Today's News

Saturday, February 24, 1996

Stretching and heel pads most effective, finds study

Stretching and over-the-counter orthotic devices are the best first-line treatment modalities for proximal plantar fasciitis, according to a new study by the American Orthopaedic Foot and Ankle Society. Glenn Pfeffer, MD, University of California Medical School, San Francisco, said the AOFAS would release the complete results of the two-year, prospective randomized comparison of initial treatments within the next month. Pfeffer discussed the initial results during a press conference Friday.

"Chronic heel pain is overwhelmingly the most common problem of the foot," Dr. Pfeffer said. "Most of these cases, perhaps 80 percent, are caused by proximal plantar fasciitis. Although some of these patients need surgery, it's a small number. The data tells us that the vast majority will get better within one year. So you can tell them when they come to your office that they don't need surgery, but it's going to be a long haul.

"The big question for us all is, how do we treat them? Most of these patients will be given some type of custom orthotic device, and we'd like to know how effective we are."

Pfeffer and colleagues compared a common polypropylene custom orthotic device from a manufacturer, three over-the-counter heel pads and stretching alone. Two hundred-fifty patients diagnosed with proximal plantar fasciitis were enrolled in the study; none had had any prior treatment. Sixty percent of these patients had been symptomatic for four or more months and 30 percent for more than a year.

The patients were randomized into five groups. All five groups were prescribed a daily stretching routine. Four groups also used over-the-counter or custom heel orthotic devices.

The researchers compiled patients who reported their symptoms as much better, somewhat better or cured. What they discovered was that 72 percent of patients who stretched alone reported improvement.

"We generated interesting data, some of which surprised me," Dr. Pfeffer said. "Only 70 percent of the group using the custom orthotic device reported improvement. That meant that it was only as effective as stretching. But the custom orthotic was $120 at the wholesale level, and stretching is free. Of course, you must consider that, although the over-the-counter devices were inexpensive, the custom orthotic device will last much longer. Our conclusion is that for the initial treatment of heel pain, stretching and a simple, inexpensive, off-the-counter device is the best way to go."

Dr. Pfeffer pointed out that many excellent over-the-counter and custom orthotic devices were available, and will warrant future studies to compare efficacy. Heel pain would probably not resolve in the absence of treatment, based on the fact that 30 percent of the study patients had symptoms for more than one year, and 40 percent for more than four months.

The study provides orthopaedists with a reference for evaluating their treatment modalities of heel pain and answers the important question of cost for many patients. Custom orthotic devices are not covered by many health plans, so many patients will appreciate less-expensive alternatives. "This is the first large-scale, scientifically based study of its kind," said Dr. Pfeffer. "It's an outcome study and it's important for all of us looking for value in our treatment."

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Last modified 27/September/1996