Full length articlePressure-relieving properties of various shoe inserts in older people with plantar heel pain
Introduction
Plantar heel pain is one of the most common musculoskeletal conditions affecting the foot [1]. It is regularly experienced by running athletes [2] and people who are overweight [3], however it has also been reported to affect 4–17% of older people [4], [5]. As the specific cause of pain is often difficult to determine clinically, the broad term plantar heel pain is regularly used [3], [6]. There are many causes of pain in the plantar heel region, although plantar fasciitis is recognised as being the most common [6]. Among older people, heel pain can have a negative impact on foot-specific and general health-related quality of life [7], which includes functional limitation [8].
The aetiology of plantar heel pain remains unclear, but it is likely to be multifactorial with many associated risk factors having been identified, including increased age, obesity, increased hours of standing and some biomechanical or functional factors [1], [9]. In addition, a strong association between plantar heel pain and calcaneal spurs has been identified [9], [10]. This finding is supported by a radiographic study which reported that older people with calcaneal spurs were 5 times more likely to have a current or previous history of heel pain [11].
Shoe inserts have been found to be effective in the management of plantar heel pain [12], [13], [14]. The mechanism by which they achieve their effect is still largely unknown, although it may include a reduction in plantar pressure under the heel [15], [16]. At present, only two studies have investigated the effects shoe inserts have on plantar pressure under the heel in people with a history of plantar heel pain, however one study measured plantar pressures while standing [15], while the other study only included participants who no longer experienced plantar heel pain [16]. In addition, neither study included participants over the age of 65 years. This may be of importance as it has been shown that ageing results in increased heel pad stiffness [17] and decreased energy dissipation [18]. Given that the biomechanics of the heel may differ between young and old people, this study aimed to investigate the pressure-relieving properties of a variety shoe inserts in older people with plantar heel pain.
Section snippets
Participants
The sample consisted of 36 participants, comprising 24 males (67%) and 12 females (33%). Participants were recruited via advertisements in local podiatry clinics, retirement villages and newspapers. Inclusion in the study was conditional on participants: (i) having symptoms consistent with plantar heel pain for a minimum of four weeks in one or both feet; (ii) being aged 65 years or older; (iii) being able to walk household distances without a walking aid; and (iv) having normal cognition, as
Plantar pressure changes
There were a number of significant plantar pressure, force and contact area differences (Fig. 2) between the 5 conditions. As overall contact times did not differ across conditions it can be assumed that the participants walked at a consistent speed during the trials and therefore any differences in plantar pressures can be attributed to the conditions being analysed (Table 2).
Discussion
The attenuation of heel peak pressure provided by the prefabricated foot orthosis was approximately five-fold that of the next two most effective inserts – the soft foam heel pad and silicon heel cup. Interestingly, the soft foam heel pad and silicon heel cup both provided similar reductions in heel contact area, peak pressure and maximum force. Such a finding may be of financial importance as both heel inserts vary substantially in cost; with supply prices at the time of the study being
Conclusion
The results of this study suggest that prefabricated foot orthoses and some heel inserts provide immediate reduction in heel plantar pressure in older people with plantar heel pain while walking. Furthermore, the cost of a heel insert or orthosis was not found to be indicative of its ability to reduce heel plantar pressure. Importantly, the contoured foot orthosis used in this study provided a five-fold attenuation in plantar heel peak pressure compared to the next most effective heel insert.
Conflicts of interest
The authors declare that there are no known conflicts of interest related to this project that could have influenced this manuscript.
Acknowledgements
The authors would like to thank: Briggate Medical Company Pty Ltd. (Melbourne, Australia) for providing the foot orthoses and heel inserts; and Texas Peak Pty Ltd. (Melbourne, Australia) for donating the socks used in this study. HBM is currently a National Health and Medical Research Council of Australia fellow (Clinical Career Development Award, ID: 433049).
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