What Are The Best Orthotics For Plantar Fasciitis

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Author(s): 
Mark A. Caselli, DPM and Ellen Sobel, DPM, PhD

Using a custom-made foot orthosis may be required when you’re treating a more severe athletic foot injury. Custom foot orthoses can be made of leather or plastic. Leather gives the patient more comfort, allows easy orthotic adjustments and is able to absorb 30 percent of its weight before it feels wet. You’ll find that using a whale pad design and deep heel seat leather orthosis is well suited for treating the painful heel caused by plantar fasciitis.

It’s more important to use a custom device for the cavus foot type as opposed to the hyper-pronated foot, which will generally improve with a well-constructed prefabricated orthosis.

Can The UCBL Orthosis Make An Impact?

The University of California Biomechanics Laboratory (UCBL) orthosis was originally designed to maintain a flexible paralytic valgus foot deformity in the corrected position. However, since then, DPMs have used it extensively to treat flexible flatfoot, plantar fasciitis and calcaneal spurs.

The UCBL is casted in a semi-weight-bearing position. Employing this device allows you to elevate the arch by holding the foot in a position of forefoot adduction and hindfoot inversion. Patients should wear it with a large shoe, such as a running sneaker. While the UCBL is not suited for running, you can use it to treat more recalcitrant conditions until the athlete is capable of returning to sports activities.

What About The Posterior Night Splint?

A classic treatment for Achilles tendinitis, the posterior night splint has been widely used by DPMs to treat plantar fasciitis as well. In one study, physicians were able to resolve recalcitrant plantar fasciitis with a night splint in 11 of 14 patients.
The splint is an ankle-foot orthosis (AFO) positioned in about 5 degrees of dorsiflexion. Patient would only wear this at night. In stretching the Achilles tendon and plantar fascia, this device prevents contractures of the Achilles tendon and plantar fascia that occur as a result of the plantar-flexed posture of the foot during sleep.

You can fabricate the posterior splint from plaster or fiberglass, or simply obtain the commercial device, Universal Plantar Fasciitis Orthosis (Orthomerica Products, CA). Regardless of the splint you use to immobilize the foot and ankle, you must ensure that it offers a good fit and maintains the desired position once you’ve applied the device.

In fabricating the splint, the patient lies prone as you initially place a stockinette on the leg. Then you would proceed to mold five to six layers of six-inch plaster splints (or three to four layers of fiberglass) to the lower extremity from the toes up to behind the knee. You should allow an extra two inches when measuring with the dry splints because the splint shrinks after immersion.

Then you can add overlapping side splint stirrups. Doing so adds strength to the cast and prevents it from failing in plantar flexion. Using a circular Ace bandage allows you to hold the entire splint in place. You can also dip the Ace bandage in water to help with molding.




References:

References 1. Janisse DJ. Indications and Prescriptions for Orthoses in Sports. Orth Clin North Am 25:95-107, 1994. 2. Jimenez AL, Goecker RM. Night splints: conservative management of plantar fasciitis. Biomechanics 4:29, 1997. 3. Jorgensen U, Bojsen-Moller F. Shock absorbency of factors in the shoe-heel with special focus on the role of the heel pad. Foot Ankle 9:294, 1989. 4. Karr SD. Subcalcaneal heel pain. Orthop Clin North Am 25:161, 1994. 5. Pezzulo DJ. Using night splints in the treatment of plantar fasciitis in the athlete. J Sport Rehabil 2:287, 1993. 6. Pribut S. Leather as an orthotic material. Biomechanics 4:61, 1997. 7. Rzonca EC, Baylis WJ. Common sports injuries of the foot and leg. Clin Podiatr Med Surg 5(3), 1988. 8. Snook GA, Chrisman OD. The management of subcalcaneal pain. Clin Orthop 82:163, 1972. 9. Sobel E, Levitz SJ, Jones LS. Orthotic variants. J Am Podiatr Med Assoc 87:23,1997.

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Anonymoussays: July 16, 2009 at 11:28 pm

Most of my patients can succesfully use a Pre-fabricated orthotic by Bodytechlab.com

The fit is superb for most patients and they are $10 per pair and sell for $95 per pair. They are thin, superbly shaped and very supportive. My office dispenses 20 to 25 pairs per week. We have all patients with any biomechanical pain try them on

Jeff Conforti DPM

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Anonymoussays: August 4, 2009 at 4:38 pm

We have excellent success with Powerstep Pro OTC inserts.

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Anonymoussays: October 5, 2009 at 5:36 am

Rehash of same old information

Greg Smith DPM

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kwall5says: February 14, 2010 at 3:37 pm

Some patients simply don't do well with any kind of orthotic, and instead need a pair of footwear that can provide the appropriate relief for their particular condition. Getting the best shoes for plantar fasciitis isn't always a simple process for many patients, and it is thus imperative that they understand that it might take some experimenting to eventually find the right pair.

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Anonymoussays: August 7, 2010 at 11:14 am

Jeff, those orthotics are $10 and sell for $95 per pair? You see.......that's what wrong with this country's healthcare. Almost a 1000% markup? You've got to be kidding.

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