Comparative trial of the foot pressure patterns between corrective orthotics, formthotics, bone spur pads and flat insoles in patients with chronic plantar fasciitis

Department of Sports Medicine, Changi General Hospital, Singapore.
Annals of the Academy of Medicine, Singapore (Impact Factor: 1.15). 10/2009; 38(10):869-75.
Source: PubMed


The objective of the study is to compare the efficacy of fl at insoles, bone spur pads, pre-fabricated orthotics and customised orthotics in reducing plantar contact pressure of subjects with plantar fasciitis.
This is a controlled non-blinded comparative study conducted in a tertiary medical institute. Thirty subjects with unilateral plantar fasciitis between the ages of 20 and 65 years were recruited at the sports medicine clinic. The contact pressures and pressure distribution patterns in both feet for each subject were measured with sensor pressure mats while standing. Repeat measurements were made with the subjects wearing shoes, fl at insoles, bone spur heel pads, pre-fabricated insoles and customised orthotics on both feet. The asymptomatic side was used as the control. Contact pressure measurements of the symptomatic and asymptomatic feet and power ratio of the pressure distribution pattern of the rearfoot were then compared.
Contact pressure was higher on the asymptomatic side due to unequal distribution of weight. Bone spur heel pads were ineffective in reducing rearfoot pressure while formthotics and customised orthotics reduced peak rearfoot pressures significantly. The power ratio of the rearfoot region decreased with the use of formthotics and customised orthotics.
Pre-fabricated orthotics and customised orthotics reduced rearfoot peak forces on both sides while bone spurs heel pad increase rearfoot peak pressures. Pre-fabricated and customised orthotics are useful in distributing pressure uniformly over the rearfoot region.

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    • "Although there is no consensus on optimum management for plantar heel pain, evidence exists for the effectiveness of foot orthoses as an intervention [1] [7] [35]. While the mechanism behind the effectiveness of orthoses is not entirely understood [36], reduction in pressure beneath the heel with the use of orthoses has been demonstrated in people with heel pain [36] [37]. The current study suggests that people with heel pain adopt a strategy to offload the heel in order to minimise pain, and it is possible that foot orthoses reduce pain by assisting this offloading strategy. "
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    ABSTRACT: Plantar heel pain is aggravated by weight-bearing, yet limited evidence exists regarding how people with heel pain load their feet during walking. Knowledge of loading patterns in people with plantar heel pain would enhance the understanding of their foot function and assist in developing intervention strategies. Plantar pressure using the Emed-AT platform (Novel Gmbh, Germany) was collected from 198 people with plantar heel pain and 70 asymptomatic controls during normal walking. Maximum force, force-time integral, peak pressure, pressure-time integral and contact time were measured in four quadrants of the heel, the midfoot and the medial and lateral forefoot. The symptomatic group was sub-divided into equal low-pain and high-pain groups using the Foot Health Status Questionnaire pain score. Following age and body mass comparison, multivariate analyses of covariance were performed to compare the heel pain group to the controls, and the low-pain group to the high-pain group, for each loading variable. The heel pain group displayed lower maximum force beneath the heel, lower peak pressure beneath the postero-lateral heel and lower maximum force beneath the medial forefoot. Force-time integrals were lower beneath the posterior heel regions and higher at the lateral forefoot. People with heel pain also had longer midfoot and forefoot contact time. Higher pain level was associated with lower peak pressure and maximum force beneath regions of the heel. Compared to the controls, people with plantar heel pain demonstrated reduced heel loading and modified forefoot loading consistent with a strategy to offload the painful heel. Copyright © 2015 Elsevier B.V. All rights reserved.
    Gait & Posture 02/2015; 41(2). DOI:10.1016/j.gaitpost.2015.01.025 · 2.75 Impact Factor
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    • "Currently available orthotics rely on different mechanical concepts. While some products soften the sole of the hind foot to reduce the maximum pressure at heel strike [15], others provide hind foot stabilization and medial midfoot support to slack off the plantar fascia [16] [17] [18]. The purpose of this study was to compare three of the most common mechanical orthotic concepts in a prospective, randomized, controlled cohort study. "
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    ABSTRACT: Evaluation of the effectiveness of three different types of prefabricated foot orthotics in the treatment of plantar fasciitis. Prospective, randomized head-to-head trial in 30 adults (21 women, 9 men) with plantar fasciitis without any anatomic alterations. Three different prefabricated orthotics were tested (thin, non supportive orthotic (NO); soft supportive foam orthotic (FO); foam covered rigid self-supporting plastic orthotic (PO)). The follow up was 3 weeks. Main outcome measures were maximum and average pain (VAS), duration of pain per day, walking distance and subjective comfort. There was no significant effect of NO on maximal pain and average pain. FO and PO had a significant effect on pain levels (p<0.05) whereas PO was superior concerning pain reduction and the time until the onset of effect (p<0.05). PO are superior regarding pain reduction and pain free time when compared to FO. NO did not demonstrate a significant effect in the test setup used.
    Foot and Ankle Surgery 06/2013; 19(2):103-7. DOI:10.1016/j.fas.2012.12.008
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    • "To our knowledge, this is the first study to report on changes in plantar fascia strain when walking in an orthotic device. Indeed, the use of an orthotic device has been recommended as the primary method for the treatment of plantar fasciitis [23-26]. Therefore, the results of the current study suggest that the treatment of foot and ankle injuries such as plantar fasciitis may be due, in part, to reductions in plantar fascia tissue strain. "
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    ABSTRACT: Semi-custom foot orthoses (SCO) are thought to be a cost-effective alternative to custom-made devices. However, previous biomechanical research involving either custom or SCO has only focused on rearfoot biomechanics. The purpose of this study was therefore to determine changes in multi-segment foot biomechanics during shod walking with and without an SCO. We chose to investigate an SCO device that incorporates a heat-moulding process, to further understand if the moulding process would significantly alter rearfoot, midfoot, or shank kinematics as compared to a no-orthotic condition. We hypothesized the SCO, whether moulded or non-moulded, would reduce peak rearfoot eversion, tibial internal rotation, arch deformation, and plantar fascia strain as compared to the no-orthoses condition. Twenty participants had retroreflective markers placed on the right limb to represent forefoot, midfoot, rearfoot and shank segments. 3D kinematics were recorded using an 8-camera motion capture system while participants walked on a treadmill. Plantar fascia strain was reduced by 34% when participants walked in either the moulded or non-moulded SCO condition compared to no-orthoses. However, there were no significant differences in peak rearfoot eversion, tibial internal rotation, or medial longitudinal arch angles between any conditions. A semi-custom moulded orthotic does not control rearfoot, shank, or arch deformation but does, however, reduce plantar fascia strain compared to walking without an orthoses. Heat-moulding the orthotic device does not have a measurable effect on any biomechanical variables compared to the non-moulded condition. These data may, in part, help explain the clinical efficacy of orthotic devices.
    Journal of Foot and Ankle Research 06/2011; 4(1):18. DOI:10.1186/1757-1146-4-18 · 1.46 Impact Factor
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