Plantar heel pain, including plantar fasciitis and plantar fasciosis, is associated with pain along the heel and arch of the foot worsened with prolonged standing, walking, or running. This diagnosis is also associated with intense pain first thing in the morning or upon standing after prolonged sitting. Researchers report athletes, active, as well as, sedentary individuals can be prone to these symptoms. Physical Therapy including manual therapy and exercise remain a first line treatment for this condition due to these intervention’s ability to accelerate a patient’s recovery from plantar heel pain. Additional studies have utilized insoles or orthotics but prior reviews of the literature have not shown significant differences between custom or off the shelf/over the counter insoles for heel pain. This is an important given custom orthotics can run 10x the cost of over the counter insoles. A recent randomized controlled trial reported additional evidence on the decision between custom or off the shelf orthotics.
Rasenberg and colleagues in the British Journal of Sports Medicine reported on their randomized controlled trial among patients with heel pain (2021). Authors randomized 185 patients with heel pain (>2weeks but < 2 years) to one of three treatment groups.
Primary care management including educational handout
Referral to podiatrist for custom orthotics as well as a home exercise program
Referral to podiatrist for a sham orthotic as well as a home exercise program
Consistent with prior research studies authors reported no differences on pain or functional activities between custom and sham orthotics at 12 week follow up. In addition, patients managed by their primary care physician with the educational handout reported better pain and functional scores than their peers in the custom orthotic group. Authors concluded referral to a podiatrist for custom orthotics did not improve pain or function among patients with plantar heel pain.
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