Original research
Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis

https://doi.org/10.1016/j.ptsp.2008.09.002Get rights and content

Abstract

Objectives

To perform a meta-analysis examining the effects of foot orthoses on self-reported pain and function in patients with plantar fasciitis.

Data Sources

MEDLINE, SPORTDiscus, and CINAHL were searched from their inception until December 2007 using the terms “foot”, “plantar fascia”, “arch”, “orthotic”, “orthoses” and “plantar fasciitis”.

Study Selection

Original research studies which met these criteria were included: (1) randomised controlled trials or prospective cohort designs, (2) the patients had to be suffering from plantar fasciitis at the time of recruitment, (3) evaluated the efficacy of foot orthoses with self-reported pain and/or function, (4) means, standard deviations, and sample size of each group had to be reported.

Results

We utilised the Roos, Engstrom, and Soderberg (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606–611) night splint condition to compare our pooled orthoses results. The meta-analysis results showed significant reductions in pain after orthotic intervention. The Roos et al.' (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606–611) study also showed significant reduction in pain after night splint treatment. The meta-analysis results also showed significant increases in function after orthotic use. In contrast, the Roos et al.' (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606–611) study did not show a significant increase in function after night splinting for 12 weeks.

Conclusion

The use of foot orthoses in patients with plantar fasciitis appears to be associated with reduced pain and increased function.

Introduction

Plantar fasciitis is a chronic injury which causes pain and inflammation at the origin of the plantar fascia on the plantar surface of the heel (Charles, 1999, Crawford, 2005, Gould, 2003). Plantar fasciitis is frequently seen in athletic populations (Lehman, 1984, Warren, 1990) and military recruits (Sadat-Ali, 1998), but it is also observed in the sedentary population (Davis et al., 1994, Riddle et al., 2004, Riddle and Schappert, 2004). In an epidemiological study (Chandler & Kibler, 1993), approximately 10% of recreational runners reported plantar fasciitis. More recently, Taunton et al. (2002) showed that 159 out of 267 running injury patients had plantar fasciitis. For more general and sedentary populations, 6.9% of the people who were randomly selected and aged over 65 years had plantar fasciitis (Badlissi et al., 2005, Dunn et al., 2004). Therefore, it has been believed that regardless of activity level of individuals, plantar fasciitis is quite common.

The pain induced by plantar fasciitis is often severe enough to make runners stop their regular running schedule and to also limit the mobility of more sedentary individuals. Symptoms of this condition are frequently reported to be worse in the morning because the plantar fascia stiffens overnight, loses its ability to stretch optimally and eventually triggers pain (Batt et al., 1996, Biedert, 1991, Charles, 1999, Cornwall and McPoil, 1999). Remaining untreated, this type of injury may further lead to the calcification of the plantar calcaneal tuberosity where the plantar fascia and intrinsic muscles are attached (Crawford, 2004, Kwong et al., 1988, Lynch et al., 1998). This condition, which is called “heel spur syndrome”, induces more severe pain than plantar fasciitis and is difficult to treat (Flicek, 2006, Torg et al., 1987, Williams, 1987).

Plantar fasciitis is successfully treated non-operatively within at most 4–6 months in approximately 90% of patients with the condition (Hawke, Burns, Radford, & du Toit, 2008). However, surgical treatment is recommended if the patient has persistent and severe symptoms refractory to nonsurgical intervention for at least 6–12 months (Hawke et al., 2008). Among various treatment for plantar fasciitis, foot orthoses are one of the most common approaches. There have been various methods used to reduce pain and increase foot function using foot orthoses. Various types of orthoses including forefoot and rearfoot posted orthoses (Kogler et al., 1999, Marr and Pod, 1980), longitudinal arch supports (Kogler et al., 1995, Kogler et al., 1996), magnetized orthoses (Winemiller, Billow, Laskowski, & Harmsen, 2003), heel pads/cups (Landorf, Keenan, & Herbert, 2004) and cushioned orthoses have been used in an effort to control excessive pronation and decrease ground reaction forces during gait. Even though biomechanical analysis to examine the effectiveness of orthoses has shown sound theoretical rationale (Hsi et al., 1999, Kogler et al., 1995, Kogler et al., 1996, Kogler et al., 1999, Torg et al., 1987), the evidence of the clinical efficacy of foot orthoses to reduce pain and enhance functional activities in patients with plantar fasciitis is not well established and has shown inconsistent results.

Lynch et al. (1998) reported that treatment with orthoses was more effective than either anti-inflammatory or traditional rehabilitation such as stretching and strengthening in terms of pain relief. Using prefabricated orthoses has been reported to relieve pain more compared to stretching and customized orthoses (Pfeffer et al., 1999). However, Landorf et al. (2004) and Martin et al. (2001) reported that there were no differences in pain between customized orthoses, and night splint and over-the-counter orthoses. Similarly, there are inconsistent findings in the literature in regards to the effectiveness of orthoses in improving self-reported foot function in patients with plantar fasciitis (Landorf et al., 2006, Rome et al., 2004, Roos et al., 2006). In addition, the number of subjects in individual studies has been typically low, thus making it difficult to generalize findings. Pooling the data from individual studies may provide more clinically meaningful information.

The purpose of this meta-analysis was to examine the short, intermediate and long-term effects of orthoses on measures of self-reported pain and function in patients with plantar fasciitis. To accomplish our goal we examined the effectiveness of orthoses intervention to decrease pain and enhance foot function solely from randomised control trials and prospective cohort studies.

Section snippets

Search strategy

Relevant studies were identified in a search of PubMed (1966–2007), SPORTDiscus (1975–2007), and CINAHL (1980–2007). The search was limited to human subjects and articles published in the English language. The search terms used in this study were: foot; plantar fascia or arch or arches; orthosis or orthoses or insert or insole; plantar fasciitis and heel pain; combination of all the above terms. All sources were cross-referenced to identify other potential studies to be included.

Study selection

Two reviewers

Results

The PEDro Scores of selected studies are shown in Table 2. The average PEDro score of the studies that is included in this paper was 6.2 ± 2.4.

As is shown in Fig. 2, the meta-analysis results showed significant reductions in pain at all three time periods: less than 6 weeks of follow-up (Z = 24.1%, 95% CI: 19.7–28.50), from 6 to 12 weeks of follow-up (Z = 15.2%, 95% CI: 11.8–18.7), and more than 12 weeks of follow-up (Z = 37.0%, 95% CI: 32.3–41.9). The Roos et al.'s (2006) study showed significant

Discussion

In this review, we aimed to assess the effectiveness of foot orthoses on plantar fasciitis in terms of pain control and foot function. The results of this review indicate that foot orthoses decrease the pain and foot function in patients with plantar fasciitis regardless of the specific type of orthosis used. Our results support the notion that the use of orthoses will alleviate plantar foot pain and improve foot function regardless of types of orthoses (e.g. magnetic, nonmagnetic,

Conclusion

There is evidence that orthosis intervention has short, intermediate, and long-term effects on decreasing pain and foot function in patients with plantar fasciitis. On the other hand, the control group (night splint group) we considered for comparison showed substantial improvement in pain, but not for self-reported foot function. Adding a true control group to examine the effectiveness of orthosis intervention is recommended in future studies. In addition, the orthosis intervention should be

Conflict of interest

Statement for conflict of interest for this study is not applicable since this study is meta-analysis.

Ethical Approval

Ethical approval of this study is not applicable for this study.

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