Plantar heel pain or Plantarfasciitis is a commonly presenting condition to podiatrists, orthotists and physiotherapists. It has been suggested that 1 in 10 people will have some form of plantar heel pain in their lives and is more prevalent in people aged 40-60.
It had previously been thought that Plantar Fasciitis involved chronic inflammation; however, more recent studies have concluded this is not the case. We will often refer to it as Plantar Heel pain. That is a more accurate description as the ’itis’ refers to inflammation of the plantar fascia that is not now thought to be present.
Due to the difficulties of accurately diagnosing and addressing plantar heel pain, there is currently no evidence to define a standard treatment or even treatment of choice. The Cochrane review of plantar heel pain published in 2009 by Crawford & Thomson found limited evidence regarding treatments. The author's conclusions summed up that:
“At the moment there is limited evidence upon which to base clinical practice.”
That review has not been updated and has been withdrawn due to being significantly out of date.
It has been suggested that pain-related fear of movement is the most potent contributor to disability with plantar heel pain.
When considering foot orthoses, the design aspects of foot orthoses will need to consider many factors such as; limitation of pronation, reducing the stress in the plantar fascia, reducing the irritation of a specific band etc. While this will vary from person to person, there will be a few common prescription variables with no defined common prescription.
In a recent review in the BJSM it is stated state
'Given the contrast with custom orthoses, it may be that having a range of prefabricated orthoses may be a suitable strategy so that prescription can be individualised. This approach would be a priority for future cost-effectiveness trials, given the lower cost compared with casting or scanning.'
The plantar fascia is the thick connective tissue that supports the arch on the underside of the foot. As it runs from the tuberosity of the calcaneus anteriorially, it fans out to attach to the proximal phalanges of the toes.
The plantar fascia is made up of predominantly longitudinally oriented collagen fibres. There are three distinct structural components, with the central component being the largest and most prominent.
One function of the plantar fascia is to help make the foot rigid at push of during gait. The process is referred to as the Windlass Mechanism and is shown above.
All the prefabricated insoles below can be adapted with wedging by either our skilled technicians or chairside.
The S90 Heel spur insole is a classic insole that is a great first-line intervention to reduce the load on the heel and plantar fascia.
The Novatherm while not as cushioned as the S90 heel its thermal properties can prove beneficial. It is also smaller in profile when compared to the S90 heel pain.
Made in prepreg Carbon fibre the Carbon edition heel pain insole provides increased levels of support over the S90 and Novatherm without increasing its thickness.
Similar in construction to the Carbon Edition insole above this version includes a padded ring to provide further offloading if a heel spur is present.
The Carbon Hallux Calca with U-pad includes a carbon morton extension to assist in limiting forces acting on the 1st metatarsal phlangeal joint for patients with heel pain and hallux limitus.
The well regarded Novaped Sports insoles come pre-designed for a range of sports. With sports specific insoles for football, running and golf they are designed to fit into the footwear typically worn for these activities. All Novaped Sports insoles include a plantar fascia and heel cut out. They are easily adaptable chairside or by our technicians prior to dispatch.
The Novaped Protect Carbon insoles are designed to be worn in safety footwear without preventing the boot from meeting the relevant safety standards. They can be ordered individually or to fit with Schein's range of safety footwear.
Plantar Fasciitis is seen as the most common cause of plantar heel pain but there are also a number of differential diagnoses, which can be easily missed. These include:
Our Clinic will assess people with heel pain in both Edinburgh and Glasgow. Appointments can be booked via our dedicated clinic site.