Orthotics for Treatment of Heel Pain

Orthotics are devices designed to control abnormal motion in the foot. Custom orthotics are made by taking a mold of the foot, while prefabricated orthotics are based on foot size. Orthotics are a common treatment for patients with plantar fasciitis, the most common cause of heel pain. The research to support the use of orthotics in the treatment of plantar fasciitis has been mixed. Below are a few articles evaluating the role of orthotics in the treatment of plantar fasciitis.

Pfeffer et al divided 236 patients with plantar fasciitis into five treatment groups and followed the patients for 8 weeks. One group performed stretching only, three groups were given different types of prefabricated inserts and the last group was given custom made foot orthoses. After 8 weeks, all groups showed improvement ranging from 68% with the custom made orthotics to 95% with the silicone inserts. All groups using prefabricated inserts had greater improvements than those using the custom made orthoses. The authors concluded that when stretching is combined with a prefabricated insert, the short term improvements in patients with plantar fasciitis are greater than with those using a custom made orthotic device.

Pfeffer G et al. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int. 1999 Apr;20(4):214-21.

Landorf et al published a randomized trial which divided 135 patients with plantar fasciitis into three orthotic treatment groups. One group was given a sham orthotic (soft, thin foam insert), the second group was given a prefabricated orthotic and the third a custom made orthotic. The individuals were followed for one year and evaluated for pain and function. Patients using the orthotics (prefabricated or custom) had mild improvements in pain and moderate improvements in function compared with the patients using the sham device in the short term, but had little benefit compared to the sham device in the long term. There was no significant difference in pain and function between the prefabricated and custom orthotics.

Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006 Jun 26;166(12):1305-10.

Roos et al studied 43 patients with plantar fasciitis by dividing them into three treatment groups; treatment with orthotics, orthotics and night splints or night splints alone. After 1 year, 88 % of the patients returned for follow up and all groups had significant improvement compared to baseline. At one year, the two groups using orthotics had a pain reduction of 62%, compared to a 48% reduction in pain with the night splint only group. Patients were more likely to continue to use the foot orthoses than the night splint at one year.

Roos E, Engström M, Söderberg B. Foot orthoses for the treatment of plantar fasciitis. Foot Ankle Int. 2006 Aug;27(8):606-11.

Hawke et al performed a systematic review of the research for custom-made orthotics in the treatment of foot pain. Although the review involved 11 trials and 1332 participants, there were five trials specifically evaluating custom orthotics for plantar fasciitis, which included 691 participants. In these five trials, the comparisons to custom made orthotics included sham orthoses, prefabricated orthotics, combined manipulation, stretching exercises, night splints, surgery and no intervention. The follow-up ranged from one week to three years. The authors concluded that the evidence to support the use of custom-made orthotics in the treatment of plantar fasciitis was inconclusive and it is unclear if custom-made foot orthoses are an effective treatment for plantar fasciitis.

Hawke F, et al. Custom-made foot orthoses for the treatment of foot pain. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006801.

Lee et al, in a recent meta-analysis of studies evaluating the effect of foot orthoses in the treatment of plantar fasciitis, concluded that orthotics are associated with reduction and pain and increased function in patients with plantar fasciitis.

Lee SY, McKeon P, Hertel J. . Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis. Phys Ther Sport. 2009 Feb;10(1):12-8. Epub 2008 Nov 20.

To date, the results are unclear and better studies are needed to evaluate the true effectiveness of orthotics in the treatment of plantar fasciitis.

More on orthotics.
More on plantar fasciitis.

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