Foot orthotics are a common treatment for the most common cause of heel pain - plantar fasciitis (also known as heel spur syndrome). It can be difficult, however, for patients to know if they are getting the best orthotic to treat their heel pain. To ensure optimum clinical outcomes from orthotic therapy both the patient and the medical practitioner who is prescribing orthotics should understand how orthotics function to treat plantar fasciitis.
The primary purpose of orthotic therapy in most pathologies is to reduce abnormal force on the body structure that is being injured. In the case of
plantar fasciitis/heel spur syndrome, the primary problem is excessive tension on the plantar fascia. Thus, in this situation, the primary function of custom orthotics should be to decrease tension on the plantar fascia. In other pathologies, the primary function of the orthoses will be different as will the orthotic prescription. Even within the single pathology of plantar fasciitis there are many different biomechanical causes and many different optimum prescriptions.
Before prescribing orthoses for plantar fasciitis your practitioner must first determine why, in your case, there is excessive tension on the plantar fascia. Sometimes it is because the heel everts and jams the medial (inside) foot into the ground. This pushes up on the bottom of the first metatarsal and causes the foot to lengthen. This stretches the plantar fascia. In this case the orthotic must stop the heel from everting (heel rolls in). In this situation we prescribe an orthotic that cups deep around the heel and has a built-in wedge that prevents the heel from rolling in.
In other patients suffering from plantar fasciitis and/or heel spurs, the heel stays straight, but the arch collapses again this lengthens the foot and stretches the fascia. In this case the orthotic will be prescribed to focus on arch support a very different function than stopping the heel from turning in. In this case the podiatrist should focus on prescribing an orthotic that conforms very tight to the arch of the foot in order to prevent arch collapse.
Another cause of plantar fasciitis is a tight heel cord. The orthotic for this patient should include a heel lift to reduce tension on the Achilles tendon.
There are other biomechanical reasons why the fascia might be stretched. Each condition might require a somewhat different orthotic prescription in order to achieve the best clinical outcome. For best outcomes, it is critical to have a skilled and knowledgeable practitioner prescribe orthotics. Nothing determines orthotic outcome more than the skill of the practitioner.
