Custom Foot Orthotics for the Treatment of Plantar Fasciitis

By Reese Wilmoth Purpose and Question

Purpose

Are custom foot orthotics effective in treating plantar fasciitis?

Question

For a 54 year old male patient with plantar fasciitis, are custom foot orthotics effective in decreasing pain and increasing function after two months of continuous use? Patient Details/Demographics

- Mr. H is a 54 year old caucasian male. - He reports no comorbidities, prior surgeries, or medications - He works in lawn care and home repair and is on his feet most of the day. Patient Details/History

- CC: pain in right heel. - Pain dates back 7 to 8 years - worse when he wakes up and with jogging and after weight bearing. - Visited PCP 2 weeks prior and was diagnosed with plantar fasciitis. - Patient reports that he has tried over the counter orthotics in the past with minimal relief. Patient Details/Goals

- Pain: Best 1/10, current 1/10, worst 8/10 - FOTO score: Intake 73/100, Predicted 80/100 - FOTO predicts 7 point improvement in 9 PT visits.

Patient Goals

Work without pain 2/10

Jogging without pain 2/10 What is FOTO?

- Series of functional questions where the following question is chosen based on previous answers. - FOTO measures patient functional status using computer adaptive technology. - Uses risk adjusted algorithms to predict outcomes and give PTs and patient benchmarks. Initial Evaluation : Significant Findings

Prone - PROM Left Right

Dorsiflexion (STJN) -10 -12 degrees

Eversion 5 0 degrees

Leg to Rearfoot (STJN)4 9 degrees of Varus

Rearfoot to forefoot (STJN) 4 3 degrees of varus Other findings

TTP - at medial calcaneal tubercle and plantar intrinsics. Sx increases with Windlass technique. PT diagnosis

Plantar fasciitis likely secondary to biomechanical deficits resulting in fat pad shearing and inflammation of the plantar aponeurosis and plantar intrinsics. Article 1 - Gross et al.

JOSPT Impact Factor:2.8 Gross et al.

Purpose - Determine impact of Custom orthotics on pain and disability for individuals with plantar fasciitis.

Design - single group pre- and post-intervention repeated measures design. Gross et al. Methods and Measures

Methods - 8 men and 7 women (mean age 44 +/- 9 years) who reported plantar fasciitis symptoms for an average of 21 to 24 months

Measures - taken before orthotics and after 12-17 days of continuous use.

- 100 m walk at self selected speed - then patients rated pain they experienced using 10 cm visual analog scale.

- Subjects also completed the pain and disability subjections of the foot function index questionnaire Gross et al. Results

Foot Function Index results

- Post-orthotic pain subsection showed 66% reduction in pain rating. - Post-orthotic disability subsection showed a 75% reduction in disability ratings. Gross et al. Results

- 100 m walk times were not significantly different pre- vs post- orthotics. - Pre- orthotic pain rating (mean 3.0 +/- 1.7) vs. post-orthotic pain rating (mean 0.7 +/- 0.7) Gross et al. Conclusions

- Custom semirigid foot orthotics may significantly reduce pain experienced during walking, and may reduce more global measures of pain and disability for patients with chronic plantar fasciitis. Gross et al.

Strengths Weaknesses

- Average 21 months of symptoms - - NO CONTROL Chronic. - Likely huge placebo effect - Difficult for normal tissue changes to - Self report outcome measures account for change in 12-17 days. - 11 subjects had used non custom arch supports, 10 had used NSAIDS. - Large magnitude of changes (treatment effect vs. Placebo effect) Article 2 - Landorf et al.

Jama

JAMA Internal Medicine Impact factor: 16.5 Landorf et al.

Purpose - Evaluate the short and long term effectiveness of foot orthoses.

Design - 3 armed, Participant Blinded Randomized Trial.

Methods - 135 (age mean 47 +/- 11.7 years) participants with plantar fasciitis randomly allocated to receive a sham orthosis (soft, thin foam), a pre-fabricated orthosis (firm foam), or a customized semirigid orthosis. Landorf et al. Outcome measures

Pain and function at 3 and 12 months

- Pain and Function domains of Foot Health Status Questionnaire.

Timeline

- Received orthotics 2-3 weeks after standardized assessment and molds were taken. Landorf et al. Results

- After 3 months, pain and function measurements favored the prefabricated and customized orthotics over the sham orthoses (only function was significant). - Prefabricated was slightly favored over custom (not significant) - No significant effects on either outcome at 12 month review. Landorf et al. Conclusions

Foot orthoses produce small short-term benefits in function and may cause small reductions in pain for people with plantar fasciitis, but they do not have long term beneficial effects compared with a sham device. Landorf et al.

Strengths Limitations

- First to compare real orthoses to a sham. - All participants were chronic (acute - 12 month follow up effects could differ) - Validated health status measures of - Assessor was not blinded. functions and pain. - 3% loss to follow up. Other Relevant Research - Pain

- Inconclusive at best. Application to Patient

Patient fits the inclusion criteria for both studies but is more chronic.

Conclusion - low likelihood of potential short term benefit. Likely no long term changes.

Patient tried prefabricated orthotics previously with little relief. Patient treatment

Eval - was casted for custom fit orthotics and given HEP of DF towel stretch, hurdle stretch, and stair stretch.

2 weeks later - Fitted with custom fit orthotics and HEP review. Shoe recommendation given.

6 weeks later (1 month follow up from fitting)... Patient Outcome - 1 month follow up

Pain - Best 0/10, Current, 0/10 Worst - 2/10

FOTO score - 81/100

Patient Goals

Work without pain 9/10

Jog without pain 8/10

- Plan to see Patient in 2-3 years for follow up and casting for new orthotics.

Cost Effective?

Pre-fabricated - $45-90

Custom - $225-300

Other PT interventions -$? Lessons Learned

- Maybe some short term benefits. - Likely little difference between Prefabricated and custom orthotics. - A tool...but an expensive one. - Need more research. References

Gross MT, Byers JM, Krafft JL, Lackey EJ, Melton KM. (2002). The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. Journal of Orthopedic and Sports Physical Therapy, 32. 149-157.

Landorf KB, Keenan A, Herbert RD. (2006). Effectiveness of foot orthoses to treat plantar fasciitis: A randomized trial. Journal of American Medical Association Internal Medicine, 166(12), 1305–1310. doi:10.1001/archinte.166.12.1305 References https://www.hirerush.com/blog/wp-content/uploads/2016/01/summer-mowing. jpg https://www.hendersonpodiatry.com/images/prefabproducts.jpg http://advancedcarephysicaltherapy.com/files/2011/09/foto1.jpg https://www.physio-pedia.com/images/c/c7/Windlass.jp http://kineticlearningcentre.com/pdf/fhsq_full.pdf