Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis

Fifteen centers for orthopaedic treatment of the foot and ankle participate d in a prospective randomized trial to compare several nonoperative treatme nts for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most rep orted duration of symptoms of 6 months or less. Patients with systemic dise ase, significant musculoskeletal complaints, sciatica, or local nerve entra pment were excluded. We randomized patients prospectively into five differe nt treatment groups. All groups performed Achilles tendon- and plantar fasc ia-stretching in a similar manner. One group was treated with stretching on ly. The other four groups stretched and used one of four different shoe ins erts, including a silicone heel pad, a felt pad, a rubber heel cup, or a cu stom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages impro ved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; ( 3) felt insert, 81%; (4) stretching only, 72%; and (5) custom orthosis, 68% . Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074 ). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a cust om polypropylene orthotic device.