Orthoses provide only temporary relief of heel pain

NEW YORK (Reuters Health) - Foot orthoses -- whether customized or prefabricated -- provide only small, short-term improvements in function and pain for patients with heel spurs, also known as plantar fasciitis, according to findings published in the Archives of Internal Medicine.

"Plantar fasciitis is one of the most common foot complaints," Dr. Karl B. Landorf, of La Trobe University, Victoria, Australia, and colleagues write. "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 researchers therefore examined the short- and long-term effectiveness of foot orthoses in the treatment of plantar fasciitis in 135 patients with plantar fasciitis. The subjects were randomly assigned to receive a sham - a soft, thin piece of foam that looked like an orthosis; a prefabricated orthosis (firm foam); or a customized orthosis (semi-rigid plastic). None of the patients were told which type they were given. The researchers measured the patients' level of heel pain and function after 3 and 12 months.

Patients in the prefabricated and customized orthoses groups had improvements in pain and function after 3 months of treatment, but only the effect on function was statistically significant.

The average pain score (on a 0-100 scale) was 8.7 points better for the prefabricated orthosis group and 7.4 points better for the customized orthosis group compared to the sham orthosis group. The average function score was 8.4 and 7.5 points better in the prefabricated and customized orthoses groups, respectively, compared with the sham orthosis group.

However, no significant effects on pain or function were seen after 12 months in any of the groups.

Some doctors and plantar fasciitis patients may consider these results to be enough to justify the use of orthoses, Landorf and colleagues comment. "In that case, it is necessary to decide whether to use prefabricated or customized orthoses." They point out that there's little difference between the two, except that customized orthoses typically cost considerably more.

SOURCE: Archives of Internal Medicine, June 26, 2006.