George Ampat and Richu Philip ask, would the use of an iStep scanner to determine a specific prefabricated orthotic best suited for the patient be more beneficial than using a standard orthotic in the treatment of plantar fasciitis?
Aim
Orthotics are commonly used in the treatment of plantar fasciitis. This study aims to distinguish whether an orthotic selected based on a pedobarograph (plantar foot pressure measurement) offers better symptom relief in comparison to a standard orthotic.
Hypothesis
A specific prefabricated orthotic selected following a pedobarograph and recommendation of the iStep scanner will be a more effective treatment modality than a standard orthotic.
Background
Plantar fasciitis (PF) is the most common cause of inferior heel pain, estimated to occur in 10 per cent of the population during their life course [1,2]. Although the exact aetiology is not understood, PF tends to affect those who have a Body Mass Index (BMI) over 30, those involved in weight-bearing occupations, middle-aged women and in athletes [2]. Young male runners seem to be more affected than other athletes by plantar fasciitis [3]. Despite being at different ends of the spectrum, the overall evidence suggests that both a sedentary lifestyle and high intensity activities can lead to plantar fasciitis. This is due to the excess pressure exerted on the foot [4].
Pathogenesis:
In order to understand plantar fasciitis, it is crucial to consider the normal anatomy and structures of the foot. The skeletal structure of the foot is composed of seven tarsal bones, five metatarsals and phalanges. The seven tarsal bones include the talus, calcaneus, navicular, cuboid and three cuneiforms [5]. These bones are arranged in two arches, longitudinal and transverse, they are held in place by ligaments and tendons. These arches are fundamental to the biomechanics of the foot, they support the body weight and gives leverage for walking. Since the arches are not rigid, they yield when weight is imposed and spring back up when the weight is removed. This way energy is stored for the next step and any shock to the foot is absorbed [5]. Figure 1 illustrates the bones of the foot and the arches [5].
Figure 1: An illustration of the bones and arches of the foot.
Anatomically, the foot is divided into dorsal (top of the foot) and plantar (under surface of the foot) sides. Muscles, tendons and ligaments allow the movement of the foot as well as provide support. The plantar fascia is deep connective tissue that runs from the calcaneus bone and then splits into five branches, one going to each of the digits [6]. The function of the plantar fascia is to support the longitudinal arch of the foot and the tendons that allow the foot to flex [5]. Plantar fasciitis refers to the inflammation of the plantar fascia due to prolonged irritation causing pain or discomfort. The exact cause of the condition has not yet been pinpointed, however it is believed that excess tensile pressure on the fascia is the cause. Abnormal biomechanics of the foot such as pes planus (flatfoot), leg length discrepancy and calf muscle tightness have been attributed to cause increased loading of the fascia [7]. It is suggested that this extra pressure on the longitudinal arch and the plantar fascia leads to microscopic tears and inflammation in the fascia. Analysis of the histologic features of the condition has shown thickening and fibrosis, calcification and collagen necrosis of the plantar fascia [8].
Diagnosis:
The diagnosis is primarily clinical as it classically presents “