Saturday February 24, 1996

Cast most effective treatment for plantar faciitis

Responses from a patient satisfaction survey taken during a 10-year period indicated that a cast was the most effective treatment to correct plantar fasciitis. The results of the survey were presented in scientific paper 186 on Friday.

Lowell H. Gill, MD, co-author of the study, asked patients to rate the success they experienced with 11 conservative treatments.

Sixty-one percent of the patients in the study were middle-aged females. Almost 77 percent of the respondents were overweight, a contributing factor to plantar fasciitis. Half of all the patients surveyed indicated that they were on their feet for most of the day, some working on a hard floor.

There were 411 patients surveyed and 40 of them were treated with a cast. Of those with casts, 62.5 percent had mild to excellent improvement. Additional treatments are listed in descending order as ranked by patients: steroid injection; rest; ice; running shoes; aspirin or other nonsteroidal anti-inflammatory drug; foam cushion; plastic heel cup; heat; crepe-sole shoes; and a rubber heel cup with a waffle design.

"Rest is a good treatment for plantar fasciitis," said Dr. Gill, "but hard to achieve because the feet are always bearing weight. Immobilizing the foot in a cast helps to enforce a rest and may help the inflammation to subside. Casts are left in place for five to six weeks. If a patient is intolerant of casts, zipper casts or walking boots are occasionally substituted, although these may be less effective."

In a few cases, surgery to release the plantar fascia helps to resolve the clinical condition of plantar fasciitis. The rest promoted by a postoperative cast may be the actual reason for the improvement, added Dr. Gill.

Steroid injections were given to 170 patients; 31 of whom rated the treatment excellent, whereas 41 ranked the injections as ineffective. Additionally, said Dr. Gill, injections are usually effective long-term only part of the time because patients return to previous activity levels rather than resting the foot, said Dr. Gill.

Plastic heel cups, which only come in one adult size, and the use of a NSAID such as an aspirin or other similar medication, were each rated as the most effective treatment by 6 percent of the patients in the study.

With the exception of the rubber cup, which none of the patients liked, the plastic heel cups, NSAIDs and other treatments were found to be unpredictable or only slightly effective overall.

Treatments such as taping and stretching, and physical therapy, such as ultrasound and diathermy, were not included in this study. Also, since the survey was not modified over time, newly available treatments such as night splints were not included.

"Some of the methods used to treat plantar fasciitis are combined," added Dr. Gill, "so a complete independent analysis of conservative treatment may be almost impossible to obtain. Despite these limitations, the statistical analysis aids interpretation of the results, especially with regard to the apparent advantage of the cast treatment which encourages rest.

"Lower scores for treatments other than casts may be due to the patients not resting. Often, when the patient is being treated with a shoe pad or medications, he or she thinks these methods alone will work. Patients often think of plantar fasciitis as a minor annoyance and place less importance on rest, compared to patients who would never question rest if they had a more complex problem such as a fracture."

Dr. Gill added that his practice has a high volume of geriatric patients, yet few of these were represented in this study. This might be due, he said, to a decrease in activity levels as patients age, resulting in less stress to the plantar fascia. In addition, although plantar fasciitis often affects athletes, these patients who often seek out sports physicians for treatment are not reflected in this study.

Co-author of the study with Dr. Gill is Gary M. Kiebzak, PhD, director of research services, both of Miller Orthopaedic Clinic, Charlotte, N.C.

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Last modified 27/September/1996