Plantar Fasciitis: Orthotics or No Orthotics, that is the Question!
Reference: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.
Plantar fasciitis is a common foot problem that can sometimes be frustrating for both the patient and the treating clinician.
Of course we automatically go for all the usual interventions such as stretching, strengthening, manual therapy and modalities, but should orthotics be the first line of defence? If it is, should we suggest custom or pre-fabricated?
Here is a pretty good RCT that randomly allocated 135 patients with plantar fasciitis into 3 groups.
Group 1: Soft, thin and flat orthotics (Placebo)
Group 2: Pre-fabricated orthotics (Firm Foam)
Group 3: Custom orthotics (semi-rigid Plastic)
Results after 3 months: Compared to the sham orthotics, the patients using the pre-fab orthotics and custom orthotics were 8% and 7% better in their pain levels and functional scores respectively. (This is less than 1 point on the 11 point VAS!)
Results after 1 year: The 3 groups were the same with respect to pain levels and functional scores!
Clinical Conclusion: Custom and prefab orthotics have only small short-term benefits for people with plantar fasciitis, and no beneficial effects in the long-term.
Personal Comment: In my humble opinion, shoes are more important than orthotics. Look at the lateral edge of the heel of their shoes, if they are worn away, suggest that they either go barefoot, or get new flatter shoes. As for the new trendy MBT shoes …I have no comment other than there are no studies yet to support them. If we were meant to walk on curvy feet, I believe a few hundred thousand years of evolution would have done that for us. I personally love my Vibram five-finger shoes…it?s as close as it gets to my ‘perfectly evolved’ bare feet!!
One theory is that the lack of natural barefoot walking has increased our risk of developing foot problems ?so why do we treat foot pain by attempting to protect and support them even more? Yes, orthotics, cushiony or curvy shoes may all help to some degree in the short-term, but it does not mean that they are of benefit in the long-term.
A neck collar may help neck pain in the acute phase, an ankle brace may help an acute ankle sprain, but surely neither is recommended as a permanent solution. That is where I stand on permanent rigid orthotics!!!
I have perfect pes planus, never had orthtotics, a runner and thus far pain-free!
Posted on: March 25, 2011
Categories: Foot & Ankle
