Advertisement

Treating Heel Pain in Adults: A Randomized Controlled Trial of Hard vs Modified Soft Custom Orthotics and Heel Pads

Published:November 17, 2020DOI:https://doi.org/10.1016/j.apmr.2020.10.124

      Abstract

      Objectives

      This study compared the effectiveness of soft vs hard orthotics in treating heel pain and plantar fasciitis in adults. It also compared the level of function after orthotic use, cost, and number of visits for orthotics and explored whether age was a factor in orthotic effectiveness.

      Design

      Randomized controlled trial. Before randomization, patients were stratified by age (younger vs older adults) in blocks of 4 to ensure that there were an equal number of participants in each group (soft vs hard orthotics).

      Setting

      An orthotic clinic in a community-based hospital and a private orthotic clinic.

      Participants

      The participants were adults aged 18 years or older (N=44) with heel pain and plantar fasciitis.

      Intervention

      Participants received hard or soft customized orthotics.

      Main Outcome Measures

      Participants rated their pain intensity and pain interference before and after orthotic use using subscales from the Brief Pain Inventory. Function was similarly measured using the Late Life Function and Disability Instrument: Function component. Analyses of age, cost, and number of visits were also compared.

      Results

      There was a reduction in pain intensity (P=.010) and pain interference (P<.001) but no change in function over time (P=.333), and no difference between the groups who received hard vs soft orthotics. Age had no effect on orthotic effectiveness. Soft orthotics were less expensive (P<.0001) and required fewer visits for fabrication (P<.0001).

      Conclusion

      Both soft and hard orthotics provided effective pain relief, but soft orthotics are less expensive.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), BPI (Brief Pain Inventory), FDI (Function and Disability Component)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dale S.
        • David D.
        • Sykes T.
        Effective approaches to common foot complaints.
        Patient Care. 1997; 31: 158-174
        • Thompson J.V.
        • Saini S.S.
        • Reb C.W.
        • Daniel J.N.
        Diagnosis and management of plantar fasciitis.
        J Am Osteopath Assoc. 2014; 114: 900-906
        • Pohl M.
        • Hamill J.
        • Davis I.
        Biomechanical and anatomic factors associated with a history of plantar fasciitis in female runners.
        Clin J Sport Med. 2009; 19: 372-376
        • Neufeld S.K.
        • Cerrato R.
        Plantar fasciitis: evaluation and treatment.
        J Am Acad Orthop Surg. 2008; 16: 338-346
        • Caselli M.
        • Clark N.
        • Lazarus S.
        • Velez Z.
        • Venegas L.
        Evaluation of magnetic foil and PPT insoles in the treatment of heel pain.
        J Am Podiatr Med Assoc. 1997; 87: 11-16
        • Bedinghaus J.M.
        • Niedfeldt M.W.
        Over-the-counter foot remedies.
        Am Fam Physician. 2001; 64: 791-796
        • Roos E.
        • Engström M.
        • Söderberg B.
        Foot orthoses for the treatment of plantar fasciitis.
        Foot Ankle Int. 2006; 27: 606-611
        • Cutts S.
        • Obi N.
        • Pasapula C.
        • Chan W.
        Plantar fasciitis.
        Ann R Coll Surg Engl. 2012; 94: 539-542
        • Rome K.
        • Gray J.
        • Stewart F.
        • Hannant S.
        • Callaghan D.
        • Hubble J.
        Evaluating the clinical effectiveness and cost-effectiveness of foot orthoses in the treatment of plantar heel pain.
        J Am Podiatr Med Assoc. 2004; 94: 229-238
        • Landorf K.
        • Keenan A.
        • Herbert R.
        Effectiveness of foot orthoses to treat plantar fasciitis.
        Arch Intern Med. 2006; 166: 1305-1310
        • Rome K.
        • Spearman M.
        Clinicians’ view of foot orthotic therapy associated with plantar heel pain.
        Br J Podiatry. 2004; 7: 77-82
        • Seligman D.A.
        • Dawson D.R.
        Customized heel pads and soft orthotics to treat heel pain and plantar fasciitis.
        Arch Phys Med Rehabil. 2003; 84: 1564-1567
        • Hulley S.
        • Cummings S.
        • Browner W.
        • Grady D.
        • Hearst N.
        • Newman T.
        Designing clinical research.
        2nd ed. Wolters Kluwer/Lippincott Williams & Wilkins, Philadelphia2001
        • Daut R.
        • Cleeland C.
        • Flanery R.
        Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases.
        Pain. 1983; 17: 197-210
        • McDowell I.
        • Newell C.
        Measuring health: a guide to rating scales and questionnaires.
        Oxford University Press, New York1987
        • Tyler E.
        • Jensen M.
        • Engel J.
        • Schwartz L.
        The reliability and validity of pain interference measures in persons with cerebral palsy.
        Arch Phys Med Rehabil. 2002; 83: 236-239
        • Mendoza T.
        • Chen C.
        • Brugger A.
        • et al.
        The utility and validity of the modified Brief Pain Inventory in a multiple-dose postoperative analgesic trial.
        Clin J Pain. 2004; 20: 357-362
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: global use of the Brief Pain Inventory.
        Ann Acad Med Singap. 1994; 23: 129-138
        • Haley S.
        • Jette A.
        • Coster W.
        • et al.
        Late Life Function and Disability Instrument: II. development and evaluation of the function component.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M217-M222
        • Maxwell J.L.
        • Keysor J.J.
        • Niu J.
        • et al.
        Participation following knee replacement: the MOST cohort study.
        Phys Ther. 2013; 93: 1467-1474
        • Davis A.M.
        • Perruccio A.V.
        • Ibrahim S.
        • et al.
        The trajectory of recovery and the inter-relationships of symptoms, activity and participation in the first year following total hip and knee replacement.
        Osteoarthritis Cartilage. 2011; 19: 1413-1421
      1. Statistics Canada. Consumer price indexes for Canada; All-items (index, 1992=100) [p1000000]. 2005.

