The use of dry needling and myofascial meridians in a case of plantar fasciitis

Immediate and short-term effects of kinesiotaping and lower extremity stretching on pain and disability in individuals with plantar fasciitis: a pilot randomized, controlled trial

Background: Plantar fasciitis (PF) can disturb individual's weight-bearing activities. Hence, conservative treatments with immediate effect in reducing pain and improving foot function is required.Objective: This study compared the effect of kinesiotaping and stretching exercise in individuals with PF.Methods: Thirty patients with PF were randomly divided into three groups, and received kinesiotaping, stretching exercise, and a combination of the two aforementioned interventions. Pain intensity and foot disability were measured at baseline, immediately after the first treatment, and at one week.Results: Immediately after the first treatment, all groups showed significant changes in heel pain intensity (p ≤ .012) with the standardized response mean (SRM) of 2.85, 1.96, and 1.43 for the taping, stretching, and the combination groups, respectively. Nevertheless, no significant change in foot disability was found (p > .05). At the one week, all groups continued to demonstrate significant reduction in heel pain (p ≤ .012) with the SRM of 1.78, 2.84, and 2.09 for the taping, stretching, and the combination groups, respectively. While the combination group showed significant reduction in foot disability (p = .024). However, there was no significant difference of the change score in all parameters among the three groups (p > .05).Conclusion: Improvement in heel pain was observed in all groups after the first treatment. However, improvement in foot function over one week was observed only among those who received the combined treatment. Further studies on larger samples are required to establish the superiority of the combined treatment over kinesiotaping or stretching alone.

Early-Application Extracorporeal Shockwave Therapy for Plantar Fasciitis in a Chiropractic Clinic: A Case Report

Objective

The purpose of this report is to describe the successful management of plantar fasciitis (PF) using only extracorporeal shockwave therapy.

Clinical Features

A 26-year-old male former athlete presented with insidious right posterior medial foot pain of 3 months' duration. He reported a past history of similar symptoms 12 years previously and was successfully treated with tape, ice, and electric stimulation. For the current episode, he attempted to manage with orthotics, motor nerve stimulation, and ice, and when that was insufficient, he sought care in our clinic. Initial history and evaluation found provocation of pain and functional limitations while wearing dress shoes, running, and playing basketball. Examination found palpatory tenderness at the medial aspect of the distal right calcaneus, and pain with right ankle dorsiflexion. Radiographs were unremarkable. Patient presentation and exam findings supported a working diagnosis of PF.

Intervention and Outcomes

Treatment was applied with a Richard Wolf WellWave low-energy shockwave therapy unit with focused dosage of 4000 shock pulsations at 10-mm depth to the site of pain. Treatment was applied 11 × over 5 weeks, after which the patient reported a complete resolution of pain and resumption of all activities.

Conclusion

Extracorporeal shockwave therapy appeared to be an effective treatment approach for the management of this patient's PF.

Efficacy of acupuncture versus sham acupuncture or waitlist control for patients with chronic plantar fasciitis: study protocol for a two-centre randomised controlled trial

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.

TRIAL REGISTRATION

NCT04185259.

Association between trigger points in hamstring, posterior leg, foot muscles and plantar fasciopathy: A cross- sectional study

BACKROUND

Plantar Fasciopathy (PF) is soreness or irritability experienced underneath infero-medial aspect of the heel. It is a multifactorial disorder where myofascial involvement also seems to be associated with it, in which, muscles of posterior thigh, leg and foot muscles are affected. Trigger points in these muscles may interfere with biomechanics and normal functioning of the lower limb.

OBJECTIVE

To find an association between trigger points of the posterior thigh, leg and foot muscles and plantar fasciopathy.

STUDY DESIGN

A cross sectional study.

METHODS

100 patients with plantar fasciopathy who fulfilled inclusion criteria were included in this study. They were examined for trigger points by manual palpation in posterior thigh, leg and foot muscles. Totally 15 muscles were examined on both affected and unaffected side.

RESULTS

Results showed that myofascial trigger points were more prevalent in medial gastrocnemius (98%, Chi-square: 110.07, p < 0.05, Phi-0.74), quadratus plantae (83%, Chi-square:126.96, p < 0.05, Phi- 0.79), soleus (69%, Chi-square: 28.88, p < 0.05, Phi-0.38), tibialis posterior (46%, Chi-square 41.98 p<0.05%, Phi-0.50), abductor hallucis (42%, Chi-square: 43.61 p<0.05% Phi-0.46), flexor halluces longus (41%, Chisquare: 39.25, p < 0.05, Phi-0.44) than other muscles on the affected side. Whereas, on the unaffected side, trigger points were more prevalent among peroneus longus (50%, Chi-square: 26.14, p < 0.05, Phi-0.36) followed by medial gastrocnemius (26%, Chisquare: 110.07, p < 0.05, Phi-0.74).

