Foot orthotics may not be superior to conservative treatment for relieving plantar heel pain

Foot orthotics, even if they're custom-made, may be no better than conservative treatments at improving pain or function in patients with plantar heel pain, according to a recent systematic review and meta-analysis.

Researchers included 20 studies, 12 of which had low risk of bias, that assessed the effects of eight different types of foot orthotics. Eligible studies were randomized controlled trials that compared foot orthotics with a control (no intervention, sham, or other conservative treatment, such as stretching exercises or corticosteroid injections) and reported the outcomes of pain, function, or self-reported recovery among patients with plantar heel pain. There were no restrictions on the type of measurement tool or intervention duration.

Results were published online on March 19 by the British Journal of Sports Medicine.

Researchers pooled data from six studies comparing the effects of custom-made, prefabricated, and sham orthotics on pain. There was no difference between prefabricated and sham orthotics in the outcome of short-term pain, defined as up to three months of follow-up (mean difference, 0.26; 95% CI, −0.09 to 0.60). In addition, there was no difference in short-term pain in comparisons of sham versus custom orthotics (mean difference, 0.22; 95% CI, −0.05 to 0.50) or prefabricated versus custom orthotics (mean difference, 0.03; 95% CI, −0.15 to 0.22).

Pooled data on short-term function from two studies showed that there was no significant difference between real and sham orthotics (standardized mean difference, 0.23; 95% CI, −0.06 to 0.51). Most studies reported no differences in the effectiveness of the interventions, but 10 studies did find significant differences in an outcome measure at some time point. However, most of the significant differences were small and not clinically relevant.

The study authors noted limitations of the review, including heterogeneity between the interventions applied in the included studies and a broad definition of plantar heel pain. “We conclude that clinicians should be reserved in prescribing foot orthoses in all patients with [plantar heel pain] and take factors like patient preference and adherence into account,” they wrote.