Custom-made foot orthotics are no better at relieving heel pain caused by plantar fasciitis than cheaper, over-the-counter insoles or other treatments, according to a study published Monday in the British Journal of Sports Medicine. 

Plantar fasciitis — inflammation of a thick band of fibrous tissue (the plantar fascia) that runs along the bottom of the foot and connects the heel to the toes — is one of the most common foot complaints. As background information in the current study points out, plantar fasciitis accounts for up to 15 percent of all visits by adults to a doctor for foot symptoms and 8-10 percent of all running-related injuries.

To ease the pain, many doctors prescribe custom-made orthotics, which are shoe inserts that are made from a three-dimensional mold of the patient’s foot. These devices are believed to relieve plantar heel pain by supporting the foot’s arch and taking pressure off the heel, although their effectiveness has long been debated. 

Prescription foot orthotics can cost hundreds of dollars, and the manufacturing and sale of the devices is a multibillion-dollar business. A 2016 market report estimated that global sales of foot orthotics would reach $3.5 billion by 2020, up from $2.5 billion in 2014. Almost half of those sales, the report adds, will be in North America.

Much of the growing demand for foot orthotics is directly related to the obesity epidemic, for being overweight is a major risk factor for foot ailments, including plantar fasciitis. 

Focusing on the best studies

For the current study, a team of Dutch and Danish researchers analyzed the results of 20 previously conducted randomized controlled clinical trials that had investigated the effectiveness of eight different types of custom and prefabricated foot orthotics for the treatment of heel pain. The studies involved a total of 1,756 patients.

Randomized control trials are considered the “gold standard” of research.

Some of the studies included in the review had compared custom orthotics to “sham” ones (insoles bought over the counter). Others had compared the devices to 10 different types of  “conservative” (nonsurgical) treatments, including stretching exercises, cortisone injections, changes in the types of shoes worn, and extracorporal shock wave therapy (which uses sound waves to stimulate healing).

Six of the studies had similar enough designs to enable the researchers to pool the data (a process that provides more reliable findings than those of single studies). 

Time was greatest healer

When the researchers analyzed all the data they found “that orthotics were “not superior in improving pain, function or self-reported recovery when compared with other conservative interventions.”

In fact, none of the interventions were better than any of the others in the short term (up to three months). Over time, patients treated with orthotics did report less pain, but so did those receiving the other forms of treatments. The researchers say that is most likely because  most people’s plantar heel pain improves after 12 months, no matter what treatment they receive.

This isn’t the first major review of the medical literature to conclude that custom-made foot orthotics may be a waste of money. An international team of Cochrane reviewers came to a similar conclusion in 2008.

FMI: You can read the current review on the British Journal of Sports Medicine’s website