High- and low-intensity acupuncture improved pain in chronic recalcitrant plantar fasciitis versus waitlist control.

Plantar fasciitis (PF) is a leading cause of heel pain, yet effective treatments for chronic, recalcitrant cases are scarce. The aim of this randomized, no-treatment-controlled trial was to assess whether acupuncture (a combination of high- and low-intensity acupuncture) would reduce pain in patients with chronic recalcitrant PF compared to a waitlist control. Participants were randomly assigned (2:1:1) to high-intensity acupuncture (n = 60), low-intensity acupuncture (n = 30), or waitlist control (n = 30). The primary outcome was the proportion of responders (≥50 % reduction in worst pain intensity) at week 4 for the combined acupuncture groups versus the waitlist control group. Key secondary outcomes included responder rates for high- and low-intensity acupuncture versus waitlist control at weeks 4, 8, and 16. Of 120 randomized participants, 109 (90.8 %) completed the trial. At week 4, the proportion of responders was significantly higher in the combined groups than in the waitlist control group (56.7 % [95 %CI, 46.4 %-66.9 %] vs 33.3 % [95 %CI, 16.5 %-50.2 %]; difference: 23.3 % [95 %CI, 3.6 %-43.1 %]; P = 0.02), with a similar trend observed through week 16. A graded response to acupuncture intensity was evident: at week 16, the responder rate in the high-intensity acupuncture group was 76.7 %, compared to 36.7 % in the waitlist control group (difference: 40.0 % [95 % CI, 19.7 %-60.3 %]; P < 0.001), while the low-intensity acupuncture group had a nonsignificant 20.0 % difference (95 % CI, -4.7-44.7 %; P = 0.11). Among patients with chronic recalcitrant PF, acupuncture, particularly high-intensity acupuncture, notably reduced pain compared with waitlist control, with lasting effects up to week 16.