Michelle Drake, DPT, et al.

In The Journal of Orthopaedic & Sports Physical Therapy. April 2011. Vol. 41. No. 4. Pp. 221-231.

American researchers are working to find effective treatment strategies for plantar fasciitis, a painful foot condition. One of those treatments is the use of a custom made foot orthosis. That’s the focus of this study. The authors of this study combined the temporary use of a custom foot orthosis with stretching to see how well these two treatment tools work. 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 authors suggest that the use of the orthotic as the only treatment worked for one of several reasons. First, just getting pressure off the plantar fascia and allowing it time to heal without repeated microtearing was important. Second, having the insert in contact with the foot may have helped reduce pain by changing sensory input to the brain.

It is also possible that transferring the load and pressure during weight-bearing from the heel to the forefoot helped reduce the pull on the plantar fascia. Again, this could prevent trauma to the fascia allowing healing to take place.

There are still many unanswered questions from a study like this. For example, was the stretching really needed? The idea behind stretching is that 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 as well.

The authors point out these and other limitations of their own study. They suggest using a temporary foot orthosis 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.