Acupuncture for Plantar Fasciitis

NewsBot · Nov 26, 2009

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Acupuncture Treatment for Plantar Fasciitis: A Randomized Controlled Trial with Six Months Follow-up.
Zhang SP, Yip TP, Li QS.
Evid Based Complement Alternat Med. 2009 Nov 23. [Epub ahead of print]

Plantar fasciitis is a common cause of heel pain. It has been suggested that some acupoints have a specific effect on heel pain. The aim of this study was to determine the efficacy and specificity of acupuncture treatment for plantar fasciitis. Subjects were randomly assigned to the treatment group (n = 28) or control group (n = 25). The treatment group received needling at the acupoint PC 7, which is purported to have a specific effect for heel pain. The control group received needling at the acupoint Hegu (LI 4), which has analgesic properties. Treatment was administered five times a week for 2 weeks, with an identical method of manual needling applied to the two acupoints. The primary outcome measure was morning pain on a 100-point visual analog scale (VAS) at one month post-treatment. Secondary outcome measures included a VAS for activity pain, overall pain rating as well as pressure pain threshold using algometry. Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6 +/- 4.0 versus 12.0 +/- 3.0, mean +/- SEM), overall pain (20.3 +/- 3.7 versus 9.5 +/- 3.6) and pressure pain threshold (145.5 +/- 32.9 versus -15.5 +/- 39.4). No serious adverse event was observed in either group. The results indicate that acupuncture can provide pain relief to patient with plantar fasciitis, and that PC 7 is a relatively specific acupoint for heel pain.
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Admin2 · Oct 15, 2023

Related threads:
Other threads tagged with plantar fasciitis
Other threads tagged with acupuncture

Craig Payne · Sep 2, 2010

Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review
Matthew P Cotchett, Karl B Landorf and Shannon E Munteanu
Journal of Foot and Ankle Research 2010, 3:18doi:10.1186/1757-1146-3-18

Background
Plantar heel pain (plantar fasciitis) is one of the most common musculoskeletal pathologies of the foot. Plantar heel pain can be managed with dry needling and/or injection of myofascial trigger points (MTrPs) however the evidence for its effectiveness is uncertain. Therefore, we aimed to systematically review the current evidence for the effectiveness of dry needling and/or injections of MTrPs associated with plantar heel pain.

Methods
We searched specific electronic databases (MEDLINE, EMBASE, AMED, CINAHL, SPORTDiscus and AMI) in April 2010 to identify randomised and non-randomised trials. We included trials where participants diagnosed with plantar heel pain were treated with dry needling and/or injections (local anaesthetics, steroids, Botulinum toxin A and saline) alone or in combination with acupuncture. Outcome measures that focussed on pain and function were extracted from the data. Trials were assessed for quality using the Quality Index tool.

Results
Three quasi-experimental trials matched the inclusion criteria: two trials found a reduction in pain for the use of trigger point dry needling when combined with acupuncture and the third found a reduction in pain using 1% lidocaine injections when combined with physical therapy. However, the methodological quality of the three trials was poor, with Quality Index scores ranging form 7 to 12 out of a possible score of 27. A meta-analysis was not conducted because substantial heterogeneity was present between trials.

Conclusions
There is limited evidence for the effectiveness of dry needling and/or injections of MTrPs associated with plantar heel pain. However, the poor quality and heterogeneous nature of the included studies precludes definitive conclusions being made. Importantly, this review highlights the need for future trials to use rigorous randomised controlled methodology with measures such as blinding to reduce bias. We also recommend that such trials adhere to the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) to ensure transparency.
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Peter · Sep 2, 2010

I have long given up trying to get pain relief from PF with acupuncture. I tried the traditional acupuncture point from Western a/p, and tried needling several muscle bellies after chatting to Shane Toohey, but it never seemed to work:craig:

NewsBot · Aug 25, 2011

Treatment of Plantar Fasciitis in Recreational Athletes; Two Different Therapeutic Protocols
Panagiotis Karagounis,
Foot Ankle Spec August 2011 vol. 4 no. 4 226-234

