Comparing two dry needling interventions for plantar heel pain: a protocol for a randomized controlled trial

Zaid Al-Boloushi, Eva María Gómez-Trullén, Pablo Bellosta-López, María Pilar López-Royo, Daniel Fernández, Pablo Herrero, Zaid Al-Boloushi, Eva María Gómez-Trullén, Pablo Bellosta-López, María Pilar López-Royo, Daniel Fernández, Pablo Herrero

Abstract

Background: Both manual therapy techniques and dry needling have shown to be effective treatment options for the treatment of plantar heel pain; however, in recent years, other techniques based on dry needling (DN), such as percutaneous needle electrolysis (PNE), have also emerged. Currently, PNE is being used in clinical practice to manage myofascial trigger points, despite the lack of studies comparing the effects of this technique over dry needling. Therefore, the aim of this randomized controlled study is to compare the effectiveness of DN versus PNE for improving the level of pain experienced by patients suffering from plantar heel pain provoked by myofascial trigger points.

Methods: A randomized controlled trial will be conducted with blinded participants and outcome assessors. A sample of 94 patients with a medical diagnosis of plantar heel pain will be recruited and divided into two treatment groups. Eligible participants will be randomly allocated to either (a) treatment group with DN and a self-stretching home program or (b) treatment group with PNE and a self-stretching home program. Each group will receive one treatment session per week over a period of 4 weeks. The primary outcome measure will be the pain subscale of the Foot Health Status Questionnaire. The secondary outcome measures will be a visual analogue scale for pain (average and highest level of pain experienced during the previous 48 h; level of pain immediately after the treatment session) and health-related quality of life (assessed using the EuroQoL-5 dimensions). Cost-effectiveness data will be extracted based on the EuroQoL-5 dimensions. Follow-up measurements will take place at baseline and at 4, 8, 12, 26, and 52 weeks.

Discussion: The justification for this trial is the need to improve current understanding regarding the effectiveness of treatments targeting the rehabilitation of plantar heel pain. This study will be the first randomized controlled trial to directly compare the effectiveness of DN and PNE combined with a specific stretching program for the treatment of plantar heel pain provoked by myofascial trigger points.

Trial registration: Clinical Trials NCT03236779. Registered at clinicaltrials.gov 2 August 2017.

Keywords: Cost-effectiveness; Dry needling; Myofascial trigger points; Percutaneous needle electrolysis; Plantar heel pain; Self-stretching protocol.

Conflict of interest statement

Ethics approval and consent to participate

The study design, procedures and informed consent procedure were approved by the Ministry of Health in the state of Kuwait. Consent to participate will be obtained from the participants.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram. Randomized controlled trial design
Fig. 2
Fig. 2
Schedule for enrolment and intervention

