October 2009, Vol. 38 No. 10
Orthotics and Heel Pain—Jason KK Chia et al
Comparative Trial of the Foot Pressure Patterns between Corrective Orthotics,
Formthotics, Bone Spur Pads and Flat Insoles in Patients with Chronic Plantar
Jason KK Chia,1MSpMed (Aust), Sanjay Suresh,2Dip Biomed Eng, Angeline Kuah,2Dip Biomed Eng, Jean LJ Ong,2Dip Biomed Eng,
Jessie MT Phua,3BSc (Podiatry), Ai Ling Seah,3 BSc (Podiatry)
Plantar fasciitis accounts for an estimated one million
visits per year to the doctor in the United States,1 and makes
up approximately 25% of all foot injuries in runners.2
Although the majority of the cases resolve within 10 months,
10% develop chronic plantar fasciitis.3 The pathomechanics
of plantar fasciitis is assumed to be due to excessive tensile
loading, exacerbated by abnormal biomechanics of the legs
such as pes planus, leg length discrepancy, and tightness
of calf muscles.4,5
Treatment includes rest, anti-infl ammatory medication,
shoe inserts, night splints, stretching, iontophoresis,
corticosteroid injections, extracorporeal shockwave therapy
and surgery. There is no evidence that any specifi c mode
of treatment is particularly effective.6
Orthotics is thought to relieve symptoms by reducing
strain in the fascia.7,8 While this has been borne out in
cadaveric studies,9,10 the clinical effi cacy of orthotics
Plantar fasciitis may result when the plantar fascia enthesis
fail to adapt to compressive, bending or shearing forces11
rather than tensile forces as suggested by Warren.12 Thus
orthoses that reduce compressive loads on the plantar fascia
may address the root cause of plantar fasciitis.
1 Department of Sports Medicine, Changi General Hospital, Singapore
2 School of Engineering, Ngee Ann Polytechnic, Singapore
3 Department of Clinical Support Services (Podiatry), Changi General Hospital, Singapore
Address for Correspondence: Dr Chia Kok Kiong Jason, Department of Sports Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
Introduction: The objective of the study is to compare the effi cacy of fl at insoles, bone spur
pads, pre-fabricated orthotics and customised orthotics in reducing plantar contact pressure of
subjects with plantar fasciitis. Materials and Methods: This is a controlled non-blinded com-
parative 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. Results: 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
signifi cantly. The power ratio of the rearfoot region decreased with the use of formthotics and
customised orthotics. Conclusion: 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
Ann Acad Med Singapore 2009;38:869-75
Key words: Biomechanics, Heel pain
October 2009, Vol. 38 No. 10
Orthotics and Heel Pain—Jason KK Chia et al
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