Plantar fasciitis (PF) commonly causes inferior heel pain and occurs in up to 10% of the US population. Treatment protocols in most studies include the use of ice therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching and strengthening protocols. The aim of the current study was to examine the effectiveness of 2 different therapeutic approaches on the treatment of PF in recreational athletes using the Pain and Disability Scale for the evaluation. A total of 38 participants with PF were randomly allocated to 2 different groups of 19 male participants in each group. Group 1 was treated with ice, non-steroidal anti-inflammatory medication, and a stretching and a strengthening program. Group 2 received the same therapeutic procedures as group 1, reinforced by acupuncture treatment. The primary outcomes, nominated a priori, were pain description and mobility-function at 1 and 2 months. Outcomes were measured with the pain scale for PF. The mean total score of the acupuncture group at the third measurement was statistically minor compared with the mean total score of the first group. Acupuncture should be considered as a major therapeutic instrument for the decrease of heel pain, combined with traditional medical approaches.
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Shane Toohey · Aug 31, 2011

Hi Peter,
You wrote:

Re: Acupuncture for Plantar Fasciitis
I have long given up trying to get pain relief from PF with acupuncture. I tried the traditional acupuncture point from Western a/p, and tried needling several muscle bellies after chatting to Shane Toohey, but it never seemed to work
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Thanks for the mention and sorry, I only just noticed this thread as not often on the arena these days.

I will assert that I have been using acupuncture techniques as my primary treatment for "plantar fasciitis" and have overwhelmingly good outcomes. I regard the diagnosis of "plantar fasciitis" as being less accurate even than "metatarsalgia" in describing the specifics of a foot problem. Every single case is unique and having a formula of specific points or even a few muscles to needle is very hit and miss (pardon).
Triggers are where you find them and you can be guided where to look by the specific presentation of where the pain is felt. So some or all of the muscles in the calf and foot intrinsics can be involved in referring pain. The full release of a trgger point may also be helped by cold spray and streching - which also has the potential to aggravate the condition. Heat on the muscles usally helps rather than the cultural wisdom of applying ice. There may also be local tissue damage which may require local needling as 'ashi points' and there are also then specific or general traditional and western points that may be used. Hopefully not as complicated as it sounds and I am trying to be succint.
Also what I am describing is a practical skill set that is best learnt in a clinical setting rather than in conversation or from the written word. I am completely amazed at how much variation occurs in the practical method of even a simple instruction.
There may also be perpetuating factors to treat such as poor function, footwear and activities. The continuation of heel pain is often multifactorial so there will never be one simple solution.
I usually see the chronic sufferers and have to mention over aggressive orthoses as a regular factor in the perpetuation of a problem that seems impossible to shift until the orthoses are removed.
The acupuncture that I practice would be difficult to do a trial on of course.
The first mentioned study did not have a control group as far as I can tell and as Cotchett et al point out research up to now has been sub standard in regards to producing reliable evidence one way or the other.
It is great that the latter group have taken on promoting far more rigorous clinical trials. I would like to suggest that they endeavour to develop an homogenous cohort in relation to the duration of the affliction and the specific site of the pain.

Cheers
Shane

NewsBot · Oct 27, 2012

The effectiveness of acupuncture for plantar heel pain: a systematic review.
Clark RJ, Tighe M.
Acupunct Med. 2012 Oct 25.

INTRODUCTION:
lantar heel pain (PHP) is a common complaint, yet there are no definitive guidelines for its treatment. Acupuncture is increasingly used by podiatrists, and there is a need for evidence to validate this practice. It is acknowledged that PHP and acupuncture are both complex phenomena.

METHOD:
A systematic review (PROSPERO no. CRD42012001881) of the effectiveness of acupuncture for PHP is presented. Quality of the studies was assessed by independent assessors with reference to Quality Index (QI), 'STandards for Reporting Interventions in Controlled Trials of Acupuncture' (STRICTA) and 'CONsolidated Standards Of Reporting Trials' (CONSORT) criteria. Pooling of data, or even close comparison of studies, was not performed.

RESULTS:
Five randomised controlled trials and three non-randomised comparative studies were included. High quality studies report significant benefits. In one, acupuncture was associated with significant improvement in pain and function when combined with standard treatment (including non-steroidal anti-inflammatory drugs). In another, acupuncture point PC7 improved pain and pressure pain threshold significantly more than LI4. Other papers were of lower quality but suggest benefits from other acupuncture approaches.

