Christ, J., Cowdrey, D., & Duffy, S. (2021). Are custom orthotics more effective than prefabricated orthotics for the treatment of plantar fasciitis?. Evidence-Based Practice.
This week's article looks at a review of studies that compare custom made foot orthotics to prefabricated orthotics for the treatment of plantar fasciitis.
As it is a review article it is tricky to draw strong conclusions from these as they don’t always compare apples with apples. As the fit, materials and makes of the custom orthotics were different, as were the prefabricated orthotics- there was no mention to what quality or materials these were made from now how was the fit.
The authors note that in ] some studies there was no improvement in orthotic wearing groups compared to standard treatment groups, neither the custom orthotics or prefabricated orthotics showed any greater result.
Other studies showed that there was little to no improvement in either custom orthotic or prefabricated orthotic group compared to sham (known not to give positive results) treatment in the short term - 6 weeks.
The overall conclusion by the authors is that orthotics do contribute to improving pain and function in those with heel pain. There is a small difference between custom-made orthotics and prefabricated orthotics in reducing pain and improving function, but this difference is so small it is not clinically significant (pain score reduction by -4.22 to -3.47). That means expensive custom made orthotics were not any more superior to a prefabricated orthotic in reducing pain and improving function.
One important note is that those with connective tissue disorders (hypermobility/ excessive movement) were excluded from some of these studies. We do know those with hypermobility do require greater control and need the support of an orthotic for a longer period of time and therefore do benefit more from a custom orthotic.
A positive aspect of this review is that it states those involved with the studies did not have any adverse reactions- a very important point.
So what does this mean? These studies really isolated the use of orthotics alone without combining them with other interventions to treat heel pain. The role of an orthotic in treating plantar fasciitis is to reduce the load placed on the plantar fascia by utilising the orthotic to support the foot.
The way we look at treating plantar fasciitis at fasciitis.com.au we use a multi faceted approach. We do like to utilise prefabricate orthotics to reduce the daily load placed on the plantar fascia, but instead of just relying on this one factor we utilise heat, peanut roller, stretching band and night splint to decrease the tightness in the plantar fascia pulling on the heel. Together combined with the positive effect of the heat, massage and strengthening on increasing the rate of healing we believe this is the most effective way to treat this condition at home. Reduce the load going in to it, decreasing the pull on the heel bone and increase the rate of healing.
The prefabricated orthotics we use at fasciitis.com.au have been specifically selected for treating plantar fasciitis and we are confident that they will assist you and your pain.
We do know that custom orthotics have their time and place for different foot types and different condition and we do respect that.
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