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Effects of a Custom-Fit Orthosis for Plantar Fasciitis
Physical therapists are front and center in the nonsurgical treatment of plantar fasciitis, a painful foot condition that affects 10 per cent of all Americans at some time in their lives. With an estimated one million patient visits to physicians each year in the United States for this painful condition, finding effective treatment strategies has become an important research goal.
One of those treatments is the use of a custom made foot orthosis. That's the focus of this study. An orthosis is a molded piece of plastic that is made to fit each individual's foot. It is worn inside the shoe with the express purpose of taking weight off the plantar fascia while standing and walking (i.e., during weight-bearing).
The plantar fascia is a thick band of connective tissue that goes from the base of the heel to the base of each toe. It actually forms an arch the length of the foot and provides needed support during all weight-bearing activities.
What goes wrong that so many people suffer from this problem? Our understanding and thinking about plantar fasciitis has changed over the years as new studies examine the tissue more closely. Instead of active inflammation, scientists report this condition is actually more of a degenerative problem.
There probably isn't one single reason why someone starts to develop heel and foot pain from plantar fasciitis. Foot and ankle alignment certainly seem to head up the list of "reasons why I have plantar fasciitis." For example, a flat foot with no arch or a naturally high arch that is not properly supported is commonly present in patients with plantar fasciitis.
Other risk factors that may contribute to the problem include being overweight, weak plantar flexor muscles, limited ankle dorsiflexion (movement of the foot toward the face), trauma, and deformity or alignment issues in other areas of the ankle and/or foot.
Likewise, there doesn't appear to be one individual way to treat this problem successfully with each patient. Treatment options range anywhere from stretching, taping, and manual therapy to electrical therapy, steroid injections, and surgery. The idea to use splinting or bracing (orthotics) is not new either.
The authors of this study combined the temporary use of a custom foot orthosis with stretching to see how well these two treatment tools work. Patients included in the study had heel pain that was the worst when getting up after resting or inactivity. This symptom called first-step pain is typical of plantar fasciitis.
No one in the study had been treated with any other approach before trying this plan of temporary orthosis and stretching. Everyone was examined closely and measures of motion for the low back, hip, knee, ankle, and foot were taken. Clinical tests for plantar fascia problems (e.g., palpation, Windlass test) were also conducted and results recorded.
A physical therapist made the special orthotic for each patient in the study. The insert was designed to...
Review of Shoes and Shoe Supports
Sometimes the foot needs protection with a special shoe or an insert inside the shoe called a foot orthosis. The orthosis absorbs shock and cushions, supports, and controls the foot.
In this article, two shoe and orthotic specialists called pedorthists review shoes and orthoses used for a variety of foot problems. Anyone from a sports athlete to an older adult with diabetes can benefit from foot orthoses.
The insert can be modified for each person. Areas of high pressure can be off-loaded. Tender sites can be cushioned to avoid skin break down. Some deformities can be corrected to improve motion and function. Rigid deformities can be stabilized and supported. The end result is to relieve pain and prevent the condition from getting worse.
Shoes that have many modifications already built-in may be enough support for some problems without using an orthosis. Flares, a strip of firm material, along the inside or outside of the main body of the shoe can help stabilize the foot. There are also different kinds of soles. For example, a steel or graphite shank may be used between the layers of the sole to provide a firm support.
The authors provide drawings and descriptions of half-a-dozen other soles available. These include a mild rocker sole as well as a heel-to-toe, toe only, severe angle, negative heel rocker and double rocker sole. Modifications to shoe soles are made to reduce bending stresses through the midfoot and forefoot.
The second half of the article is a review of foot orthoses. These shoe inserts can be purchased off-the-shelf and used as is. Or they can be custom-made by a pedorthist. Custom-made means a mold or model of the patient's foot is used to construct the device. A three-dimensional (3-D) scan of the foot can be used to make a computer-generated model.
Orthotics come in a wide range of materials and densities. Most people can use a prefab orthotic. Patients with severe deformities, loss of sensation, and/or pressure ulcers often need a custom foot orthosis.
Selection is based on the desired function of the insert. For example, soft, less dense materials can be used with preventive padding for the active patient who is not too large or overweight. This type of insert is called an accomodative foot orthoses.
A semi-rigid orthosis has a soft, top layer of cushion over a firm, supportive base. This design distributes support across the foot without compressing the tissues. Patients with pressure over areas of bone can use this type of orthosis to off-load the weight-bearing surfaces. The semi-rigid orthosis is also good for reducing shear needed to get rid of blisters and prevent calluses from forming.
More involved custom foot orthotics are needed for patients with foot amputations. The rigid foot orthosis provides good arch support but does not mold or conform to bony prominences on the bottom of the foot. They are made of rigid plastics and are not easy to adjust. Rigid orthos...