---
title: "Plantar heel pain"
url: "https://acuiq.com/wiki/evidence/plantar-heel-pain"
updated: 2026-10-12
last_verified: 2026-10-12
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-12"
reading_minutes: 11
sources: 23
---

# Plantar heel pain

_What a withdrawn Cochrane protocol, later systematic reviews, randomised trials and two professional bodies report on acupuncture, electroacupuncture and dry needling for plantar heel pain._

Plantar heel pain, usually diagnosed as plantar fasciitis, is pain under the heel where the plantar fascia, the band of tissue along the sole, attaches to the heel bone. It is typically worst with the first steps in the morning or after rest. The needling trials fall into three groups: dry needling, in which a physiotherapist or podiatrist needles tender trigger points in the calf and sole muscles; manual and electroacupuncture at acupuncture points, including points far from the foot; and Chinese trials that add warm needling, where burning mugwort heats the needle handle.

## No Cochrane review

Cochrane has published no review of acupuncture for plantar heel pain. A [protocol for one](https://doi.org/10.1002/14651858.CD010394.pub2), by Seunghoon Lee and colleagues at Kyung Hee University and the Korea Institute of Oriental Medicine, was registered in 2013 to assess acupuncture, acupressure, electrotherapy and moxibustion. The Bone, Joint and Muscle Trauma Group withdrew it in October 2019, with the authors' agreement, for lack of progress, and states that there are no plans to republish it.

The broader [Cochrane review of interventions for plantar heel pain](https://doi.org/10.1002/14651858.CD000416), by Fay Crawford and Colin Thomson, searched to September 2002 and found 19 randomised trials with 1,626 participants, of poor quality overall and not pooled. Its abstract names no acupuncture or needling trial; it found limited evidence for corticosteroid by injection or iontophoresis and concluded that most treatments brought marginal gains over no treatment. Cochrane [withdrew it in 2010](https://doi.org/10.1002/14651858.CD000416.pub2) as substantially out of date, with discussions under way to split it by type of intervention.

## Systematic reviews

| Review | Searched to | Trials (people) | Compared with | Certainty |
| --- | --- | --- | --- | --- |
| Cotchett 2010 | April 2010 | 3 non-randomised | Dry needling or trigger point injection, alone or with acupuncture | Quality Index 7 to 12 of 27; not pooled |
| Clark 2012 | Not stated in the abstract | 5 randomised, 3 non-randomised | Standard care, another point, other approaches | Not pooled |
| Thiagarajah 2017 | Not stated in the abstract | 4 | Standard treatment (3), sham (1) | Delphi list; not pooled |
| He 2017 | Not stated in the abstract | 7 | Placebo or other treatment, trigger point needling | GRADE moderate for pain, low for adverse events |
| Llurda-Almuzara 2021 | Not stated in the abstract | 6 | Any comparison group, trigger point dry needling | GRADE low short term, moderate long term |
| Yang 2024 | December 2022 | 12 (781) | Routine treatment alone; other treatments | Not graded |
| Asokumaran 2024 | October 2020 | 32 (2,390), randomised and not | Shockwave, ultrasound-guided therapy, steroid and platelet-rich plasma injection, placebo | Not stated in the abstract |
| Li 2026 | January 2026 | 24 (1,240), 7 treatments | Home exercise alone, dry needling added to it | Moderate short term, high medium term (CINeMA) |

At La Trobe University, [Cotchett and colleagues](https://doi.org/10.1186/1757-1146-3-18) found two trials reporting less pain when trigger point dry needling was combined with acupuncture, and one with lidocaine injections, all of poor quality on the Quality Index, a 27-point score of trial reporting and bias. [Clark and Tighe](https://doi.org/10.1136/acupmed-2012-010183), writing from the Peninsula College of Medicine and Dentistry in Plymouth, judged the evidence for acupuncture comparable to that for stretching, night splints or dexamethasone, and asked for trials to follow STRICTA, the reporting standard for acupuncture trials. [Thiagarajah](https://doi.org/10.11622/smedj.2016143) in Singapore found that pain fell between four and eight weeks of treatment with no further reduction after, and that the evidence was insufficient for a conclusion about the longer term.