CONCLUSIONS:
There is evidence supporting the effectiveness of acupuncture for PHP. This is comparable to the evidence available for conventionally used interventions, such as stretching, night splints or dexamethasone. Therefore acupuncture should be considered in recommendations for the management of patients with PHP. Future research should recognise the complexity of PHP, of acupuncture and of the relationship between them, to explore the optimum use and integration of this approach. There is a need for more uniformity in carrying out and reporting such work and the use of STRICTA is recommended.
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NewsBot · Dec 12, 2012

Efficacy of electro-acupuncture in chronic plantar fasciitis: a randomized controlled trial.
Kumnerddee W, Pattapong N.
Am J Chin Med. 2012;40(6):1167-76.

The aim of the study was to investigate the efficacy of electro-acupuncture coupled with conventional treatments and compare it with the efficacy of conventional treatments alone in patients with chronic plantar fasciitis. Thirty patients with chronic refractory plantar fasciitis were randomly assigned to two groups. Subjects in the control group received five weeks of conventional treatments, including stretching exercise, shoe modification and rescue analgesics. Subjects in the acupuncture group received the same treatments plus ten sessions of electro-acupuncture twice weekly. Endpoints included a success rate determined by a minimum of a 50% decrease in Visual Analog Scale (VAS) and Foot Function Index (FFI). At the end of treatment, VAS decreased significantly from 6.00 ± 1.69 to 1.89 ± 1.59 and from 6.27 ± 2.34 to 5.40 ± 2.26 in the acupuncture and control groups, respectively. FFI decreased significantly only in the acupuncture group (p < 0.05). Subjects in the acupuncture group obtained higher success rates than those in control group (80% and 13.3%, respectively). FFI in the acupuncture group was better than those in the control group (p < 0.001). At the sixth week follow-up, subjects in the acupuncture group showed a better FFI and success rate for pain during the day than those in the control group (p < 0.05). Electro-acupuncture coupled with conventional treatments provided a success rate of 80% in chronic planar fasciitis which was more effective than conventional treatments alone. The effects lasted for at least six weeks.
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NewsBot · Jun 9, 2013

Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial
Matthew P Cotchett, Karl B Landorf and Shannon E Munteanu
Journal of Foot and Ankle Research 2013, 6(Suppl 1):O8 doi:10.1186/1757-1146-6-S1-O8

Background
Plantar heel pain (plantar fasciitis) can be managed with myofascial trigger point dry needling of myofascial trigger points, however there is only poor quality evidence supporting its use. Therefore, we aimed to evaluate the effectiveness of trigger point dry needling for plantar heel pain.

Methods
84 participants with plantar heel pain were randomized to real or sham trigger point dry needling. The intervention consisted of one treatment per week for six weeks. Participants were followed for 12 weeks. Primary outcome measures included ‘first-step pain’ measured with a Visual Analogue Scale and foot pain measured with the pain subscale of the Foot Health Status Questionnaire. The primary end-point for predicting the effectiveness of dry needling for plantar heel pain was six weeks.

Results
At the primary end-point, significant effects favored real dry needling over sham dry needling for pain (adjusted mean difference: VAS first-step pain -14.4 mm, 95% CI -23.5 to -5.2, p=0.002; FHSQ foot pain 10.0 points, 95% CI 1.0 to 19.1, p=0.029), although the between-group difference was lower than the minimal important difference. The frequency of minor transitory adverse events was significantly greater in the real dry needling group (70 real dry needling appointments [32%] compared with only 1 sham dry needling appointment [<1%]).

Conclusion
We found that dry needling provided statistically significant improvements in plantar heel pain, but the magnitude of this effect should be considered against the frequency of minor transitory adverse events.
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Shane Toohey · Jun 9, 2013

Thanks for doing this guys!

Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial
Matthew P Cotchett, Karl B Landorf and Shannon E Munteanu
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I have a couple of queries re this study as I am unable to find any more info beyond the abstract that the link takes us to.

1. What was your method with the "sham" dry needling?

2. what trigger points were you needling and how did you needle them?

