Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis

Abstract

BackgroundPlantar heel pain (PHP) is common. Foot orthoses are often applied as treatment for PHP, even though there is little evidence to support this.ObjectiveTo investigate the effects of different orthoses on pain, function and self-reported recovery in patients with PHP and compare them with other conservative interventions.DesignSystematic review and meta-analysis.Data sourcesA systematic literature search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL and Google Scholar up to January 2017.Eligibility criteria for selecting studiesRandomised controlled trials comparing foot orthoses with a control (defined as no intervention, sham or other type of conservative treatment) reporting on pain, function or self-reported recovery in patients with PHP.ResultsTwenty studies investigating eight different types of foot orthoses were included in the review. Most studies were of high quality. Pooled data from six studies showed no difference between prefabricated orthoses and sham orthoses for pain at short term (mean difference (MD) of 0.26 (95% CI −0.09 to 0.60)). No difference was found between sham orthoses and custom orthoses for pain at short term (MD 0.22 (95% CI −0.05 to 0.50)), nor was there a difference between prefabricated orthoses and custom orthoses for pain at short term (MD 0.03 (95% CI −0.15 to 0.22)). For the majority of other interventions, no significant differences were found.ConclusionsFoot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with PHP.PROSPERO registration numberCRD42015029659.

Should foot orthoses be used for plantar heel pain?

“…However, arguably more important than simply basing this on the cut-off of the lower confidence limit is consideration of the magnitude of the effect (standardised mean difference) and the associated 95% CI. The standardised mean difference indicates that there is a small effect in the Rasenberg et al 1 review (as it did in our review), but the lower confidence limit marginally crossed the line of no effect (figure 1). …”

“…Because of this difference, both the effect size and the CIs in the Rasenberg et al 1 review (SMD 0.22, –0.05 to 0.50) are different to our review (SMD 0.28, 0.01 to 0.65) 2. It is important to note that neither review is incorrect in its methods, and the difference in conclusions between the reviews likely reflects the statistical imprecision for this comparison.…”

“…To put the findings of both reviews in context for health practitioners, both the Rasenberg et al 1 review and our review2 found small effect sizes favouring foot orthoses; they found the effect to be not statistically significant, while we found it was statistically significant (based on the lower confidence limit crossing or not crossing zero, respectively). However, arguably more important than simply basing this on the cut-off of the lower confidence limit is consideration of the magnitude of the effect (standardised mean difference) and the associated 95% CI.…”

“…The reason for the different findings between the Rasenberg et al 1 systematic review and our systematic review2 is the outcome measure for pain that was selected from one trial, by Oliveira et al ,3 for the comparison of customised foot orthoses to sham orthoses. In the Rasenberg et al 1 review, the authors chose to extract data from the Foot Health Status Questionnaire pain subscale, whereas for our review,2 we chose to extract the outcome measure from each trial that was the primary outcome (if specified by the authors of each included trial), and therefore we extracted pain with activity measured using the visual analogue scale (VAS). Although Oliveira et al 3 did not prespecify a primary outcome measure, they used the VAS to justify their sample size, and on this basis, we considered VAS to be the primary outcome, which we still believe is appropriate.…”

“…The authors of this systematic review1 found that foot orthoses are not effective for plantar heel pain (when compared with sham devices) and suggest ‘that clinicians should be reserved in prescribing foot orthoses in all patients with plantar heel pain’. This finding is in contrast to a similar systematic review and meta-analysis that we recently published in the  British Journal of Sports Medicine  that concluded foot orthoses are effective at reducing pain in those with plantar heel pain and that ‘health practitioners may consider using foot orthoses … but the reduction in pain may not be sufficient for some people’ 2…”