Definition

Plantar fasciitis is a generic term for mechanically induced heel and arch pain.

Overview

Plantar fasciitis occurs when tension within the plantar fascia increases. This tension is commonly caused by dorsiflexion of the first ray or supination of the long axis of the midtarsal joint. Calcaneal eversion or compensation for an everted forefoot position (either forefoot valgus or plantarflexed first ray) will cause the midtarsal joint to supinate, increasing tension on the plantar fascia.

Clinical Goal for Orthotic Treatment

The goal of orthotic therapy for patients with plantar fasciitis due to an everted rearfoot is to decrease tension within the plantar fascia by decreasing calcaneal eversion and reducing the ground reactive force under the medial column of the foot.

Prescription

To prescribe this device check “Plantar Fasciitis due to Everted Rearfoot” under the Pathology Specific Orthoses section (Part A) of the prescription form.

Plantar Fasciitis due to Everted Rearfoot  Prescription Recommendations

• Polypropylene Shell – semirigid
• Wide Width
  • A wider width increases surface area under the arch preventing arch collapse while plantarflexing the first ray
• Deep Heel Cup
  • A deep cup limits calcaneal eversion
• Minimum Cast Fill
  • Minimum cast fill produces an orthosis that conforms closely to the arch of the foot and aid first ray plantarflexion
• Medial Heel Skive – 4mm
  • A medial heel skive transfers force medial to the subtalar joint (STJ) axis reducing excessive STJ pronation and heel eversion

Summary

There is evidence to indicate that foot orthoses can be very effective in reducing tension on the plantar fascia. The orthoses for plantar fasciitis due to an everted rearfoot is designed to plantarflex the first ray which brings the first metatarsal head closer to the calcaneus reducing plantar fascia tension. It also limits eversion of the heel.

References

1. Bordelon RL: Subcalcaneal pain. Clin Orthop 177:49, 1983
2. Capon, N, Higgs, ER, Dieppe, PA, et al: Arthritis in Behcet’s syndrome. Br J Radiol 56:87,1983
3. Cheung JT et al: Effect of Achilles tendon loading on plantar fascia tension in the standing foot. Clinical Biomechanics (Bristol, Avon) 21(2):194-203, 2006
4. Digiovanni BF, et al: Plantar fascia specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up: J Bone Joint Surg 88A:1775-81, 2006
5. Harty J: The role of hamstring tightness in plantar fasciitis: Foot Ankle Int 26(12) 1089-92, 2005
6. Kogler GF, Veer FB, Solomonidis SE, et al. The influence of medial and lateral placement of orthotic wedges on loading of the plantar aponeurosis. J Bone Joint Surg Am 81(10):1403-1413, 1999
7. Lynch DM, Goforth WP, Martin JE, et al. Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc 88(8):375-380, 1998
8. Scherer PR. Heel spur syndrome. Pathomechanics and non-surgical treatment. Biomechanics Graduate Research Group for 1988. J Am Podiatr Med Assoc 81(2):68-72, 1991