What Are The Best Orthotics For Plantar Fasciitis
- Volume 14 - Issue 12 - December 2001
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The irritation is the result of biomechanical deformities such as limb length discrepancy, gastrocsoleus equinus, and excessive foot or leg varus, producing midtarsal and subtalar hyperpronation. In turn, this pronation produces a stretch of the plantar fascia as well as unwanted pulling on the origin of the fascia (the medial calcaneal tubercle).
The classic history of plantar fasciitis is marked by the insidious onset of sharp pain at the fascial insertion of the plantar surface of the anteromedial calcaneus. With these patients, you’ll note arch fatigue and generalized soreness on the sole of the foot. The patients will usually tell you that the pain is more severe when they get up in the morning and eases some after walking. You’ll also commonly hear that pain decreases during the middle of a run, but returns at the end of the day.
Upon palpation, you’ll typically detect heel tenderness anteromedially at the origin of the plantar fascia on the medial calcaneal tubercle. However, keep in mind that the patient may have pain along the entire length of the plantar fascia. If you note tenderness over the distal and midportion of the plantar fascia, your patient may have the less common distal fasciitis. If the entire heel is tender, it may be a stress fracture, calcaneal apophysitis (Sever’s disease) in a child, or possibly a bone tumor.
Although plantar fasciitis treatment often includes nonsteroidal oral medication, local steroid injections, ice after the run, ultrasound and stretching exercises, your main focus should be on treating the biomechanical imbalance. Employing orthotic devices can play a key role in this endeavor.
When You Should Use Heel Pads And Cushions
The first line of relief for treating plantar fasciitis, heel cushions provide extra shock absorption in the heel area. They help absorb the shock of heel strike in walking and running. Heel pads are generally constructed of polyvinyl chloride, silicone, leather, polyethylene foams like Plastizote, and thermoplastics.
Soft heel cups cushion and contain the fat pad. They are effective for a plantar calcaneal bursitis or plantar heel spur syndrome. When you’re treating patients who have heel pain as a result of fat pad atrophy, employing hard plastic heel cups (M-F Athletic, Cranston, RI) can sometimes be effective in positioning the heel pad underneath the calcaneus, restoring the natural cushioning and compressibility.
You may also consider the Anti-Shox heel cradle (Apex, South Hackensack, N.J.), which is made from a firm, open cell polymer. Designed to cup the heel, this orthotic provides both shock absorption and support. Another option is the SofSpot Viscoheel (Bauerfeind, Germany). This silicone heel cushion has a built-in area of softer durometer that is especially designed to disperse weight around the plantar medial tubercle of the calcaneus.
Sometimes, using a heel lift is helpful in shifting pressure to the forefoot. Keep in mind that a heel lift in the shoe should be no thicker than one-quarter inch.
An Overview Of Custom And Prefabricated Foot Orthoses
There are a variety of orthotic devices that you can use inside the shoe to provide support, increase shock absorption or influence foot position. Orthoses include dynamic insoles, heel cushions, prefabricated commercial foot orthoses and custom foot orthoses. Using an orthosis can help you reduce arch strain associated with plantar fasciitis.
When it comes to dynamic insole orthoses, you can construct them from Spenco (Spenco Medical Corp., Waco, TX), which is a closed-cell neoprene impregnated with nitrogen bubbles.
Prefabricated foot orthoses are commercially available in a wide variety of styles. Employing pre-made orthoses is adequate for treating many athletes with plantar fasciitis. They are also significantly less expensive than custom-made orthoses.
You can fabricate a custom-made orthosis from a negative plaster impression of the patient’s foot. The orthosis is composed of the shell, a layer of material next to the foot and the posting, the material that fills in the space between the shell and the shoe. You can add materials such as metatarsal pads to the device to customize it further.