2006 Media Releases
Thursday, 24 August 2006
Orthoses research surprises Podiatry profession
What is the best kind of footwear insert to treat plantar fasciitis – a nasty foot condition that can feel like a hot knife being driven into your heel and afflicts up to 100,000 Australians every year?
La Trobe University Senior Lecturer and Research Coordinator in the Department of Podiatry, Dr Karl Landorf, has come up with an answer that has surprised many members of the podiatry profession.
His recently completed PhD research on plantar fasciitis found little difference in the beneficial effects of expensive, individually designed orthoses in the form of footwear inserts (insoles) compared to a ‘standard’ prefabricated off-the-shelf insert.
‘This finding was quite unexpected and surprised some members of the podiatry profession,’ said Dr Landorf.
His research findings were recently published in the prestigious journal Archives of Internal Medicine. One of the top eight medical journals in the world, it has a print circulation to over 100,000 physicians in more than 75 countries.
Dr Landorf’s investigation of 135 patients with plantar fasciitis took two and a half years to complete, and he says it was the most thorough and extensive ever conducted.
He explains that plantar fasciitis, which affects the heel, is an inflammation of the plantar fascia, a band of strong tissue that supports the arch of the foot. An estimated 70,000 to 100,000 Australians seek treatment for this condition each year, many of them experiencing severe pain, particularly when they first step out of bed in the morning.
‘The longer sufferers are on their feet, the more intense the pain becomes, making this an extremely difficult affliction for people like shop staff and others who spend their working day on their feet,’ he said.
‘This condition often puts people in a Catch 22 situation. People are usually about 40-60 years of age when they develop this condition – the age when they are often starting to put on weight. Many are advised to walk to counteract their potential weight problem – but cannot do so because of the pain from their plantar fasciitis.
‘While podiatrists have for many years prescribed footwear inserts for plantar fasciitis – and some research has been done on them in the past – nobody had ever carried out such a rigorous randomised trial evaluating their effectiveness. Further, previous research had only investigated the effectiveness of footwear inserts in the short term up to three months,’ he said.
After attracting 135 people with plantar fasciitis by advertising in local papers, Dr Landorf randomly allocated each participant to wear one of three types of orthoses for 12 months.
One group received a ‘sham’ orthosis – an insert of material so soft it quickly flattened and had little if any effect. A second group received a standard, relatively inexpensive off-the-shelf device and the third received an orthosis specifically designed (customised) for them after analysis of their feet. The subjects were unaware which type they had received.
The trial found that in the long-term (12 months) there was no difference in effectiveness between all three orthoses. However, for the first three months both the customised and prefabricated devices produced small but significant benefits compared to the sham orthosis.
‘So there is a short-term benefit from appropriately designed foot orthoses. However, on average there was no difference in effectiveness between the relatively cheap prefabricated device and the more expensive customised orthosis used in our study, even up to 12 months of treatment,’ he said.
Dr Landorf said there were significant cost differences between the customised and prefabricated orthoses. Therefore, if orthoses are deemed necessary for the treatment of plantar fasciitis, practitioners should prescribe an appropriate prefabricated orthosis first, rather than a more expensive customised device.
‘Fortunately there is a natural course in the progress of plantar fasciitis as it normally gets better over time. It usually lasts about 6-12 months but can be longer or shorter for some patients. Nevertheless, the need for cost-effective pain relief in the short-term is critical and this research has made a significant contribution to this,’ he added.
For further information:
Dr Landorf can be contacted on Tel: (03) 9479 5300 or
Email: k.landorf@latrobe.edu.au
See also: http://www.latrobe.edu.au/humanbio/staff/landorf.htm