VICTORIA, Australia—Foot orthoses can improve pain and function from plantar fasciitis in the short-term, but the effects don't seem to last a year, Karl B. Landorf, PhD, of La Trobe University in Victoria, Australia, and colleagues, report in the June 26 issue of the Archives of Internal Medicine.¹

In the participant-blinded trial of 135 patients with plantar fasciitis, patients were randomized to receive either a sham orthosis made of soft thin foam, a commercially available prefabricated orthosis made of firm foam, or a customized orthosis made of semirigid plastic. Subjects were followed for 1 year.

The primary outcomes were pain and function, measured by the Foot Health Status Questionnaire. Outcomes were assessed after 3 months and after 12 months of use.

Patients using the prefabricated or customized orthoses had less pain and better function than those using sham orthoses after 3 months of treatment, but only the changes in function were statistically significant. Compared with sham orthoses, the mean pain score was 8.7 points better for the prefabricated orthoses and 7.4 points better for the customized orthoses. The mean function score was 8.4 points better for the prefabricated orthoses and 7.5 points better for the customized orthoses when compared with sham orthoses.

However, these improvements were not sustained. By 1 year of follow-up, there were no significant differences between the treatment groups.

Choose prefabricated orthoses first

Since the data in this trial show similar effects from customized and prefabricated orthoses in the treatment of plantar fasciitis, the researchers conclude that the new findings should change clinical practice.

"Our results indicate that if a practitioner conducts a thorough assessment of a patient with plantar fasciitis and concludes that a foot orthosis is necessary to treat it, he or she should use a prefabricated orthosis in the first instance," Dr. Lansdorf told CIAOMed. He advised that customized foot orthoses be tried if symptoms remain.

He pointed out that both the prefabricated and customized orthoses performed better than the sham device in the short-term, but not in the long-term. "We assume that this was, in part, due to the natural course of this condition—ie, that there is on average a natural resolution to plantar fasciitis," he said.

Cary M. Golub, DPM, a podiatrist in private practice in Long Beach, New York, told CIAOMed that "even though the benefit was only small, there is still a benefit, which proves modification of footwear is important whether with an inexpensive, over-the-counter device or a true fabricated device."

Reference