[He and Ma](https://doi.org/10.2147/jpr.s141607) at Xinjiang Medical University excluded needling at traditional acupuncture points. They found pain 15.5 points lower on a 100-point visual analogue scale with trigger point needling than with control, but the share of people whose pain counted as a treatment success did not differ (risk ratio 1.15, 95% CI 0.87 to 1.51), and neither did adverse events. [Llurda-Almuzara and colleagues](https://doi.org/10.1093/pm/pnab114) at the Universitat Internacional de Catalunya reported pain 1.70 points lower on a 10-point scale in the short term and 1.77 points lower in the long term, and said the small number of trials calls for caution. The trials were at generally low risk of bias, and their disagreement with one another lowered the certainty.

[Yang and colleagues](https://doi.org/10.3389/fneur.2024.1520585) in Chengdu found that dry needling added to routine treatment lowered pain and Foot Function Index scores, while against other treatments it improved function but not pain (95% CI −0.66 to 0.06). The [network meta-analysis by Asokumaran and colleagues](https://doi.org/10.7759/cureus.68959) in Malaysia, which compares treatments directly and through common comparators, ranked acupuncture first at one month, 1.33 points better than placebo; at three months no treatment's confidence interval excluded no effect. [Li and colleagues](https://doi.org/10.1093/ptj/pzag056) compared seven physical therapies, each added to home exercise, and found dry needling's effect on pain still present between six and twelve weeks. [Dry needling](/wiki/techniques/dry-needling) describes how the method differs from acupuncture.

Two reviews compared dry needling with steroid injection. [Sousa Filho and colleagues](https://doi.org/10.1186/s12998-021-00408-y), pooling six trials across four conditions, rated the evidence very low certainty that injection reduces heel pain more in the short and medium term and needling more in the long term. [Guimarães and colleagues](https://doi.org/10.1177/02692155221143865), covering every treatment ever trialled, found dry needling among nine that reduced pain against control in the short term, and only shockwave therapy effective in the medium and long term.

## Trials

### Against sham or another point

- **Dry needling against sham, 2014.** [Cotchett, Munteanu and Landorf](https://doi.org/10.2522/ptj.20130255) at La Trobe University gave 84 people six weekly sessions of real or sham trigger point dry needling, with participants blinded but not the therapist. At six weeks first-step pain was 14.4 mm lower on a 100 mm scale with real needling, a difference smaller than the minimal important difference, the change patients notice. Four people needed treating for one to benefit. Minor transient adverse events followed 32% of real needling appointments and under 1% of sham ones.
- **A wrist point against a hand point, 2011.** At Hong Kong Baptist University, [Zhang, Yip and Li](https://doi.org/10.1093/ecam/nep186) randomised 53 people to 10 sessions over two weeks at [`PC07`](/points/PC07) (Daling), at the centre of the wrist crease, or at [`LI04`](/points/LI04) (Hegu), chosen as a control because it is held to relieve pain generally. Needles went in on the side opposite the painful heel. At one month morning pain had fallen by 22.6 points against 12.0, favouring `PC07`; at three and six months the groups differed little. No serious adverse event occurred.

[Sham acupuncture](/wiki/research/sham-acupuncture) sets out what an active control point does and does not control for.

### Added to usual care

- **Recreational athletes, 2011.** [Karagounis and colleagues](https://doi.org/10.1177/1938640011407320) in Greece treated 38 men with ice, anti-inflammatory drugs and stretching and strengthening, and added acupuncture for half. The acupuncture group's mean score on a plantar fasciitis pain scale was lower at the final measurement.
- **Electroacupuncture, 2012.** [Kumnerddee and Pattapong](https://doi.org/10.1142/s0192415x12500863) in Bangkok gave 30 people with long-standing plantar fasciitis stretching, shoe modification and rescue painkillers, with or without 10 sessions of electroacupuncture, which passes a small current through the needles. Pain fell by at least half in 80% against 13.3%, and the difference in function held at six weeks.
- **Electroacupuncture with exercise, 2026.** In a multisite trial led from a US military medical centre in Nevada, [Moss and colleagues](https://doi.org/10.1089/acu.2024.0107) randomised 72 people to a home exercise programme with or without electroacupuncture every two weeks for six weeks. Pain and foot function improved more in the acupuncture group over 12 weeks.

