A number of debilitating lower extremity injuries were addressed during this week’s readings. Plantar fasciitis is the most common cause of heel pain, so I wanted to supplement this week’s text with a review of the literature regarding the best practices in non-operative treatment, rehabilitative treatment for this condition.
Anderson and Stanek (2013) recently published a review of four studies (only one of which was a randomly controlled trial) examining the effects of foot orthoses as treatment for plantar fasciitis. In each of the studies reviewed, the outcome of the treatment was measured by the patient’s subjective pain level as elicited through a questionnaire or use of a visual Likert scale. All four studies showed a significant reduction in pain when using orthotics. However, three of the four studies reviewed had a low number of enrolled subjects (10-15), and they failed to examine the differences in outcome between custom made and off-the-shelf orthotic use.
The most interesting of the three studies was a randomly controlled trial with a larger subject sample that actually compared the different orthoses. 236 patients from fifteen foot and ankle centers across the nation were randomly assigned to one of five groups for an 8 week treatment trial of Achilles tendon and plantar fascia stretching combined with one of four orthotic interventions: (1) the Tuli Heel Cup; (2) the Beuerfeind ViscoSpot; (3) custom polypropylene medial longitudinal arch support; (4) the Hapad Comforthotic; or (5) the control group performing stretching alone (Pfeffer et al., 2009).
Ten minutes of stretching was performed twice daily by the subjects. Following the 8 week trial, it was determined that patients with a higher overall pain in the initial questionnaire experienced greater improvement, but those with more chronic pain improved the least. This makes the case for early intervention as a best practice in plantar fasciitis treatment. Additionally, the pre-fabricated orthotics produced significantly greater reductions in pain compared to the custom-made orthotics. Pfeffer et al. (1999) opines that this may be a result of the material itself as custom orthotics are typically hard (provide less cushioning and dissipation of impact forces) while commercial off-the-shelf orthotics are typically softer. Moreover, this study shows that the incorporation of an orthotic into a plantar fasciitis rehabilitation protocol may produce significantly greater improvement in the patient’s condition as opposed to stretching alone.
Anderson, J. & Stanek, J. (2013). Effect of foot orthoses as treatment for plantar fasciitis or heel pain. Journal of Sport Rehabilitation, 22, 130-136.
Pfeffer, G., Bacchetti, P., Deland, J., Lewis, A., Anderson, R., Davis, W., Alvarez, R., Brodsky, J., Cooper, P., Frey, C., Herrick, R., Myerson, M., Sammarco, J., Janecki, C., Ross, S., Bowman, M., & Smith, R. (1999). Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot and Ankle International, 20(4), 214-221.