CONCLUSION

Plantar fasciopathy is strongly associated with trigger points of medial gastrocnemius, quadratus plantae followed by soleus, tibialis posterior, abductor hallucis and flexor hallucis longus.

Preliminary Report on the Role of Dry Needling Versus Corticosteroid Injection, an Effective Treatment Method for Plantar Fasciitis: A Randomized Controlled Trial

Plantar fasciopathy (PF) is a common disorder for which there is no consensus regarding an optimal treatment strategy. We hypothesized that dry needling would be as effective as the use of corticosteroid injections for treating PF while avoiding the potential adverse effects of corticosteroids. After approval was received from the institutional review board, patients diagnosed with PF were prescribed a 3-week nonoperative treatment regimen. In addition to using oral and topical antiinflammatory drugs, patients engaged in plantar fascia and gastrocnemius stretching exercises. A study population of 98 patients was planned. An appointment was made in the third week of first-line treatment. Patients whose pain did not abate and who required further treatment were included in the study. One week later, we randomly divided patients into 2 groups using an online random number generator. Group 1 underwent dry needling, and group 2 underwent corticosteroid injection. All dry needling was performed by a single physiotherapist, and all corticosteroid injections were performed by the second author. Patients were assessed in the third week and sixth month by a single investigator using the foot function index. In terms of foot function index scores, dry needling caused significant decrease in the third week and also in the sixth month. However, although corticosteroid use led to a significant decrease at the third week, it lost efficacy in the sixth month (p < .001). In conclusion, dry needling seems to be a reliable procedure for treating PF, with better outcomes than corticosteroid injection.

Dry Needling in myofascial tracks in Non-Relaxing Pelvic Floor Dysfunction: A case study

OBJECTIVE

The aim of this case report is to describe the use of Dry Needling (DN) in myofascial tracks related to the pelvic floor (PF) in the management of a male with Non-Relaxing Pelvic Floor Dysfunction (NRPFD).

CLINICAL FEATURES

A 42-year-old man, with a 20-year history of frequent urination, was referred to the physical therapy clinic by a urologist with diagnosis of NRPFD. The patient was suffering from a sense of incomplete evacuation and difficulty to start urination. He had to urinate every 30 min. The initiation of urination was so difficult that patient had to facilitate it by splashing warm water on his penis.

INTERVENTION AND OUTCOME

DN was performed for 10 sessions. The first three sessions were performed every other day in the same week. In the second week, DN was performed twice at three-day intervals, and the other sessions were performed such that one session was held per week. Selected stretching exercises were prescribed in the first session. The results showed that the patient had reported no urination during sleep, and urination six to eight times when was awake. A three-month follow-up with a telephone-based interview showed that the symptoms did not recur.

CONCLUSION

This study showed the possible efficacy of prescribing DN in myofascial tracks in the management of a male with NRPFD. More studies are required to clarify the issue.

Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial

BACKGROUND

This study examined the effects of dry needling on chronic heel pain due to plantar fasciitis.

METHODS

During this single-blinded clinical trial, 20 eligible patients were randomized into two groups: A case group treated with dry needling and a control group. Patients' plantar pain severity, (using modified visual analog scale [VAS] scoring system), range of motion of ankle joint in dorsiflexion [ROMDF] and plantar extension[ROMPE] and foot function index (using standard questionnaires of SEM5 and MDC7) were assessed at baseline, four weeks after intervention and four weeks after withdrawing treatment. Independent sample t-test, Mann-Whitney U test, paired t-test, Wilcoxon signed rank tests, and chi square test were used for data analysis.

RESULTS

The mean VAS scores in the case group was significantly lower than the control group after four weeks of intervention (p<0.001). Comparison of the ROMDF and ROMPE did not reveal any significant changes after four weeks of intervention in the case and control groups (p=0.7 and p=0.65, respectively). The mean of MDC7 and SEM5 scores in the case group were significantly lower than the control group following four weeks of intervention (p<0.001).

CONCLUSION

Despite the insignificant effect on ROMDF and ROMPE, trigger point dry needling, by improving the severity of heel pain, can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis.