Abstract
Background Plantar heel pain can be managed with dry needling of myofascial trigger points; however, there is only poor-quality evidence supporting its use.
Objective The purpose of this study was to evaluate the effectiveness of dry needling for plantar heel pain.
Design The study was a parallel-group, participant-blinded, randomized controlled trial.
Setting The study was conducted in a university health sciences clinic.
Patients Study participants were 84 patients with plantar heel pain of at least 1 month's duration.
Intervention Participants were randomly assigned to receive real or sham trigger point dry needling. The intervention consisted of 1 treatment per week for 6 weeks. Participants were followed for 12 weeks.
Measurements Primary outcome measures included first-step pain, as measured with a visual analog scale (VAS), and foot pain, as measured with the pain subscale of the Foot Health Status Questionnaire (FHSQ). The primary end point for predicting the effectiveness of dry needling for plantar heel pain was 6 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% confidence interval [95% CI]=−23.5 to −5.2; FHSQ foot pain=10.0 points, 95% CI=1.0 to 19.1), although the between-group difference was lower than the minimal important difference. The number needed to treat at 6 weeks was 4 (95% CI=2 to 12). 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%]).
Limitations It was not possible to blind the therapist.
Conclusion Dry needling provided statistically significant reductions in plantar heel pain, but the magnitude of this effect should be considered against the frequency of minor transitory adverse events.
Footnotes
All authors provided concept/idea/research design, writing, data analysis, and facilities/equipment. Mr Cotchett provided data collection, project management, fund procurement, study participants, and clerical support. Dr Landorf and Dr Munteanu provided consultation (including review of manuscript before submission). The authors acknowledge the assistance of Mr Andrew McMillan with recruitment of participants.
Ethics approval for the study was obtained from the La Trobe University's Faculty Human Ethics Committee (No. 10–015).
This study was funded by the Australian Podiatry Education and Research Foundation (APERF).
This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12610000611022). The authors acknowledge that following trial registration, 3 changes were made to the “Method” section: (1) the addition of a visual analog scale to record first-step pain, (2) the inclusion of the Credibility/Expectancy Questionnaire, and (3) selection of 6 weeks as the primary end point to evaluate the effectiveness of dry needling for plantar heel pain. All changes made to the “Method” section were included in the protocol paper, which was published on January 23, 2011,37 prior to the first participant being recruited on February 8, 2011.
- Received June 18, 2013.
- Accepted March 31, 2014.
- © 2014 American Physical Therapy Association
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