title: Rationales and treatment approaches underpinning the use of acupuncture and related techniques for plantar heel pain: a critical interpretive synthesis.
abstract: BACKGROUND
  Acupuncture shows promise as a treatment for plantar heel pain (PHP) or plantar fasciitis (PF), but data heterogeneity has undermined demonstration of efficacy. Recognising that acupuncture is a diverse field of practice, the aim of this study was to gain a broader, global perspective on the different approaches and rationales used in the application of acupuncture in PHP.
  
  
  METHODS
  We built upon an earlier systematic review (which was limited by the necessity of a methodological focus on efficacy) using the critical interpretive synthesis (CIS) method to draw upon a wider international sample of 25 clinical sources, including case reports and case series. Multiple tracks of analysis led to an emergent synthesis.
  
  
  RESULTS
  Findings are presented at three levels: primary (summarised data); secondary (patterns observed); and tertiary (emergent synthesis). Multiple treatments and rationales were documented but no single approach dominated. Notable contradictions emerged such as the application of moxibustion by some authors and ice by others. Synthesis of findings revealed a 'patchwork' of factors influencing the approaches taken.
  
  
  CONCLUSIONS
  The complexity of the field of acupuncture was illustrated through the 'lens' of PHP. The 'patchwork' metaphor provides a unifying framework for a previously divergent community of practice and research. Several directions for future research were identified, such as: importance of prior duration; existence of diagnostic subgroups; and how practitioners make clinical decisions and report their findings. CIS was found to provide visibility for multiple viewpoints in developing theory and modelling the processes of 'real world' practice by acupuncturists addressing the problem of PHP.
authors.affiliation: Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Clark
authors.affiliation: Integrative Healthcare, Birmingham, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Clark
authors.affiliation: Podiatric Medicine Unit, School of Surgery, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Shane
authors.initials: S
authors.lastname: Toohey
authors.affiliation: Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bradbury-Jones
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D036981:Fasciitis, Plantar / Q000628:therapy*; D006365:Heel; D006801:Humans; D059352:Musculoskeletal Pain / Q000628:therapy*; D016896:Treatment Outcome
keywords: ACUPUNCTURE; PAIN MANAGEMENT; REHABILITATION MEDICINE