Plantar Fasciitis: Orthotics Don’t Help Much

Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006 Jun 26;166(12):1305-10. Landorf KB, Keenan AM, Herbert RD.

Abstract
BACKGROUND:
Plantar fasciitis is one of the most common foot complaints. It is often treated with foot orthoses; however, studies of the effects of orthoses are generally of poor quality, and to our knowledge, no trials have investigated long-term effectiveness. The aim of this trial was to evaluate the short- and long-term effectiveness of foot orthoses in the treatment of plantar fasciitis.
METHODS:
A pragmatic, participant-blinded, randomized trial was conducted from April 1999 to July 2001. The duration of follow-up for each participant was 12 months. One hundred and thirty-five participants with plantar fasciitis from the local community were recruited to a university-based clinic and were randomly allocated to receive a sham orthosis (soft, thin foam), a prefabricated orthosis (firm foam), or a customized orthosis (semirigid plastic).
RESULTS:
After 3 months of treatment, estimates of effects on pain and function favored the prefabricated and customized orthoses over the sham orthoses, although only the effects on function were statistically significant. Compared with sham orthoses, the mean pain score (scale, 0-100) was 8.7 points better for the prefabricated orthoses (95% confidence interval, -0.1 to 17.6; P = .05) and 7.4 points better for the customized orthoses (95% confidence interval, -1.4 to 16.2; P = .10). Compared with sham orthoses, the mean function score (scale, 0-100) was 8.4 points better for the prefabricated orthoses (95% confidence interval, 1.0-15.8; P = .03) and 7.5 points better for the customized orthoses (95% confidence interval, 0.3-14.7; P = .04). There were no significant effects on primary outcomes at the 12-month review.
CONCLUSIONS:
Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device. The customized and prefabricated orthoses used in this trial have similar effectiveness in the treatment of plantar fasciitis.

My comments:
I’ve seen a number of studies that compared inexpensive over the counter orthotics to expensive custom made orthotics for plantar fasciitis, and they found there was no difference for the patient. This study was much the same. In fact, the over the counter orthotics came out very slightly ahead of the custom made ones with regards to both pain reduction and improved function (by about 1%), though the difference was not statistically significant.

What was more interesting is that this was the first, and still only, study to compare real orthotics to placebo “sham” orthotics. What they found was that 3 months out, the real orthotics decreased pain only 7-8% better than the sham ones, which was statistically significant but it had the authors question whether orthotics of any kind were worth the effort for plantar fasciitis. I have to admire the honesty coming from the researchers who are Podiatrists with a long history of researching plantar fasciitis and other foot problems.  At 12 months out there was no statistical significance between any of the three groups (custom, over the counter, or sham). The good news is that all three groups did improve over time, but it seems orthotics whether custom made or not only have a minimal beneficial effect. Certainly it seems the custom made orthotics are not worth the expense, with over the counter ones being relatively inexpensive and maybe worth trying on before you buy, or maybe not.

I’m of the opinion that plantar fasciitis should be treated more like tendinopathy, with a greater focus on strengthening muscles of the lower leg and foot with a combination of progressive resistance exercise for the larger muscles and electric muscle stimulation for the foot intrinsics (which most certainly works the foot muscles more intensely than towel bunches do). I notice a pretty good benefit from both clinically, but as of yet, there no research on either strengthening nor EMS for plantar fasciitis. The similarities of the condition with various tendinopathy conditions, along with my outcomes, makes me think it’s worth pursuing.

Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember Spinal Flow Yoga for you or someone you know in the future.


Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.

2 thoughts on “Plantar Fasciitis: Orthotics Don’t Help Much”

  1. Looks like this was posted back in 2014
    Have your thoughts changed at all on treating PF with strength training the feet and lower legs?
    I am about to start EMS on my legs and feet since nothing else seems to have worked for me.

    • Hi Tom,

      I still think total leg strengthening, combined with EMS to the foot intrinsics is ideal. Stretching the calves, but not the plantar fascia are also something I recommend if the calves are tight. I still love the weight training, but as I have worked to make my spine program something that can be done entirely at home with Spinal Flow Yoga, I did add in components of the program that should help with plantar fasciitis among other things, though I would add on calf stretches and EMS in addition.

      One new thing: I think when I wrote the above blog I was having people do EMS standing on the electrodes with two channels, one channel per foot, with electrodes placed at the ball and heal of each foot. This was sprint coach Charlie Francis’ idea, and a very good one, and he liked it because standing on the electrodes your bodyweight would keep your toes from cramping up under the force of the EMS. Now I’m using one channel with each electrode strapped to the bottom side of the foot between the ball and heel. With the straps I can sit down and read a book. The cramping of the toes you just get used to, and with the electrodes being so far apart the electrical current runs so deep that it hits the calf as well as several other muscles that help support the foot arch, so overall I think it’s better. Losing weight certainly helps if it’s an issue, taking a load off the foot arches, otherwise stay away from cortisone shots and plantar fasciitis should eventually heal on its own.

      If you haven’t seen them, check out my blogs one EMS for strength to know if your EMS machine is, or can be, programmed properly, and rubber carbon electrodes make all the difference in the world. I hope that helps.

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