Cheers

Shane

JFAR · Jun 17, 2013

Full details are provided in the protocol paper:

http://www.jfootankleres.com/content/4/1/5

Kind regards,

The JFAR editorial team

NewsBot · Sep 22, 2016

Shane Toohey said: ↑

1. What was your method with the "sham" dry needling?
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NewsBot · Jul 9, 2016

Rationales and treatment approaches underpinning the use of acupuncture and related techniques for plantar heel pain: a critical interpretive synthesis.
Clark MT, Clark RJ, Toohey S, Bradbury-Jones C
Acupunct Med. 2016 Jul 7

BACKGROUND:
Acupuncture shows promise as a treatment for plantar heel pain (PHP) or plantar fasciitis (PF), but data heterogeneity has undermined demonstration of efficacy. Recognising that acupuncture is a diverse field of practice, the aim of this study was to gain a broader, global perspective on the different approaches and rationales used in the application of acupuncture in PHP.
METHODS:
We built upon an earlier systematic review (which was limited by the necessity of a methodological focus on efficacy) using the critical interpretive synthesis (CIS) method to draw upon a wider international sample of 25 clinical sources, including case reports and case series. Multiple tracks of analysis led to an emergent synthesis.
RESULTS:
Findings are presented at three levels: primary (summarised data); secondary (patterns observed); and tertiary (emergent synthesis). Multiple treatments and rationales were documented but no single approach dominated. Notable contradictions emerged such as the application of moxibustion by some authors and ice by others. Synthesis of findings revealed a 'patchwork' of factors influencing the approaches taken.
CONCLUSIONS:
The complexity of the field of acupuncture was illustrated through the 'lens' of PHP. The 'patchwork' metaphor provides a unifying framework for a previously divergent community of practice and research. Several directions for future research were identified, such as: importance of prior duration; existence of diagnostic subgroups; and how practitioners make clinical decisions and report their findings. CIS was found to provide visibility for multiple viewpoints in developing theory and modelling the processes of 'real world' practice by acupuncturists addressing the problem of PHP.
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NewsBot · Aug 17, 2016

How effective is acupuncture for reducing pain due to plantar fasciitis?
Thiagarajah AG
Singapore Med J. 2016 Aug 16. doi: 10.11622/smedj.2016143

INTRODUCTION:
Plantar fasciitis is a commonly seen outpatient condition that has numerous treatment modalities of varying degrees of efficacy. This systematic review aimed to determine the effectiveness of acupuncture in reducing pain due to plantar fasciitis.
METHODS:
Online literature searches on the PubMed and Cochrane Library databases were done for studies on the use of acupuncture for pain due to plantar fasciitis. Studies designed as randomised controlled trials and which compared acupuncture with standard treatments or had real versus sham acupuncture arms were selected. The Delphi List was used to assess the methodological quality of the studies retrieved.
RESULTS:
Three studies that compared acupuncture with standard treatment and one study on real versus sham acupuncture were found. These showed that acupuncture significantly reduced pain levels in patients with plantar fasciitis, as measured on the Visual Analogue Scale and the Plantar Fasciitis Pain/Disability Scale. These benefits were noted between four and eight weeks of treatment, with no further significant reduction in pain beyond this duration. Side effects were found to be minimal.
CONCLUSION:
Although acupuncture may reduce plantar fasciitis pain in the short term, there is insufficient evidence for a definitive conclusion regarding its effectiveness in the longer term. Further research is required to strengthen its acceptance among healthcare providers.
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NewsBot · Mar 4, 2017

Two Cases of Plantar Fasciitis Treated with Magnetic Acupuncture
Gee Won Yun et al
The Acupuncture 2017; 34(1): 89-96.

Objectives :
The aim of the study was to ascertain the effectiveness of magnetic acupuncture in patients with plantar fasciitis.
Methods :
The patients were treated with magnetic acupuncture using a magnetic therapy stimulator (Whata 153), as well as with moxibustion therapy. Acupuncture treatment was conducted on the acupoints of Ashi—as well as on 太谿 (KI3), 崑崙 (BL60), and 委中 (BL40)—for 15 minutes. The intensity of pain was evaluated using the visual analogue scale (VAS), and the tenderness threshold (TT) was measured at each visit using an algometer.
Results :
After treatment, evaluation using the VAS had improved, as had the TT; furthermore, plantar fasciitis pain was reduced.
Conclusion :
Magnetic acupuncture relieved pain in plantar fasciitis. In further clinical study, more research on magnetic acupuncture is required.
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NewsBot · Aug 23, 2020

Comparison of electroacupuncture and manual acupuncture for patients with plantar heel pain syndrome: a randomized controlled trial
Weiming Wang et al
Acupunct Med. 2020 Aug 18

Background: Plantar heel pain syndrome (PHPS), also known as plantar fasciitis, affects millions of people worldwide. Electroacupuncture (EA) and manual acupuncture (MA) are the two acupuncture modalities frequently used for PHPS in the clinical setting. However, which modality is more effective has yet to be determined.

