| ObjectiveTo observe the clinical efficacy of acupuncture on the muscular nodular spots of the gastrocnemius muscle in the treatment of heel pain,and its correlation with gastrocnemius contracture,to provide a basis for the clinical treatment of Pain Heel Syndrome to find a new treatment plan.MethodsIn this study,patients with Pain Heel Syndrome were recruited in a Chinese medicine clinic in Hong Kong.With reference to the "Special Prescription Manual for Orthopedics and Traumatology of Traditional Chinese Medicine" and the diagnostic criteria of Pain Heel Syndrome in the"Science of Chinese Orthopedics and Traumatology",patients who met the inclusion criteria were recruited using computer-based method,were randomly divided into the treatment group and control group according to the ratio of 1:1.1.Treatment plan(1)Treatment group(acupuncture at muscular nodular spots of the gastrocnemius muscle)①Acupoint selection:muscular nodular spots of the gastrocnemius muscle on the affected side②Method:The patient is placed in the prone position,referring to the palpation and inspection method of the muscular nodular spots in the Chinese Journal of Meridian and Tendons,8-12 knots of tendon lesions were selected each time.After disinfection,0.25mm x 25mm disposable sterile needles is used for acupuncture operation according to the position and depth of the muscular nodular spots.Soreness,numbness,bloating,pain or electric shock,it is better to have needles radiating to the surrounding area.After obtaining qi with normal reinforcement and reduction method,the needle was kept for 30 minutes.(2)Control group(acupuncture at local acupoints on the heel)①Point selection:Taixi,Rangu,Kunlun,Shenmai,Ashi point on the heel(affected side)The acupoint selection was based on data mining technology to analyze the relevant literature of acupuncture treatment of heel pain,and selected the most commonly used acupuncture points for the treatment of heel pain.②Method:The patient is in the prone position,and locate and mark the tender point of the heel.After that,the other acupoints were marked according to the standard selection.After disinfection,0.25mm x 25mm disposable sterile needles is used for acupuncture operation,directly pierce 0.5 cun in Taixi,Rangu,Kunlun,Shenmai,and Ashi points on the heel.After obtaining qi with normal reinforcement and reduction method,the needle was kept for 30 minutes.2.Course of treatmentThe total course of treatment is 5 weeks,once a week,and one course of treatment is completed as an effective case.3.Evaluation indicatorsThe clinical efficacy and safety of acupuncture in the treatment of heel pain patients were evaluated in the first week and the fifth week,and the data related to the ankle dorsiflexion angle were analyzed.Primary outcome measures:Visual Imitation Pain Scale(VAS),Maryland Foot Scale(MFS);Secondary outcome measures:Silfverskiold test.4.StatisticsStatistical software(SPSS26.0)was used to analyze the data.The general information and data results of the two groups were compared to assess the quality of randomization.Categorical data are described using frequency distributions.After the Shapiro-Wilk normal distribution test,the data conforming to the homogeneity of variance and the normal distribution were compared using the Student’s t test;the comparison of the non-normal distribution data was using the Mann-Whitney U test and the Wilcoxon signed-rank paired test.Baseline data were analyzed by chi-square test and t-test;Mann-Whitney U test was used for comparison between two groups,and Wilcoxon signed-rank paired test was used for intra-group comparison;Logistic Regression logistic regression analysis was used to analyze the correlation between gastrocnemius muscle contracture and various data.Two-sided test was used for statistical test,and the significance level of difference was α=0.05.The test result P>0.05 indicated no statistical difference,P<0.05 indicated a statistical difference,and P<0.01 indicated a significant statistical difference.ResultsThere was no significant difference in the VAS score between two groups before treatment(P>0.05).After treatment,there was a significant difference in VAS score between two groups(P<0.05).The ratio of patient with no pain after treatment in the treatment group(6.7%,2 cases)was higher than that in the control group(0%,0 cases).The ratio of patient with mild pain after treatment in treatment group(56.7%,17 cases)was higher than that of in the control group(33.3%,10 cases).The ratio of patient with morderate pain after treatment in the treatment group(36.7%,11 cases)was lower than that in the control group(60%,18 cases).The