SMR Brief: Efficacies of Different External Controls for Excessive Foot Pronation
Van Lunen B, Cortes N, Andrus T, Walker M, Pasquale M, & Onate J (2011). Immediate effects of a heel-pain orthosis and an augmented low-dye taping on plantar pressures and pain in subjects with plantar fasciitis. Clinical Journal of Sport Medicine, 21 (6), 474-9 PMID: 22011796
Immediate Effects of a Heel-Pain Orthosis and an Augmented Low-Dye Taping on Plantar Pressures and Pain in Subjects with Plantar Fasciitis
Van Lunen B, Cortes N, Andrus T, Walker M, Pasquale M, and Onate J. Clin J Sport Med. 2011 Nov;21(6):474-9.
Plantar fasciitis is an injury which affects 10% of the general population and is characterized by medial heel pain near the insertion of the plantar fascia into the calcaneal tubercle, and is the third most common injury among runners. While common treatments include, R.I.C.E., stretching, taping, and orthosis, no study has compared arch taping and a heel-pain orthosis on plantar pressure and pain among patients with plantar fasciitis. Therefore, Van Lunen and colleagues, performed a cross-over study of 17 individuals (12=women, 5=men), to compare the effects of augmented low-dye ankle taping (ALD) and a heel-pain orthosis (HPO; VASYLI Heel Pain Orthotic, VASYLI International, Queensland, Australia) on pain, peak plantar pressure, and mean plantar pressure in 4 areas of the foot. The authors measured peak pressure and mean plantar pressure using a Pedar in-shoe pressure system (measures 4 regions – lateral rearfoot, lateral forefoot, medial rearfoot, and medial forefoot) as well as pain using a 100-mm visual analog scale. Participants wore their own athletic shoes and were given a 5 minute warm-up. Each participant walked for 90 seconds and jogged for 90 seconds (2 separate trials) during each intervention (control [no intervention], ALD, and HPO). A 6 minute rest period was provided between each intervention. Plantar pressure data were collected for the middle 30 seconds of each trial, whereas pain was recorded after 60-seconds for each trial. The authors found that the ALD intervention had lower mean plantar pressure in the lateral rearfoot region compared with the other interventions. Analysis of peak plantar pressure revealed a higher peak plantar pressure in HPO trials than either control (no intervention) or ALD trials. Both interventions decreased pain during walking (HPO = 59% decrease, ALD = 64% decrease) and jogging (HPO = 54% decrease, ALD = 62% decrease) compared to no intervention. The changes in pain were considered clinically relevant (reduction of 9 to 13mm on visual analog scale). The authors also stated that the ALD “was better at decreasing overall plantar pressure in jogging, and may be a better choice for treatment of active adults.”
This study begins to address a commonly asked question among clinicians: Are orthotics or taping more effective? This particular study demonstrated that in the case of plantar fasciitis, ALD decreased pain and overall plantar pressure sufficiently. However, it is difficult to interpret these findings clinically as only 1 orthotic was tested, and the ALD taping was performed by 1 researcher, limiting the generalizability of the findings (e.g., will these findings be consistent with other clinicians). The authors also listed this among the study’s limitations as the orthotic used was “a cross between a study heel cup and a 3-quatrer length orthosis. Longer on the medial side it extends through the [medial longitudinal arch], extending proximal to the first metatarsophalangeal joint.” This suggests that the type of orthotic used may actually have increased plantar pressure, when other orthotics may decrease plantar pressures. It will be interesting to see future studies that explore plantar pressure in smaller regions of the foot (e.g., forefoot, midfoot, rearfoot) or evaluate how ALD and HPO hold up during longer walks or runs. Overall though, this study presents a great starting point in the discussion of whether orthotics or taping are more effective at acutely treating symptomatic plantar fasciitis. What have you found in your clinical experience? How do you prefer to treat plantar fasciitis? Are there any financial limitations? If you have used any of these interventions, how long have they provided relief?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban