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Are Orthoses Effective Against Plantar Fasciitis In The Long Run?
Orthoses are an integral part of the podiatric armamentarium to treat plantar fasciitis. However, a recent study calls into question the long-term efficacy of using orthoses to treat the condition.
The study, which was published in a recent issue of the Archives of Internal Medicine, looked at 135 patients with plantar fasciitis, who were randomized to wear either a prefabricated orthosis made of firm foam, a customized orthosis made of semirigid plastic or a sham orthosis. The follow-up period was 12 months. After three months, researchers found that both the prefab and customized orthoses provided better pain relief and improvement in function, although only the effects on function were statistically significant, according to the study. At 12 months, researchers said the study showed no significant effects on primary outcomes for those who wore custom or prefab orthoses.
While the study authors noted small short-term benefits in function and reduction in plantar fasciitis pain with orthoses, they say orthoses do not have beneficial long-term effects when compared to a sham.
What The DPMs Have Found In Their Experience
In contrast to the study, Russell Volpe, DPM, has found a better long-term orthotic efficacy for patients with plantar fasciitis. He says it may take time for symptoms to improve. The key, when using prefab or custom orthoses for plantar fasciitis, is combining them with other therapies, according to Dr. Volpe. One should undertake therapies such as oral medications, injections, icing, stretching, rehabilitation or shoe changes concurrently with the orthotic devices in order to improve pain and function, according to Dr. Volpe, the Chair of the Department of Orthopedics and Pediatrics at the New York College of Podiatric Medicine.
Orthoses normalize and neutralize the biomechanical imbalances that cause pronatory compensation that contribute to or aggravate plantar fasciitis, according to Dr. Volpe. He adds that orthotic devices function best at preventing further damage or reinjury to the fascia that has been treated for an inflammatory condition.
Ronald Valmassy, DPM, says his patients respond “exceptionally well” to custom orthoses in the short term.
“I feel that a prescription device typically improves foot function throughout the day and is generally instrumental in improving the effectiveness of other forms of treatment such as corticosteroid injections and physical therapy,” says Dr. Valmassy, a Staff Podiatrist at the Center for Sports Medicine at St. Francis Memorial Hospital in San Francisco, Calif.
Furthermore, Dr. Valmassy feels orthoses generally improve pre-existing abnormal foot function. His patients typically wear orthoses even after their plantar fasciitis symptoms improve. He notes that when his patients wear orthoses, they feel more stable, comfortable and functional in gait.
Questioning The Study And Suggesting More Specific Studies In The Future
The fact that orthotic devices alone are often not enough is a “serious flaw” in the study, opines Dr. Volpe.
“This may make for difficulties with research as combined therapies are very hard to assess when it comes to the effect of each therapy. However, we must be careful about these conclusions about orthoses when no other treatments were provided, given that this is not how orthoses are used by most serious, respected foot professionals,” cautions Dr. Volpe.
Dr. Volpe also has a concern that the patients in the study were a generalized group of people with plantar fasciitis, noting there was no discussion of their biomechanics and pronation. He suggests the next study examine patients with plantar fasciitis in those with acquired pes plano valgus of biomechanical origin. Furthermore, he notes that those with plantar fasciitis and pronated feet respond better to orthoses than those with cavus feet, and says future studies should differentiate those groups.