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Treating Plantar Fasciitis in the Chronic Patient: Do Orthotics Work?

For the past 3 years, my use of orthotics in treating foot conditions, especially plantar fasciitis, has greatly decreased. As a result of being one of the leading advocates of minimalist and barefoot running, I have been able to incorporate this into my practice to help even those who do not run.

Here is an example of a patient who had continuously been led down the wrong path by being recommended orthotics. She has a high arch, which is not necessarily pathologic or prone to injury, and was told that it needs “supported” with an orthotic. If you have ever examined or felt the foot of someone who has a high arch, it is rigid. In other words it does not collapse upon standing. Why then does it need support? It doesn’t. A high arch is just a variance of foot type. She has dealt with plantar fasciitis for over a year and a half and was treated with 4 pairs of orthotics and numerous shoes all with no relief.

What do I try next? As a surgeon, we used to advocate operative release of the plantar fascia. Studies have demonstrated inflammatory cells are not present within the plantar fascia suggesting that the condition may not be “inflammation” within the plantar fascia. There are 3 muscles that attach to the heel bone in conjunction with the planar fascia. These muscles develop tendonitis when overused or weak by leading to pain upon arising in the morning, and again throughout the day after increased activity. Therefore, treat this like a tendonitis. Splinting may be done but only temporarily. In this case the patient needs to strengthen the musculature and change her gait by not “heel striking” to the degree that most do in shoes with a heel.

We advised her to begin going barefoot everyday for 20 minutes increasing each day as tolerated. When she experiences pain, she needs to activate the flexors to her toes and almost “stand on her toes” to do this. This will build strength. She was educated on proper shoe gear that is minimal and will allow her foot to function naturally without accentuating a heel strike. “Walk as though you are walking across ice” she was told. This is obviously extreme, but it does teach a more correct gait.

See the gallery of images below revealing the orthotics she was prescribed over the past year and her current shoe gear.

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