Objective: To examine whether EA is more effective than MA with regards to pain relief for patients with PHPS.

Methods: Participants were randomly assigned (1:1) to receive 12 treatment sessions of EA or MA over 4 weeks with 24 weeks of follow-up. The primary outcome was the proportion of treatment responders, defined as patients with at least a 50% reduction from baseline in the worst pain intensity experienced during the first steps in the morning after a 4-week treatment, measured using a visual analogue scale (VAS, 0-100; higher scores signify worse pain). Analysis was by intention-to-treat.

Results: Ninety-two patients with a clinical diagnosis of PHPS were enrolled from 29 July 2018 through 28 June 2019. Of the patients, 78 (85%) completed the treatment and follow-up. The primary outcome occurred in 54.8% (23/42) of the EA group compared to 50.0% (21/42) of the MA group after the 4-week treatment (difference -4.76, 95% confidence interval, -26.10 to 16.57, P = 0.662). There were no significant between-group differences for any secondary outcomes after 4 weeks of treatment and at 16 weeks and 28 weeks of follow-up. There were no serious treatment-related adverse events in either group.

Conclusion: Among patients with PHPS, EA did not have a better effect with respect to relieving pain intensity than MA at week 4, although both EA and MA appeared to have positive temporal effects, with decreased heel pain and improved plantar function.
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NewsBot · Oct 25, 2020

Efficacy of acupuncture versus sham acupuncture or waitlist control for patients with chronic plantar fasciitis: study protocol for a two-centre randomised controlled trial
Weiming Wang et al
BMJ Open. 2020; 10(9): e036773.

Introduction
Plantar fasciitis (PF) is reported to be the most common cause of plantar heel pain. Acupuncture has been used for patients experiencing PF, but evidence of the efficacy of acupuncture on PF is limited. The primary objective of this trial is to compare combined acupuncture and sham acupuncture (SA) versus waitlist control for improving the level of pain experienced by patients suffering from chronic PF.

Methods and analysis
This will be a two-centre, parallel-group, sham and no-treatment controlled, assessor-blinded randomised trial. We will randomly allocate 120 participants with chronic PF to acupuncture, SA and waitlist control groups at a ratio of 2:1:1. Participants in the acupuncture and SA groups will receive a 30 min acupuncture or SA treatment for a total of 12 sessions over 4 weeks, with a 12-week follow-up. Participants in the waitlist control group will not undergo treatment for a period of 16 weeks but instead will have the option of 4 weeks (12 sessions) of acupuncture free of charge at the end of the follow-up period. The primary outcome will be the treatment response rate 4 weeks after randomisation, assessed as a minimum of 50% improvement in the worst pain intensity during the first steps in the morning compared with the baseline. All analyses will be performed with a two-sided p value of <0.05 considered significant following the intention-to-treat principle.

Ethics and dissemination
The study has been approved by the Ethical Committee of the Guang’anmen Hospital, China Academy of Chinese Medical Sciences (approval no. 2019-210-KY). The results will be disseminated through presentation at a peer-reviewed medical journal, the relevant conferences and scientific meetings.
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NewsBot · May 30, 2022

Effectiveness and safety of warm needling therapy combined with electroacupuncture for patients with plantar heel pain syndrome: A protocol for systematic review and meta-analysis
Juecan Wu et al
Medicine (Baltimore). 2022 May 27

Background: Several studies have reported positive therapeutic effects of electroacupuncture, warm needling, or a combination of the 2 for heel pain; however, the quality of the evidence is limited by methodological limitations. Given that there are no high-quality meta-analyses or reviews incorporating the available evidence, the aim of this study was to systematically review the level I evidence in the literature to determine whether a combination of electroacupuncture and warm needling therapy is more beneficial than acupuncture alone in patients with plantar heel pain syndrome.

