With time, shoe inserts may help ease plantar heel pain

23 October 2017: It could take a little time for orthotic shoe inserts to help relieve plantar heel pain, but the prefabricated versions sold in drugstores may work just as well as more expensive custom alternatives, a recent study suggests.

Plantar heel pain is one of the most common foot ailments, affecting about 4 percent of the population and an even higher proportion of elderly people and athletes, researchers note in the British Journal of Sports Medicine. Many doctors recommend shoe inserts to ease this pain by supporting the arches and taking pressure off the heel, but research to date has been inconclusive about the effectiveness of this approach.

For the current study, researchers analyzed data from 19 previously published studies with a total of 1,660 participants. They found moderate-quality evidence that orthotic shoe inserts worked better than sham inserts at reducing pain after people had worn them for a bit - from about 7 to 12 weeks of use.

For this same time frame, customized orthotics appeared a bit better at easing pain than prefabricated versions, but the difference was too small to rule out the possibility that it was due to chance, the study also found.

“Our finding that foot orthoses can effectively reduce pain suggests that they are a valid treatment option for plantar heel pain,” said lead study author Glen Whittaker, a podiatry researcher at La Trobe University in Victoria, Australia.

“Furthermore, because we found that contoured prefabricated foot orthoses are as effective for plantar heel pain as customized foot orthoses, prefabricated foot orthoses should be used initially rather than customized foot orthoses because they cost less and are immediately available,” Whittaker said by email.

The most common cause of heel pain is what’s known as plantar fasciitis, which occurs when the ligament connecting the heel bone to the toes gets strained, weakened, swollen and irritated or inflamed.

Shoe inserts may reduce plantar heel pain by redistributing pressure away from the bottom of the heel to the arch, and may also prevent the arch from dropping, which could reduce tension in the plantar fascia, Whittaker said.

Foot orthotics didn’t appear to help ease pain or improve function after up to 6 weeks of use, or beyond 12 weeks of use, the study also found.

This suggests that patients who want to try orthotics might want to initially use them in conjunction with medication to ease pain and inflammation, Whittaker said. Other treatment options include getting corticosteroid injections or using tape or a brace on the foot to relieve pressure on the heel.

One limitation of the study is that it didn’t include data focused specifically on sports-related pain, so it’s unclear if the results would apply to athletes, the authors note.

It’s also possible that some people could get little or no benefit from using the shoe inserts, the authors also conclude.

“The main take-home message for patients is that the evidence for relief of plantar heel pain by orthotic treatment is weak,” said Peter Cavanagh, a researcher in orthopedics and sports medicine at the University of Washington in Seattle who wasn’t involved in the study.

“Thus, their level of expectation for a cure of plantar heel pain by using orthotics should be moderate,” Cavanagh said by email.

While it may make sense for patients to try over-the-counter prefabricated shoe inserts before spending more on custom versions, it’s also possible that seeing a health care provider first might help people get a device that’s better suited to the shape of their foot, Cavanagh added.

“Patients often try many different therapies sequentially or simultaneously,” Cavanagh said. “Orthotics can reasonably be considered to be one of them.”