### Against a waiting list or another form of acupuncture

- **Warm needling, 2021.** At a Chinese medicine centre in Hong Kong, [Ho and colleagues](https://doi.org/10.1177/0964528420946048) randomised 80 people, mean age 60, to six sessions of electroacupuncture with warm needling over four weeks or a waiting list. First-step pain and foot function improved more with treatment at two and four weeks, and no study-related adverse event occurred.
- **Electro against manual, 2021.** In Beijing, [Wang and colleagues](https://doi.org/10.1177/0964528420947739) gave 92 people 12 sessions of electroacupuncture or manual acupuncture. Pain halved in 54.8% and 50.0%, a difference within chance, and no secondary outcome differed through 28 weeks.
- **High and low intensity, 2026.** The [same group](https://doi.org/10.1016/j.ctim.2026.103329) randomised 120 people with recalcitrant plantar fasciitis to high-intensity acupuncture, low-intensity acupuncture or a waiting list. At four weeks 56.7% of the acupuncture groups combined were responders against 33.3%. At 16 weeks the high-intensity group's rate was 76.7% against 36.7%, and the low-intensity difference was not significant.

## What guidelines say

The [clinical practice guideline on heel pain](https://www.orthopt.org/uploads/content_files/files/Heel_Pain_Plantar_Fasciitis_revision_2023_1_.pdf) from the Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy, by Koc and colleagues and published in December 2023, states that clinicians should use dry needling to trigger points in the calf and the plantar muscles of the foot for short- and long-term pain and long-term function. That is a grade B recommendation, meaning moderate evidence. Its 2014 edition had said, on expert opinion, that trigger point dry needling could not be recommended; the change rests on the 2021 meta-analysis and later trials. The guideline notes that dry needling was usually given alongside stretching and manual therapy, that reported harms were post-needling soreness and bleeding under the skin, and that it makes no recommendation on acupuncture. It is due to be considered for review in 2028.

The American College of Foot and Ankle Surgeons' [clinical consensus statement](https://doi.org/10.1053/j.jfas.2017.10.018), by Schneider and colleagues and published in 2018 as an update to its 2010 guideline, lists needling among other injection techniques that it rated uncertain, neither appropriate nor inappropriate, because they rested on low-quality studies without long-term follow-up. It does not address acupuncture. [Clinical guidelines](/wiki/evidence/clinical-guidelines) compares how guideline bodies treat acupuncture across conditions.

## What the reviews could not settle

The one sham-controlled dry needling trial above found a difference smaller than patients are expected to notice, alongside far more minor adverse events with real needling. The acupuncture trials compared needling with a waiting list, with usual care alone or with another point, so they cannot separate the needle from the attention and expectation that come with treatment, and the Cochrane review that would have weighed them was never written. The reviews disagree on duration: one found too little evidence to judge beyond eight weeks, while a 2021 meta-analysis reported larger effects in the long term than the short. Against steroid injection the certainty is very low, and the two professional bodies, writing five years apart, reached different verdicts on needling. The [tennis elbow](/wiki/evidence/tennis-elbow) page reports a similar split for dry needling at the elbow.

AcuiQ's symptom pages for [plantar fasciitis](/symptoms/plantar-fasciitis), [heel pain](/symptoms/heel-pain), [plantar fascia pain](/symptoms/plantar-fascia-pain) and [plantar heel pain](/symptoms/heel-plantar-pain) list the protocols individual studies prescribed, each with its citation.

