I have worn orthotics in the past for other problems and they always seemed to help. Now I have a new problem -- heel pain from plantar fasciitis. What do you think about wearing an orthotic for plantar fasciitis?
Plantar fasciitis, a painful foot condition is a fairly common problem. And one that affects 10 per cent of all Americans at some time in their lives. With an estimated one million patient visits to physicians each year in the United States for this painful condition, finding effective treatment strategies has become an important research goal.
One of those treatments is the use of a special shoe insert that you mentioned called an orthotic. An orthotic is a molded piece of plastic that is made to fit each individual's foot. It is worn inside the shoe with the express purpose of taking weight off the plantar fascia while standing and walking (i.e., during weight-bearing).
The authors of a recent study combined the temporary use of a custom foot orthosis with stretching to see how well these two treatment tools work for plantar fasciitis. Patients included in the study had heel pain that was the worst when getting up after resting or inactivity. This symptom called first-step pain is typical of plantar fasciitis.
No one in the study had been treated with any other approach before trying this plan of temporary orthosis and stretching. Everyone was examined closely and measures of motion for the low back, hip, knee, ankle, and foot were taken. Clinical tests for plantar fascia problems (e.g., palpation, Windlass test) were also conducted and results recorded.
A physical therapist made the special orthotic for each patient in the study. The insert was designed to put the foot in a toe-down (plantar flexed) position with the toes turned in slightly (inversion). The goal was to take pressure off the plantar fascia during weight-bearing activities.
The orthotic was worn everyday for two weeks whenever in a standing or weight-bearing position. At the end of two weeks, a twice-daily stretching program was started. The stretches were specific to the plantar fascia, calf muscles, and ankle joint.
Patients were re-evaluated and weaned off the orthotics as symptoms improved. The therapist reheated the plastic molded orthotic and reshaped it to lower the heel as the painful symptoms decreased. Once the patient was completely orthotic-free, then a supportive shoe was recommended.
Everyone was followed for a full 12 weeks. The results showed that this type of program with temporary use of a foot orthotic followed by soft tissue stretching was quite successful in reducing foot pain from plantar fasciitis.
By the end of the first two weeks, 80 per cent of the group had a significant improvement in pain. There was an equally big change in function of the lower leg during daily activities and sports participation. Improvements were maintained through to the end of the study.
The evidence from this study suggests that using a foot orthosis even temporarily is a good place to get started in the treatment of plantar fasciitis. It is noninvasive, provides early relief of symptoms, and improves leg function quickly.
Stretching may be an important step in treatment as it allows the soft tissues to return to their normal length. By remaining flexible, it may be possible to prevent recurrence of the problem. The long-term effects of this program remain unknown.
If you don't get the results you were hoping for, there are other forms of treatment to pursue as well. Treatment options range anywhere from stretching (already mentioned), taping, and manual therapy to electrical therapy, steroid injections, and surgery.
Michelle Drake, DPT, et al. The Short-Term Effects of Treating Plantar Fasciitis with a Temporary Custom Foot Orthosis and Stretching. In The Journal of Orthopaedic & Sports Physical Therapy. April 2011. Vol. 41. No. 4. Pp. 221-231.
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