TUESDAY, March 20, 2018 -- For people with chronic heel pain, costly "custom" shoe inserts are probably a waste of money, a new research review suggests.
Researchers found that pricey devices were generally no better than inexpensive store-bought inserts -- or any other "conservative" treatment -- when it came to managing plantar fasciitis.
Plantar fasciitis causes pain in the heel, due to irritation in the fibrous band of tissue that runs from the heel to the base of the toes.
People who put a lot of "wear and tear" on their feet are more prone to the condition, according to the American Orthopedic Foot and Ankle Society (AOFAS). That includes runners and people who work on their feet -- especially without good, supportive shoes -- and those who are obese or who have very high arches or "flat" feet.
In most cases, the pain goes away within six months, and simple measures, like stretching exercises, are the best way to manage it, the AOFAS says.
Doctors also often recommend "orthoses" -- shoe inserts that support the arch and cushion the heel. The inserts range from basic, off-the-shelf supports to expensive, custom-made versions.
The evidence, however, suggests the pricey types offer no advantage, said Nadine Rasenberg, lead researcher on the new review.
"In studies, it does not seem to matter whether patients were treated with expensive orthoses or over-the-counter orthoses," said Rasenberg, a doctoral student at Erasmus Medical Center in Rotterdam, the Netherlands.
Until there's evidence otherwise, she said, people with plantar heel pain "might consider trying cheaper orthoses first."
Dr. Keith Wapner, a foot and ankle specialist who was not involved in the study, was more blunt.
"There is no reason for people to spend $300 to $500 on custom orthotics for plantar fasciitis," said Wapner, chief of foot and ankle orthopedic surgery at Penn Medicine in Philadelphia.
And patients foot the bill, he noted, because insurance doesn't cover the inserts, due to the lack of evidence.
"Unfortunately," Wapner said, "this has become a cash cow for some providers."
In reality, he said, most patients do well with simple measures.
Wapner explained that plantar fasciitis typically involves tightness in the calf's gastrocnemius muscle. So "proper stretching," which includes targeting that muscle, is a key part of dealing with the condition, he said.
"The problem is, most people don't stretch properly," Wapner noted.
He advised getting advice from your doctor on how to do it: Some patients end up going to physical therapy, Wapner said, but most are fine with a "home program."
He also advised investing in a good, supportive running shoe -- and, if needed, an off-the-shelf insert for extra cushioning.
Wearing a "night splint" to bed can also help, Wapner added. Generally, he explained, people sleep with the foot pointed, which contracts the calf and plantar fascia at the bottom of the foot. A night splint keeps the foot flexed, which stretches the tissue.
People with plantar fasciitis often have pain when they get out of bed and take their first steps of the day, Wapner said.
The review, published in the current British Journal of Sports Medicine, looked at 20 studies testing various foot orthoses.
Overall, researchers found no evidence that custom devices were any better at easing pain or improving people's daily functioning, compared to either off-the-shelf supports or a "sham" insert. The sham versions were simple insoles.
And in most studies, orthoses of any kind proved no better than other conservative therapies, including stretching and night splints, the researchers said.
For the most part, study patients' pain got much better over time, the review found. But it's not clear whether any therapy was better than doing nothing: None of the studies, Rasenberg said, compared treatment with a "wait and see" approach.
The natural course of plantar fasciitis, she said, is "generally favorable" -- so it's hard to tell how that played into study patients' recovery.More information
The AOFAS has an overview of plantar fasciitis.
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