Inexpensive off-the-shelf shoe inserts more effective in
treating heel pain than custom-made arch supports.
Could save patients and health care system more than $200 million.
The American Orthopedic Foot and Ankle Society (AOFAS) announced today the results of a
two-year prospective randomized national study on the treatment of heel pain. The study
found inexpensive off-the-shelf shoe inserts to be more effective than plastic custom arch
supports in the initial treatment of heel pain (plantar fasciitis). Potentially, this
finding could save more than $200 million in health care costs annually.
Heel pain affects over two million Americans annually and is the most common foot problem
seen in medical practice. Nonoperative care for heel pain provides satisfactory treatment
for 90 percent of patients. However, research has not established which initial
nonoperative care is best. The current study, involving 15 orthopedic foot and ankle
centers, was designed to answer this question.
The investigation, conducted by the AOFAS Heel Pain Study Group, looked at the
effectiveness of stretching exercises and orthotic devices in the treatment of heel pain.
The researchers examined 236 patients who had no previous treatment for their heel pain
and no serious medical problems. The study did not include chronic heel pain sufferers who
had received other treatments for their condition.
The patients were divided (randomized prospectively) among five treatment groups. One
group did only Achilles tendon and plantar fascia stretching exercises. (The plantar
fascia is the band of tissue that stretches from the ball of the foot to the heel.) The
other four groups used either an off-the-shelf shoe insert or custom arch support along
with the stretching exercises. The devices studied included the Bauerfeind Viscoheel, Hapad Comforthotic,
Tulis Heel Cup, and a custom-made polypropylene
arch support. All of the patients were examined by an orthopedic foot and ankle
specialist and asked to fill out an activity and symptom questionnaire. They returned
after eight weeks of treatment for a repeat examination and questionnaire.
Seventy-two percent of those who did only Achilles tendon and plantar fascia stretching
improved. Ninety-five percent of those who used the Bauerfeind Viscoheel (silicon heel cushion),
88 percent of those who used the Tulis Heel Cup
(rubber heel cushion) and 81 percent of those who used the Hapad Comforthotic (felt heel
cushion/arch support) improved. Sixty eight percent of the patients who wore a custom-made
plastic arch support improved. Interestingly, patients who stood on their feet for a full
work day showed significantly less improvement with a custom arch support than those who
used an off-the-shelf insert: 44 percent showed improvement with a custom arch support
versus 96 percent who showed improvement with an off-the-shelf insert.
"The study clearly demonstrates that a stretching program plus an inexpensive
off-the-shelf insert is the best and most cost effective treatment for the first onset of
heel pain," said Glenn Pfeffer, M.D., San Francisco, Chairman of the AOFAS Heel Pain
Study Group. "These findings will allow patients and the health care system to save
hundreds of millions of dollars each year by avoiding the unnecessary prescription of a
rigid custom arch support for the initial treatment of heel pain."
Dr. Pfeffer noted that even without a doctor's visit almost three quarters of individuals
can find significant relief from heel pain by performing a home exercise program that
includes Achilles tendon and plantar fascia stretching. "Adding an inexpensive
off-the-shelf shoe insert to the stretching program leads to an even better result,"
Dr. Pfeffer said. He emphasized that rigid custom arch supports have a clear role in the
treatment of many foot conditions, but the results of this study indicate that they have
no role in the initial treatment of heel pain.
