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 Plantar heel pain is one of the most common foot ailments,
accounting for about 15 percent of foot symptoms requiring medical
attention and 10 percent of running injuries, researchers note in
the British Journal of Sports Medicine. Many doctors recommend shoe
inserts to ease this pain by supporting the arches and taking
pressure off the heel, but research to date has been inconclusive
about the effectiveness of this approach.
For the current study, researchers examined data from 20 previously
conducted experiments that randomly assigned some participants to
wear shoe inserts and other participants to join a control group
receiving no treatment, a sham insert or a different intervention.
Altogether they tested eight different custom or mass-produced shoe
inserts.
Short-term pain relief was similar with and without shoe inserts,
and there wasn’t any difference between pre-fabricated models and
custom versions, the study found.
“A patient might still prefer to try an orthotic and based on this
study, could try a cheaper orthotic first as opposed to a more
expensive one, which is custom made,” said lead author Nadine
Rasenberg of Erasmus Medical Centre Rotterdam in the Netherlands.
While shoe inserts might be better than nothing, the current study
wasn’t designed to answer this question, Rasenberg said by email.
“Most patients prefer to try an intervention as opposed to a `wait
and see’ approach,” Rasenberg added. “It remains unknown, whether
orthotics are better than doing nothing.”
Orthotics did appear slightly better than sham inserts in the
current study, but the difference was too small to rule out the
possibility that it was due to chance.
This suggests that orthotics might work for some people, but not
others, said Glen Whittaker, a podiatry researcher at La Trobe
University in Victoria, Australia, who wasn’t involved in the study.
More research is still needed to determine who might benefit, and
under what circumstances, Whittaker said by email.
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“Appropriately contoured foot orthoses may reduce plantar heel pain
by redistributing pressure away from the bottom of the heel to the
arch, and may also prevent the arch from dropping, which may reduce
tension in the plantar fascia,” Whittaker said.
One limitation of the current study is that it examined results from
many small experiments with different methods for testing the
effectiveness of orthotics. The small studies also differed in
duration and how they assessed pain relief.
Even though they’re widely used, orthotics aren’t the only option
for plantar heel pain, said Dr. Selene Parekh, a researcher at Duke
University in Durham, North Carolina and partner in the North
Carolina Orthopedic Clinic.
Patients can also try night splints or stretching exercises done at
home or as part of a supervised physical therapy program, Parekh,
who wasn’t involved in the study, said by email. Modified exercise
and activity habits may also help avoid irritating the tissues
around the heel that cause pain.
If they choose orthotics, patients should look for the cheapest
option.
“It seems that patients can attempt to provide some relief to their
plantar heel pain using cheaper, readily available orthotics found
in grocery stores, online, and stores in their community,” Parekh
added. “Based on this study, it appears that the cost of a custom
orthotic, which can reach hundreds of dollars, is not medically
necessary.”
SOURCE: http://bit.ly/2puzUbm British Journal of Sports Medicine,
online March 19, 2018.
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