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Feb 2

Written by: Cherri Choate, DPM
2/2/2011

I am unaware of the exact statistics, but in my personal experience I would say that at least 15-20% of new patients present with complaints of heel pain.  One component of the treatment plan for these patients is biomechanical control.  Although the biomechanical component is usually addressed, the choice of when and how, continues to vary considerably.  For many years, the common practice was to calm down the acute pain and then recommend custom orthotics.  More recently, with changes in health coverage and economic pressures, dispensing of pre-fabricated orthotics is on the rise.  If these external issues were removed, is there a significant difference between the effectiveness of the custom and pre-fabricated devices for plantar fasciitis? 

A few studies have attempted to address this very question.  One study, by Landorf, et al, chose to target a temporal variable between device types.  They found that both pre-fabricated and custom orthotics offered significant improvement of both pain and quality of life issues after 3 months of use.  Curiously, the improvement did not increase significantly after the 3 month mark.  Even after 12 months, the improvement was similar to the data at 3 months of use.  This particular study supports the use of pre-fabricated and custom orthotics equally.  The significance clinically is that biomechanical intervention for plantar fasciitis is effective.  In addition, it should be noted that both the pain AND quality of life issues improved when using orthotic devices. 

This information validates the use of either custom devices or "custom-like" devices when treating plantar fasciitis.  It encourages me to continue to evaluate any pre-fabricated products to assure that my choices provide patients with quality correction and quality materials.  The bottom line is that some type of functional device, will continue to be part of my treatment plan for plantar fasciitis.

A more detailed summary of the Landorf article can be found in today's eJournal section of the Prolab website.

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

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