Should custom foot orthotics be used for the treatment of plantar heel pain?

Chris Bishop17th of July 2018www.thebiomechanicslab.com.au / blog / research / plantar-heel-pain-and-foot-orthotics

Should custom foot orthotics be used for the treatment of plantar heel pain?

 

Given that I have spent the last five to six years with my head purely focused on this exact question, I hope that I can anwser this very simply. After all, it is what earnt me my PhD...

Unfortunately, life isn't always that simple. 
Isn't that why we go to work each day? The thrill of the unknown and difficult case?

As a clinican, plantar heel pain is such a big part of my practice. Yes, I have developed expertise in it following  my PhD, but it has always been a frequent presentation. The data says plantar heel pain will effect 10% of adults in their life time, yet a quick audit of the patients presenting to The Biomechanics Lab and what they report as the reason for seeking a consult - plantar heel pain sat at 19.4% over the last three years. That's one in five people that walk in the door!

So, with regards to custom foot orthotics - yes they are used widely.
We know that when prescribed properly, custom foot orthotics work really well. However, we know there are other treatments that may also work.
So how as a clinician, do I appropriately advise my patients as to whether orthotics are required?

At The Biomechanics Lab, we believe our patients have great success with our prescribed methods of treatment. Our internal data reveals that  more than 85% patient satisfaction with prescribed custom foot orthotics when audited at three months.
This data is further supported by the research from my PhD which indicated that at least 80% of those individuals in the orthotic group were better off at tweleve weeks with the use of custom foot orthtoics compared to when they started the trial.

So often I have patients come to see me for a second opinion who have previously trialed orthotics with little to no success. Why is this so?

1. Patients often present to use without a clear diagnosis. 
Often these patients present to their first appointment with us with one, two and sometimes even three pairs of orthotics and are unable to tell us exactly what is causing their pain.

Is it the plantar fascia?
Is it a nerve? Note: approximately 20% of all plantar heel pain is likely neural in origin.
Is it referred pain?
Is it because of the bone? Think bone brusing or a heel spur.
Or is there perhaps a systematic cause that could explain the patients symptoms?

There is a lot of evidence coming out to support different rheumatological conditions causing pain in the plantar heel. 

2. Our patients report that orthotics were prescribed to them very quickly. 
This often and unfortunately occurs on the first appointment without a thorough due diligence process as to understanding the mechanism as to what is causing the pain, as well as a detailed understanding of how the individual walks and/or runs. 

3. When the orthotics have not worked straight away, patients are told that they should have worked and there is nothing else that can be done.  
Rather that time will heal and resolve the pain. 

So is there hope for you? Should you consider custom foot orthotics for treatment of your plantar heel pain?

YES you should, but only if we can demonstrate in the clinic that there is likely to be a benefit First.

What I mean by this is that it is important that prior to even considerin orthotics, that we can represent their likely effect for a period of time - say with tape, often these effects will last a few days AND the effect you recieve is actually beneficial in terms of reducing pain, improving symptoms and improving quality of life. 


CLICK HERE to understand more about how we can do this at The Biomechanics Lab.

To find out more as to how orthotics can help you and your plantar heel pain, please call us at The Biomechanics Lab on (08) 7130 0130.  

Dr Chris Bishop PhD
Director of The Biomechanics Lab