Custom Foot Orthotics for the Treatment of Plantar Fasciitis By - - PowerPoint PPT Presentation

Custom Foot Orthotics for the Treatment of Plantar Fasciitis

By Reese Wilmoth

Purpose and Question

Purpose Are custom foot orthotics effective in treating plantar fasciitis? Question For a 54 year old male patient with plantar fasciitis, are custom foot orthotics effective in decreasing pain and increasing function after two months of continuous use?

Patient Details/Demographics

• Mr. H is a 54 year old caucasian male.
• He reports no comorbidities, prior surgeries, or

medications

• He works in lawn care and home repair and is
• n his feet most of the day.

Patient Details/History

• CC: pain in right heel.
• Pain dates back 7 to 8 years - worse when he

wakes up and with jogging and after weight bearing.

• Visited PCP 2 weeks prior and was diagnosed

with plantar fasciitis.

• Patient reports that he has tried over the

counter orthotics in the past with minimal relief.

Patient Details/Goals

• Pain: Best 1/10, current 1/10, worst 8/10
• FOTO score: Intake 73/100, Predicted

80/100

• FOTO predicts 7 point improvement in 9

PT visits. Patient Goals Work without pain 2/10 Jogging without pain 2/10

What is FOTO?

• Series of functional questions

where the following question is chosen based on previous answers.

• FOTO measures patient functional

status using computer adaptive technology.

• Uses risk adjusted algorithms to

predict outcomes and give PTs and patient benchmarks.

Initial Evaluation : Significant Findings

Prone - PROM Left Right Dorsiflexion (STJN)

• 10
• 12

degrees Eversion 5 degrees Leg to Rearfoot (STJN)4 9 degrees of Varus Rearfoot to forefoot (STJN) 4 3 degrees of varus

Other findings

TTP - at medial calcaneal tubercle and plantar intrinsics. Sx increases with Windlass technique.

PT diagnosis

Plantar fasciitis likely secondary to biomechanical deficits resulting in fat pad shearing and inflammation of the plantar aponeurosis and plantar intrinsics.

Article 1 - Gross et al.

JOSPT Impact Factor:2.8

Gross et al.

Purpose - Determine impact of Custom orthotics on pain and disability for individuals with plantar fasciitis. Design - single group pre- and post-intervention repeated measures design.

Gross et al. Methods and Measures

Methods - 8 men and 7 women (mean age 44 +/- 9 years) who reported plantar fasciitis symptoms for an average of 21 to 24 months Measures - taken before orthotics and after 12-17 days of continuous use.

• 100 m walk at self selected speed - then patients rated pain they experienced

using 10 cm visual analog scale.

• Subjects also completed the pain and disability subjections of the foot function

index questionnaire

Gross et al. Results

Foot Function Index results

• Post-orthotic pain subsection

showed 66% reduction in pain rating.

• Post-orthotic disability subsection

showed a 75% reduction in disability ratings.

Gross et al. Results

• 100 m walk times were not

significantly different pre- vs post- orthotics.

• Pre- orthotic pain rating

(mean 3.0 +/- 1.7) vs. post-orthotic pain rating (mean 0.7 +/- 0.7)

Gross et al. Conclusions

• Custom semirigid foot orthotics may significantly reduce pain experienced

during walking, and may reduce more global measures of pain and disability for patients with chronic plantar fasciitis.

Gross et al.

Strengths

• Average 21 months of symptoms -

Chronic.

• Difficult for normal tissue changes to

account for change in 12-17 days.

• 11 subjects had used non custom arch

supports, 10 had used NSAIDS.

• Large magnitude of changes (treatment

effect vs. Placebo effect) Weaknesses

• NO CONTROL
• Likely huge placebo effect
• Self report outcome measures

Article 2 - Landorf et al.

Jama

JAMA Internal Medicine Impact factor: 16.5

Landorf et al.

Purpose - Evaluate the short and long term effectiveness of foot orthoses. Design - 3 armed, Participant Blinded Randomized Trial. Methods - 135 (age mean 47 +/- 11.7 years) participants with plantar fasciitis randomly allocated to receive a sham orthosis (soft, thin foam), a pre-fabricated

• rthosis (firm foam), or a customized semirigid orthosis.

Landorf et al. Outcome measures

Pain and function at 3 and 12 months

• Pain and Function domains of Foot

Health Status Questionnaire. Timeline

• Received orthotics 2-3 weeks after

standardized assessment and molds were taken.

Landorf et al. Results

• After 3 months, pain and function measurements favored the prefabricated and

customized orthotics over the sham orthoses (only function was significant).

• Prefabricated was slightly favored over custom (not significant)
• No significant effects on either outcome at 12 month review.

Landorf et al. Conclusions

Foot orthoses produce small short-term benefits in function and may cause small reductions in pain for people with plantar fasciitis, but they do not have long term beneficial effects compared with a sham device.

Landorf et al.

Strengths

• First to compare real orthoses to a sham.
• 12 month follow up
• Validated health status measures of

functions and pain.

• 3% loss to follow up.

Limitations

• All participants were chronic (acute

effects could differ)

• Assessor was not blinded.

Other Relevant Research - Pain

• Inconclusive at best.

Application to Patient

Patient fits the inclusion criteria for both studies but is more chronic. Conclusion - low likelihood of potential short term benefit. Likely no long term changes. Patient tried prefabricated orthotics previously with little relief.

Patient treatment

Eval - was casted for custom fit orthotics and given HEP of DF towel stretch, hurdle stretch, and stair stretch. 2 weeks later - Fitted with custom fit orthotics and HEP review. Shoe recommendation given. 6 weeks later (1 month follow up from fitting)...

Patient Outcome - 1 month follow up

Pain - Best 0/10, Current, 0/10 Worst - 2/10 FOTO score - 81/100 Patient Goals Work without pain 9/10 Jog without pain 8/10

• Plan to see Patient in 2-3 years for follow up and casting for new orthotics.

Cost Effective?

Pre-fabricated - $45-90 Custom - $225-300 Other PT interventions -$?

Lessons Learned

• Maybe some short term benefits.
• Likely little difference between Prefabricated and custom orthotics.
• A tool...but an expensive one.
• Need more research.

References

Gross MT, Byers JM, Krafft JL, Lackey EJ, Melton KM. (2002). The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. Journal of Orthopedic and Sports Physical Therapy, 32. 149-157. Landorf KB, Keenan A, Herbert RD. (2006). Effectiveness of foot orthoses to treat plantar fasciitis: A randomized trial. Journal

• f American Medical Association Internal Medicine, 166(12), 1305–1310. doi:10.1001/archinte.166.12.1305

References

https://www.hirerush.com/blog/wp-content/uploads/2016/01/summer-mowing. jpg https://www.hendersonpodiatry.com/images/prefabproducts.jpg http://advancedcarephysicaltherapy.com/files/2011/09/foto1.jpg https://www.physio-pedia.com/images/c/c7/Windlass.jp http://kineticlearningcentre.com/pdf/fhsq_full.pdf