Podiatrist

New research says regular inserts are just as effective but may fail to account for the personal nature of plantar heel pain and the need for customised treatment

Plantar heel pain ( PHP ) accounts for 11-15 percent of all foot symptoms that require medical attention in adults and 8 – 10 percent of all runningrelated injuries

new European study has advised doctors to stop prescribing foot orthoses , or medical shoe inserts , for patients with plantar heel pain after its authors found no evidence that specially moulded footwear was more effective than over-the-counter insoles .

Not all podiatrists , however , agree with the report ’ s findings , claiming that it fails to take into account the many combinations a prescription orthotic will employ to offset a patient ’ s particular needs .

The European analysis of 20 existing randomised control trial studies , which had investigated eight different types of foot orthoses , found no significant differences between prefabricated orthoses and custom orthoses for pain in the short-term .

Plantar heel pain ( PHP ) accounts for 11-15 percent of all foot symptoms that require medical attention in adults and 8 – 10 percent of all running-related injuries . The most commonly prescribed treatments for plantar pain include modified footwear , taping , stretching exercises , and strengthening exercises . Extra-corporal shock wave therapy , anti-inflammatory agents , and cortisone injections are also administered , but there is still a lack of consensus on which treatments are most effective .

Researchers at the Universitair Medisch Centrum , Rotterdam in The Netherlands set out to investigate the effects of different orthoses on pain , function , and self-reported recovery in patients with plantar heel pain and compared them with other conservative interventions .

Collectively , the studies looked at 1,756 patients with the condition . Pooled data from six studies showed no difference between prefabricated orthoses and simple insoles bought over the counter — known as “ sham ” orthoses — for short-term pain .

Overall , for the majority of other interventions , no significant differences were found .

While most of the studies analysed had reported a significant improvement over time in patients treated with orthoses , this was probably due to the fact that plantar heel pain tends to improve after 12 months .

However , the authors said orthosis interventions did not appear to be superior in improving pain , function , or self-reported recovery when compared with other conservative interventions .

“ Foot orthoses are not superior for improving pain and function compared with sham or other orthoses or other conservative interventions in patients with PHP ,” the report concluded . “ Clinicians should be reserved in prescribing foot orthoses in all patients with PHP and take factors like patient preference and adherence into account .”

Yet the study will not satisfy all clinicians , according to Dr Mark Reyneker , founder and clinical director of the Family Podiatry Centre in Singapore . Speaking to Global Health and Travel , he cautioned that such studies are commonplace and do not take into account the unique nature of each individual ’ s PHP condition .

“ Every time they try to compare a sham orthotic , which is a ready-made device , to a custom-made device , the results are always more or less the same ,” he said .

The Universitair Medisch Centrum analysis is one of many that fails to represent true orthotic usage in clinics where a patient is diagnosed and given an orthotic based on his own precise condition .

“ Every person who presents with PHP will have it for a different set of reasons to the next patient , even though he will come along with exactly the same problem ,” said Dr Reyneker . “ The clinician will always examine the person , there will have to be a diagnosis , and he will customise the orthotic based on the foot movement that he has found in his examination , which contributes to , or maybe is a causative factor for , the condition that the patient has .”

Dr Reyneker stated that it was impossible for researchers to give a “ blanket statement ” saying that orthoses do not work . n

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