References

    1. Landorf KB, Menz HB. Plantar heel pain and fasciitis. BMJ Clin Evid. 2008;2:1111.
    1. Landorf KB. Plantar heel pain and plantar fasciitis. BMJ Clin Evid. 2015;11:1111.
    1. Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK, et al. Heel pain-plantar fasciitis: clinical practice guidelines linked to the International Classification of Functioning, Disability and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2014;44(11):A1–A33. doi: 10.2519/jospt.2014.0303.
    1. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain--plantar fasciitis: clinical practice guidelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(4):A1–A18. doi: 10.2519/jospt.2008.0302.
    1. Riddle DL, Schappert SM. Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors. Foot Ankle Int. 2004;25(5):303–310. doi: 10.1177/107110070402500505.
    1. Tong KB, Furia J. Economic burden of plantar fasciitis treatment in the United States. Am J Orthop (Belle Mead NJ) 2010;39(5):227–231.
    1. Dommerholt J, Grieve R, Layton M, Hooks T. An evidence-informed review of the current myofascial pain literature--January 2015. J Bodyw Mov Ther. 2015;19(1):126–137. doi: 10.1016/j.jbmt.2014.11.006.
    1. Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B. Plantar fasciitis. J Res Med Sci. 2012;17(8):799–804.
    1. Lareau CR, Sawyer GA, Wang JH, DiGiovanni CW. Plantar and medial heel pain: diagnosis and management. J Am Acad Orthop Surg. 2014;22(6):372–380. doi: 10.5435/JAAOS-22-06-372.
    1. Rio E, Mayes S, Cook J. Heel pain: a practical approach. Aust Fam Physician. 2015;44(3):96–101.
    1. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. 2005;72(11):2237–2242.
    1. Rosenbaum AJ, DiPreta JA, Misener D. Plantar heel pain. Med Clin North Am. 2014;98(2):339–352. doi: 10.1016/j.mcna.2013.10.009.
    1. Toomey EP. Plantar heel pain. Foot Ankle Clin. 2009;14(2):229–245. doi: 10.1016/j.fcl.2009.02.001.
    1. Sweeting D, Parish B, Hooper L, Chester R. The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review. J Foot Ankle Res. 2011;4:19. doi: 10.1186/1757-1146-4-19.
    1. Renan-Ordine R, Alburquerque-Sendin F, de Souza DP, Cleland JA, Fernandez-de-Las-Penas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011;41(2):43–50. doi: 10.2519/jospt.2011.3504.
    1. Eftekharsadat B, Babaei-Ghazani A, Zeinolabedinzadeh V. Dry needling in patients with chronic heel pain due to plantar fasciitis: a single-blinded randomized clinical trial. Med J Islam Repub Iran. 2016;30:401.
    1. Travell JG, Simons DG. Myofascial pain and dysfunction: the trigger point manual. Baltimore: Williams & Wilkins; 1982.
    1. Cotchett MP, Munteanu SE, Landorf KB. Effectiveness of trigger point dry needling for plantar heel pain: a randomized controlled trial. Phys Ther. 2014;94(8):1083–1094. doi: 10.2522/ptj.20130255.
    1. Hains G, Boucher PB, Lamy AM. Ischemic compression and joint mobilisation for the treatment of nonspecific myofascial foot pain: findings from two quasi-experimental before-and-after studies. J Can Chiropr Assoc. 2015;59(1):72–83.
    1. Abat F, Diesel WJ, Gelber PE, Polidori F, Monllau JC, Sanchez-Ibañez JM. Effectiveness of the Intratissue Percutaneous Electrolysis (EPI®) technique and isoinertial eccentric exercise in the treatment of patellar tendinopathy at two years follow-up. Muscles Ligaments Tendons J. 2014;4(2):188–193.
    1. Abat F, Sanchez-Sanchez JL, Martin-Nogueras AM, Calvo-Arenillas JI, Yajeya J, Mendez-Sanchez R, et al. Randomized controlled trial comparing the effectiveness of the ultrasound-guided galvanic electrolysis technique (USGET) versus conventional electro-physiotherapeutic treatment on patellar tendinopathy. J Exp Orthop. 2016;3(1):34. doi: 10.1186/s40634-016-0070-4.
    1. Valera-Garrido F, Minaya-Muñoz F, Medina-Mirapeix F. Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results. Acupunct Med. 2014;32(6):446–454. doi: 10.1136/acupmed-2014-010619.
    1. Budiman-Mak E, Conrad KJ, Mazza J, Stuck RM. A review of the foot function index and the foot function index - revised. J Foot Ankle Res. 2013;6(1):5. doi: 10.1186/1757-1146-6-5.
    1. Chan AW, Tetzlaff JM, Altman DG, Laupacis A, Gøtzsche PC, KK A-J, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Rev Panam Salud Publica. 2015;38(6):506–514.
    1. Dommerholt J, Fernández-de-las-Peñas C. Trigger point dry needling: an evidenced and clinical-based approach. Edinburgh: Churchill Livingstone; 2013.
    1. Martin RL, Davenport TE, Reischl SF, McPoil TG, Matheson JW, Wukich DK, et al. Heel pain-plantar fasciitis: revision 2014. J Orthop Sports Phys Ther. 2014;44(11):A1–33. doi: 10.2519/jospt.2014.0303.
    1. Lewit K. The needle effect in the relief of myofascial pain. Pain. 1979;6(1):83–90. doi: 10.1016/0304-3959(79)90142-8.
    1. Hong CZ. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil. 1994;73(4):256–263. doi: 10.1097/00002060-199407000-00006.
    1. Riskowski JL, Hagedorn TJ, Hannan MT. Measures of foot function, foot health, and foot pain: American Academy of Orthopedic Surgeons Lower Limb Outcomes Assessment: Foot and Ankle Module (AAOS-FAM), Bristol Foot Score (BFS), Revised Foot Function Index (FFI-R), Foot Health Status Questionnaire (FHSQ), Manchester Foot Pain and Disability Index (MFPDI), Podiatric Health Questionnaire (PHQ), and Rowan Foot Pain Assessment (ROFPAQ) Arthritis Care Res (Hoboken) 2011;63(Suppl 11):S229–S239. doi: 10.1002/acr.20554.
    1. Barnes A, Sullivan J, Pappas E, Adams R, Burns J. Clinical and functional characteristics of people with chronic and recent-onset plantar heel pain. PM R. 2017;S1934-1482(17):30540–30543.
    1. Bennett PJ, Patterson C, Wearing S, Baglioni T. Development and validation of a questionnaire designed to measure foot-health status. J Am Podiatr Med Assoc. 1998;88(9):419–428. doi: 10.7547/87507315-88-9-419.
    1. Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166(12):1305–1310. doi: 10.1001/archinte.166.12.1305.
    1. Radford JA, Landorf KB, Buchbinder R, Cook C. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. 2007;8:36. doi: 10.1186/1471-2474-8-36.
    1. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8(12):1153–1157. doi: 10.1111/j.1553-2712.2001.tb01132.x.
    1. Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res. 2008;31(2):165–169. doi: 10.1097/MRR.0b013e3282fc0f93.
    1. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45–56. doi: 10.1016/0304-3959(83)90126-4.
    1. Southerst D, Côté P, Stupar M, Stern P, Mior S. The reliability of body pain diagrams in the quantitative measurement of pain distribution and location in patients with musculoskeletal pain: a systematic review. J Manip Physiol Ther. 2013;36(7):450–459. doi: 10.1016/j.jmpt.2013.05.021.
    1. EuroQol Group EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208. doi: 10.1016/0168-8510(90)90421-9.
    1. Cotchett MP, Landorf KB, Munteanu SE. Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review. J Foot Ankle Res. 2010;3:18. doi: 10.1186/1757-1146-3-18.
    1. Duning J, Butts R, Perreault T. On “Effectiveness of trigger point dry needling … ” Cotchett MP, Munteanu SE, Landorf KB. Phys Ther. 2014;94:1083-1094. Phys Ther 2014;94(11):1677–1680.
    1. Kumnerddee W, Pattapong N. Efficacy of electro-acupuncture in chronic plantar fasciitis: a randomized controlled trial. Am J Chin Med. 2012;40(6):1167–1176. doi: 10.1142/S0192415X12500863.
    1. Abat F, Valles SL, Gelber PE, Polidori F, Jorda A, García-Herreros S, et al. An experimental study of muscular injury repair in a mouse model of notexin-induced lesion with EPI® technique. BMC Sports Sci Med Rehabil. 2015;7:7. doi: 10.1186/s13102-015-0002-0.

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