The clinical and biomechanical effects of customized foot orthoses in individuals with plantar heel pain: A pre-post intervention study

Abstract

Background: Customized foot orthoses (CFOs) are often recommended for the management of plantar heel pain. However, there is a lack of information regarding lower limb and multi-segment foot motion during gait.
Research question: This study aimed to determine the effects of heat moulded CFOs on foot and lower limb kinematics when compared with prefabricated foot orthoses (PFOs) and wearing no orthoses (shod condition), and to determine the short-term effects of CFOs on pain intensity and foot function.
Methods: The immediate effects of CFOs on the lower limb and multi-segment foot motion were assessed. Participants were then asked to use the CFOs for one month and foot pain, function, and temporal-spatial parameters were assessed at baseline and at one month follow up.
Results: Thirty-five participants (22 females), aged 40.1 (10.5) years, with a mean duration of symptoms of 12.59 months were recruited. The symptomatic limbs showed a higher forefoot varus angle and greater rearfoot and forefoot corrections were required compared to the non-symptomatic limbs. When compared with PFOs and shod conditions, CFOs provided the least forefoot and knee motion in the transverse plane during contact phase (P<0.05, d=0.844-1.720), least rearfoot motion in the coronal plane during midstance (P<0.05, d=0.652), and least forefoot motion in the frontal plane, knee motion in the transverse plane, and hallux motion during the propulsive phase (P<0.05, d=0.921-1.513). Significant improvements were seen for foot pain and function (P<0.05, d=1.390-2.231) with significant increases in cadence and walking velocity after one month of CFO use (P<0.05, d=0.315-0.353), and those most likely to respond had greater pain and less ankle eversion (P<0.05, d=0.855-1.115).
Significance: CFOs appear to improve pathological biomechanics associated with plantar heel pain. After one month follow up, the CFOs decreased pain intensity and increased foot function, and showed significant improvements in temporal and spatial parameters of gait.