        • Young B.
        • Walker M.J.
        • Strunce J.
        • Boyles R.
        A combined treatment approach emphasizing impairment-based manual physical therapy for plantar heel pain: a case series.
        J Orthop Sports Phys Ther. 2004; 34: 725-733
        • McClinton S.M.
        • Cleland J.A.
        • Flynn T.W.
        Predictors of response to physical therapy intervention for plantar heel pain.
        Foot Ankle Int. 2015; 36: 408-416
        • Hillstrom H.J.
        • Whitney K.
        • Mcguire J.
        • et al.
        Biomechanical assay of a specially designed insole for plantar fasciitis/heel spur syndrome.
        Gait Posture. 1996; 4: 195
        • Lynch D.
        • Goforth W.
        • Martin J.
        • Odom R.
        • Preece C.
        • Kotter M.
        Conservative treatment of plantar fasciitis. A prospective study.
        J Am Podiatr Med Assoc. 1998; 88: 375-380
        • Doxey G.
        The semi-flexible foot orthotic: fabrication and guidelines for use.
        J Orthop Sports Phys Ther. 1983; 5: 26-29
        • Eng J.
        • Pierrynowski M.
        The effect of soft foot orthotics on three-dimensional lower-limb kinematics during walking and running.
        Phys Ther. 1994; 74: 836-844
        • Bergmann J.N.
        History and mechanical control of heel spur pain.
        Clin Podiatr Med Surg. 1990; 7: 243-259
        • World Health Organization
        International classification of functioning, disability, and health.
        World Health Organization, Geneva2001
        • Doxey G.
        Calcaneal pain: a review of various disorders.
        J Orthop Sports Phys Ther. 1987; 9: 25-32
        • Nawoczenski D.A.
        • Epler M.E.
        Orthotics in functional rehabilitation of the lower limb.
        WB Saunders Co, Philadelphia1997
        • Kwong P.K.
        • Kay D.
        • Voner R.T.
        • White M.W.
        Plantar fasciitis. Mechanics and pathomechanics of treatment.
        Clin Sports Med. 1988; 7: 119-126