ratio of patient with severe pain after treatment in the control group(6.7%,2 cases)was higher than that in the treatment group(0%,0 cases),indicating that the improvement rate of VAS score in the treatment group was higher than that in the control groupVAS scores were used to analyze the data of two groups before and after treatment,both treatment group(Wilcoxon test,P<0.01)and control group(Wilcoxon test,P<0.01)had therapeutic effects in improving pain.The improvement of VAS score(D)was analyzed,the result showed that the improvement of VAS score in the treatment group was significantly higher than that in the control group(Mann-Whitney U test,P<0.01).There was no significant difference in VAS score between the two groups before treatment(Mann-Whitney U test,P>0.05),and the overall VAS score of patients in the treatment group was significantly lower than that of the control group after treatment(Mann-Whitney U test,P<0.05).Based on the data of the Maryland foot score,the difference between two groups before and after treatment showed that both the treatment group(Wilcoxon test,P<0.01)and control group(Wilcoxon test,P<0.01)were effective in improving pain and foot function.The improvement of Maryland foot score(d)was analyzed,the result showed that the score of the treatment group was significantly higher than that of the control group(Mann-Whitney U test,P<0.05).There was no significant difference in Maryland foot score between the two groups before treatment(P>0.05),and the overall Maryland foot score of patient in the treatment group was significantly higher than that of the control group(Mann-Whitney U test,P<0.01).The results showed that 38(63%)patients with Pain Heel Syndrome accompanied by gastrocnemius contracture,including 20 in the treatment group and 18 in the control group.The difference of ankle dorsiflexion angle between the two groups was analyzed,the result showed that the treatment group(Wilcoxon test,P<0.01)and the control group(Wilcoxon test,P<0.01)were effective in improving ankle dorsiflexion angle.The improvement of the difference of ankle dorsiflexion angle(d)with knee joint extension before and after treatment showed that the difference of dorsiflexion angle with knee joint extension in the treatment group was significantly higher than that in the control group(Mann-Whitney U test,P<0.01),and the improvement of dorsiflexion angle with knee joint extension in the treatment group was significantly higher than that in the control group.Logistic regression was used to analyze the correlation between pain improvement and patients with gastrocnemius contracture.In treatment group,there was a significant correlation between the improvement of pain and the patients with gastrocemius contracture(Logistic Regression,P<0.01).The higher chance of gastrocnemius contracture,the greater improvement in pain in the treatment group.In control group,there was no significant correlation between pain improvement and patients with gastrocemius contracture(Logistic Regression,P>0.05).There was a significant correlation between ankle range of motion and gastrocemus contracture(Logistic Regression,P<0.01).Logistic Regression(P<0.01)showed a significant correlation between terrain and gastrocemius contracture.The higher the score of terrain,the lower the probability of gastrocemius contracture.Gastrocemius contracture had an impact on patients’ walking terrain.There was no significant correlation between the score of foot appearance and gastrocnemius contracture(Logistic Regression,P>0.05).Conclusion1.The effectiveness of acupuncture on the muscular nodular spots on the gastrocnemius in the treatment group is better than that of the control group by acupuncture on the local acupoints of the heel.Both treatment group and control group could improve the VAS score and Maryland foot score,and the therapeutic effect of the treatment group was better than that of the control group.Acupuncture a on the muscular nodular spots on the gasfrocnemius has clinical efficacy and safety in the treatment of heel pain,and is worthy of clinical promotion.2.The occurrence of Pain heel syndromes is related to the tightness of gastrocnemius,and up to 63%of patients with Pain heel syndromes have gastrocnemius contracture.Both the treatment group and control group could improve the range of ankle dorsiflexion angle.The treatment group was more effective in improving the ankle dorsiflexion angle and VAS pain,which was related to the gastrocnemius muscle contracture.Treatment in the control group showed no correlation with gastrocnemius contracture... |
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