Orthotics & plantar heel pain – the debate continues
There is much debate and mixed evidence of the effects of custom orthotics and prefabricated orthotics on plantar heel pain. A recent European research article has sparked further debate concluding that foot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with plantar heel pain.
As a podiatrist with close to 20 years clinical experience in treating plantar heel pain I have some big issues with this statement as outlined below.
Clinical experience counts when treating heel pain
At Melbourne Podiatrists & Orthotics our treatment is always based on a combination of evidence, clinical expertise and the individual needs of the patient. Clinically we have always seen great results with both custom orthotics and prefabricated devices when treating plantar heel pain. Interestingly a recent Australian research review supports this and found some evidence that foot orthoses are effective at reducing plantar heel pain.
At our Melbourne clinic we see a lot of patients with plantar heel pain that have failed conservative treatment. In my experience conservative treatment (taping and stretching) works well in mild cases of plantar heel pain. In chronic cases of plantar heel pain there usually is a biomechanical fault that needs addressing and this is where orthotics (both custom and prefabricated) can help.
Why is there conflicting research with custom orthotics?
Unfortunately there is a lack of high quality evidence as high quality research is often difficult when it comes to custom orthotics. The main reason is that there are just far too many variables that can affect custom orthotic prescription, function and results. Consider the following factors that can all affect how a custom orthotic functions:
- Accuracy of diagnosis
- Skill and accuracy of custom orthotic prescription
- Expertise and technique of the manufacturing orthotic lab
- Individual biomechanics of the patient
- Weight and height of the patient
- Footwear of the patient
- Fit of the orthotics in the shoes
- Activities of the patient
Custom orthotics are customised to each individual
For research purposes a lot of studies will use custom orthotics that have be standardised. This means that the custom orthotics used for treatment in the studies are often standardised with the same prescription for every patient. In the clinical setting as podiatrists we do completely the opposite to the research. Each custom orthotic is tailor made to the individual and to each foot.
Custom orthotics can be prescribed over a thousand different ways. Factors such as diagnosis, weight, height, biomechanics, activities and footwear are all taken into consideration when prescribing a custom orthotic for an individual patient. An accurate prescription is paramount for success.
Diagnosis is key when prescribing orthotics
Another key area where a lot of research studies fail is in the accurate diagnosis and cause of plantar heel pain. Often in research studies all cases of heel pain are just lumped together under one banner, either plantar heel pain or plantar fasciitis. Little detail is often paid to the exact cause of the heel pain.
In the clinical setting it is a completely different story. Accurate diagnosis of the true cause of plantar heel pain is of vital importance to successful treatment. At Melbourne Podiatrists & Orthotics we deal with plantar heel pain on a daily basis. We not only see heel pain caused by plantar fasciitis but also by tarsal tunnel and medial calcaneal nerve entrapment. To further complicate matters sometimes we see these different causes coexist in an individual.
Clinically we find that each different cause of plantar heel pain benefits from a completely different orthotic. For example we see great results treating plantar fasciitis with a custom orthotic (especially if the foot has a high arch) whilst we get excellent results treating medial calcaneal nerve entrapment with softer prefabricated devices.
Custom orthotics provide additional benefits
Yes custom orthotics are expensive. But so is conservative care. For example if you are seeing a health professional weekly for 2 months then you could have already paid for custom orthotics if they were indicated. Long term I know which treatment I would rather have, particularly if you are trying to prevent a reoccurrence.
Plantar heel pain aside it is important to realise that custom orthotics provide many other functional advantages over other devices when it comes to treating foot pain. This includes:
- Customised to individual needs
- More corrective
- Superior shoe fit
- More durable and longer lasting
To read more about the benefits please visit our page on custom orthotics.
We recommend the best treatment to get you results
Whilst plantar heel pain is a complex condition, we are firm believers that both custom orthotics and prefabricated orthotics have a successful role to play and our clinical results supports this statement. Ultimate success of plantar heel pain treatment depends on diagnosis and the individual.
With regards to plantar heel pain our podiatrist’s job is to recommend and discuss with you the best treatment options (using both evidence and clinical experience) to get results. In situations where we feel that both a custom orthotic or prefabricated orthotic are indicated we will always outline the benefits of each option. At the end of the day all important treatment decisions are always left up to you the patient.