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Don Lavoie is alcohol programme manager at Public Health England and Gul Root is lead pharmacist, Health and Wellbeing Directorate, Public Health England
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a foot orthotics imageMarch 23 2018

Custom-made foot orthoses appear to be no more effective than cheaper over-the-counter insoles or other treatments to stop heel pain, a new study has concluded.

Dutch researchers looked at the outcomes on plantar heel pain as foot orthoses are often recommended, despite a lack of evidence. The meta-analysis included 20 trials involving eight different foot orthoses with results from 1,756 patients. Outcomes were the effects on pain, function and self-reported recovery in patients with plantar heel pain.

“Pooled data from six studies showed no difference between prefabricated orthoses and ‘sham’ orthoses (simple insoles bought over the counter) for pain in the short term,” the researchers found. “Nor was there a difference between prefabricated orthoses and custom orthoses for pain in the short term. Overall, for the majority of other interventions, no significant differences were found.”

Most of the studies showed that symptoms had improved significantly in all patients, whether with custom-made orthoses or other conservative interventions. Much of this was probably due to plantar heel pain tending to improve after 12 months on its own.

“Foot orthoses are not superior for improving pain and function compared with sham or other orthoses, or other conservative interventions in patients with PHP [plantar heel pain],” the researcher said. “We conclude that clinicians should be reserved in prescribing foot orthoses in all patients with PHP and take factors like patient preference and adherence into account.”

Plantar heel pain accounts for between 11% and 15% of all foot symptoms that require medical attention in adults and for 8%–10% of all running-related injuries.

“The most commonly prescribed treatments for plantar pain include modified footwear, taping, stretching exercises, anti-inflammatory agents, extra-corporal shock wave therapy, strengthening exercises and cortisone injections, but there is still a lack of consensus on which treatments are most effective,” said the British Journal of Sport Medicine, which published the study.

N Rasenberg et al. ‘Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis’. Br J Sports Med. Published online March 19 2018. doi: 10.1136/bjsports-2017-097892.    

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