Methods: From the inception to May 2022, the Wanfang, CNKI, EMBASE, PubMed, Web of Science, and Cochrane Library electronic databases will be searched using the key phrases "acupuncture", "warm needling", "electroacupuncture", "heel pain", "plantar pain", and "prospective" for all relevant studies. The outcomes include pain, physical disability, plantar fascia thickness, and foot functional status. Quality assessment of all studies included in this review will be independently assessed by 2 reviewers using the Cochrane Collaborations tool. We consider significant heterogeneity between trials if I2 > 50%, and severe heterogeneity if I2 > 75%. When significant heterogeneity is indicated, we will find the source of heterogeneity by subgroup or sensitivity analysis.

Results: The results of our review will be reported strictly following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and the recommendations of the Cochrane Collaboration.

Conclusions: We initially hypothesized that combination therapy would lead to better treatment outcomes.
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NewsBot · Oct 23, 2022

Reflective and Refractive Practice: Lessons from Reviewing Acupuncture for Plantar Heel Pain.
Clark, Richard J.
Journal of Chinese Medicine . Oct2022, Issue 130, p17-28. 12p.

Reviews of the use of acupuncture for plantar heel pain reveal great heterogeneity. A wide range of approaches may be subsumed under the rubric 'acupuncture and related techniques'. Similarly, many different labels have been used for plantar heel pain, some of which may be anachronistic and misleading. Problems of such labelling are discussed, and alternative generalisations considered. A selection of findings from literature reviews is highlighted, including use of ashi points, Taixi KID-3, diagonally opposite points and point combinations. Rationales underpinning these interventions are summarised and mapped. It can be helpful for practitioners to reflect on their own practice in the context of these research findings. A co-constructive approach is recommended and the concept of refractive practice is developed via consideration of 'whole systems' and postmodern practice. Illustrative examples of its usefulness are given. The combined use of refraction and reflection is recommended as a tool to enhance theoretical visibility in postmodern practice. Practitioners are encouraged to embrace complexity and heterogeneity, question longstanding assumptions and view clinical phenomena afresh. Questions for future study and for individual reflection are proposed.
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NewsBot · Jan 5, 2023

Acupuncture for Plantar Fasciopathy: A Randomized Controlled Trial
Stephen D. CagleJr., Carlton Covey, Jennifer Farrell, Danny J. Sharon, and Paul Crawford
27 Dec 2022

Objective: Plantar fasciopathy has a lifetime prevalence of 10% in the general population and can have a significant impact on quality of life. This research was conducted determine if a quick and simple acupuncture technique + a home-exercise program would reduce pain and improve function more than a home-exercise program alone.

Materials and Methods: A randomized controlled trial was conducted at 2 U.S. Air Force military treatment facilities. Department of Defense beneficiaries ≥18 years' old with PF were recruited; 94 subjects were randomized to home exercise only (control) or home exercise + acupuncture (intervention). The intervention group had a acupuncture every 2 weeks for 4 treatments. There was no blinding. Patients initially in the control group were allowed to cross over to acupuncture after the initial 12-week study. Primary outcomes were pain reduction and improved functioning. Scores were obtained at baseline, each visit, and 6 weeks post-treatment.

Results: The control group had a 21% reduction in pain scores (p < 0.05) at the study's end. The intervention group had a >50% reduction in pain score immediately after acupuncture during the visits (p < 0.05) and a 37% reduction at the study's end (p < 0.01). Subjects who crossed over to acupuncture had a >50% reduction of pain score acutely and a 30% reduction at 12 weeks post-acupuncture (p < 0.05). Function scores improved but were not statistically different (p = 0.535).

Conclusions: A simple acupuncture technique acutely reduced pain by >50% in plantar fasciopathy and, when combined with a home-exercise program, achieved greater sustained clinically significant reduction in pain at 12 weeks than a home-exercise program alone.
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Brian A. Rothbart · Jan 5, 2023

Acupuncture, like muscle strengthening exercises, are regimens which are treating a symptom (e.g., Inflammation of the plantar connective tissue). Both methods are, no doubt, effective in controlling pain.

A far better approach, IMO, is to identify and treat the primay cause of Plantar Fasciitis.

scotfoot · Jan 7, 2023

I'm not sure strengthening the intrinsic foot muscles will be that effective at reducing plantar heel pain unless the muscles are allowed to function fully.

Moving from a modern shoe to a minimal shoe for everyday activities improved toe flexor strength by 57% in one study, indicating increased IF muscle involvement in foot function .This might lead to reduced PF involvement and pain improvements .

But what aspect of the modern shoes dampens IFM activity. I would guess the toe spring.

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