs, a stretch/strengthening program, and 16 acupuncture sessions to the affected heel.² Both groups reported improvement in symptoms over the eight-week treatment period. However, there were no statistically significant differences found on the plantar fasciitis pain and disability scale between the two groups after four weeks oftreatment. The treatment group showed minimal statistical improvements after eight weeks compared with the control group.

Most patients with plantar fasciitis improve in a few months without specific therapies. As mentioned in our article, there is no conclusive evidence about which modality (NSAIDs, ice, stretching, orthotics, injections, extracorporeal shockwave therapy) is the best for treating this painful, self-limiting foot condition.