ABSTRACT
Introduction: The objective of the study is to compare the efficacy of flat insoles, bone spur pads, pre-fabricated orthotics and customised orthotics in reducing plantar contact pressure of subjects with plantar fasciitis. Materials and Methods: This is a controlled non-blinded comparative study conducted in a tertiary medical institute. Thirty subjects with unilateral plantar fasciitis between the ages of 20 and 65 years were recruited at the sports medicine clinic. The contact pressures and pressure distribution patterns in both feet for each subject were measured with sensor pressure mats while standing. Repeat measurements were made with the subjects wearing shoes, flat insoles, bone spur heel pads, pre-fabricated insoles and customised orthotics on both feet. The asymptomatic side was used as the control. Contact pressure measurements of the symptomatic and asymptomatic feet and power ratio of the pressure distribution pattern of the rearfoot were then compared. Results: Contact pressure was higher on the asymptomatic side due to unequal distribution of weight. Bone spur heel pads were ineffective in reducing rearfoot pressure while formthotics and customised orthotics reduced peak rearfoot pressures significantly. The power ratio of the rearfoot region decreased with the use of formthotics and customised orthotics. Conclusion: Pre-fabricated orthotics and customised orthotics reduced rearfoot peak forces on both sides while bone spurs heel pad increase rearfoot peak pressures. Pre-fabricated and customised orthotics are useful in distributing pressure uniformly over the rearfoot region.
Plantar fasciitis accounts for an estimated one million visits per year to the doctor in the United States,1 and makes up approximately 25% of all foot injuries in runners.2 Although the majority of the cases resolve within 10 months, 10% develop chronic plantar fasciitis.3 The pathomechanics of plantar fasciitis is assumed to be due to excessive tensile loading, exacerbated by abnormal biomechanics of the legs such as pes planus, leg length discrepancy, and tightness of calf muscles.4,5
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