### Sources

1. Lee S, Kim JE, Kim JH, Kim TH, Choi SM, Acupuncture and related interventions for treating plantar heel pain in adults (protocol, withdrawn), Cochrane Database of Systematic Reviews 2019, CD010394 — https://doi.org/10.1002/14651858.CD010394.pub2
2. Crawford F, Thomson C, Interventions for treating plantar heel pain, Cochrane Database of Systematic Reviews 2003, CD000416 — https://doi.org/10.1002/14651858.CD000416
3. Crawford F, Thomson CE, WITHDRAWN: Interventions for treating plantar heel pain, Cochrane Database of Systematic Reviews 2010, CD000416.pub2 — https://doi.org/10.1002/14651858.CD000416.pub2
4. Cotchett MP, Landorf KB, Munteanu SE, Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review, Journal of Foot and Ankle Research 2010 — https://doi.org/10.1186/1757-1146-3-18
5. Clark RJ, Tighe M, The effectiveness of acupuncture for plantar heel pain: a systematic review, Acupuncture in Medicine 2012 — https://doi.org/10.1136/acupmed-2012-010183
6. Thiagarajah AG, How effective is acupuncture for reducing pain due to plantar fasciitis?, Singapore Medical Journal 2017 — https://doi.org/10.11622/smedj.2016143
7. He C, Ma H, Effectiveness of trigger point dry needling for plantar heel pain: a meta-analysis of seven randomized controlled trials, Journal of Pain Research 2017 — https://doi.org/10.2147/jpr.s141607
8. Llurda-Almuzara L, Labata-Lezaun N, Meca-Rivera T, et al., Is dry needling effective for the management of plantar heel pain or plantar fasciitis? An updated systematic review and meta-analysis, Pain Medicine 2021 — https://doi.org/10.1093/pm/pnab114
9. Yang A, Lin R, Xia M, Su H, He Y, The effectiveness of dry needling for plantar fasciitis: a systematic review and meta-analysis, Frontiers in Neurology 2024 — https://doi.org/10.3389/fneur.2024.1520585
10. Asokumaran I, Verasamy BS, Hasan MIB, et al., Comparative effectiveness of acupuncture versus non-surgical modalities for treating plantar fasciitis: a network meta-analysis, Cureus 2024 — https://doi.org/10.7759/cureus.68959
11. Li Z, He S, Wu J, et al., Efficacy of physical therapy interventions delivered with home exercise programs for pain and function in plantar fasciitis: a systematic review and network meta-analysis of randomized controlled trials, Physical Therapy 2026 — https://doi.org/10.1093/ptj/pzag056
12. Sousa Filho LF, Barbosa Santos MM, Dos Santos GHF, da Silva Júnior WM, Corticosteroid injection or dry needling for musculoskeletal pain and disability? A systematic review and GRADE evidence synthesis, Chiropractic and Manual Therapies 2021 — https://doi.org/10.1186/s12998-021-00408-y
13. Guimarães JS, Arcanjo FL, Leporace G, et al., Effects of therapeutic interventions on pain due to plantar fasciitis: a systematic review and meta-analysis, Clinical Rehabilitation 2023 — https://doi.org/10.1177/02692155221143865
14. Cotchett MP, Munteanu SE, Landorf KB, Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial, Physical Therapy 2014 — https://doi.org/10.2522/ptj.20130255
15. Zhang SP, Yip TP, Li QS, Acupuncture treatment for plantar fasciitis: a randomized controlled trial with six months follow-up, Evidence-Based Complementary and Alternative Medicine 2011 — https://doi.org/10.1093/ecam/nep186
16. Karagounis P, Tsironi M, Prionas G, Tsiganos G, Baltopoulos P, Treatment of plantar fasciitis in recreational athletes: two different therapeutic protocols, Foot and Ankle Specialist 2011 — https://doi.org/10.1177/1938640011407320
17. Kumnerddee W, Pattapong N, Efficacy of electro-acupuncture in chronic plantar fasciitis: a randomized controlled trial, American Journal of Chinese Medicine 2012 — https://doi.org/10.1142/s0192415x12500863
18. Moss D, Rasmussen B, Williams W, Crawford P, Electroacupuncture for plantar fasciopathy: a multisite randomized clinical trial, Medical Acupuncture 2026 — https://doi.org/10.1089/acu.2024.0107
19. Ho LF, Guo Y, Ching JY, et al., Efficacy of electroacupuncture plus warm needling therapy for plantar heel pain: a randomised waitlist-controlled trial, Acupuncture in Medicine 2021 — https://doi.org/10.1177/0964528420946048
20. Wang W, Liu Y, Jiao R, Liu S, Zhao J, Liu Z, Comparison of electroacupuncture and manual acupuncture for patients with plantar heel pain syndrome: a randomized controlled trial, Acupuncture in Medicine 2021 — https://doi.org/10.1177/0964528420947739
21. Wang W, Kang J, Wang X, et al., Efficacy of acupuncture for chronic recalcitrant plantar fasciitis: a randomized trial, Complementary Therapies in Medicine 2026 — https://doi.org/10.1016/j.ctim.2026.103329
22. Koc TA, Bise CG, Neville C, Carreira D, Martin RL, McDonough CM, Heel pain – plantar fasciitis: revision 2023, Journal of Orthopaedic and Sports Physical Therapy 2023 — https://www.orthopt.org/uploads/content_files/files/Heel_Pain_Plantar_Fasciitis_revision_2023_1_.pdf
23. Schneider HP, Baca JM, Carpenter BB, Dayton PD, Fleischer AE, Sachs BD, American College of Foot and Ankle Surgeons clinical consensus statement: diagnosis and treatment of adult acquired infracalcaneal heel pain, Journal of Foot and Ankle Surgery 2018 — https://doi.org/10.1053/j.jfas.2017.10.018