Outcomes Study: Foot Orthoses & Plantar Fasciitis
The featured article in a recent Medscape Today issue was a randomized, single-blinded study published in the June 26, 2006 issue of the Archives of Internal Medicine [ Arch Intern Med. 2006;166:1305-1310] that investigated the use of foot orthoses to treat plantar fasciitis. The authors, from the University of LaTrobe in Melbourne, Australia, compared a sham orthosis, a prefab FO, and a custom-made FO in their effectiveness in reducing pain from plantar fasciitis for 139 patients with at least a one-year follow-up.
Patients were randomized into one of the three treatment groups and did not know which type of orthosis they received. At the three month follow-up, it appeared that pain was reduced more effectively by the genuine orthoses than by the sham foam inlay and that function was increased. However, at the twelve month follow-up, there were no statistically significant differences between any of the treatments on the measured parameters.
The authors concluded that prefab and custom orthoses offered short term benefits in treating this pathology but were not effective long term treatments for plantar fasciitis. If these findings are corroborated in future studies, this may be a good illustration of the very commonplace clinical bias toward seeing a "halo effect" from active interventions. Particularly when contact with patients ends with a "call me if you have any problems" after a very positive initial follow-up, clinicians tend to assume that their treatment has been generally effective.
Controlled studies such as this one suggest that rosy viewpoint is not always accurate. Kudos are due to the Australian Podiatry Education and Research Foundation for funding this research. As P&O moves into an evidence-based future, we will experience similar challenges to many of our cherished assumptions.
The Medscape Today article is posted online at www.medscape.com/viewarticle/537579 .
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