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Seligman DAR, Dawson D, Streiner DL, et al. Treating Heel Pain in Adults: A Randomized Controlled Trial of Hard vs Modified Soft Custom Orthotics and Heel Pads. Arch Phys Med Rehabil. 2021 Mar;102(3):363-370. doi: 10.1016/j.apmr.2020.10.124. Epub 2020 Nov 18. (Original study)
Abstract

OBJECTIVES: This study compared the effectiveness of soft vs hard orthotics in treating heel pain and plantar fasciitis in adults. It also compared the level of function after orthotic use, cost, and number of visits for orthotics and explored whether age was a factor in orthotic effectiveness.

DESIGN: Randomized controlled trial. Before randomization, patients were stratified by age (younger vs older adults) in blocks of 4 to ensure that there were an equal number of participants in each group (soft vs hard orthotics).

SETTING: An orthotic clinic in a community-based hospital and a private orthotic clinic.

PARTICIPANTS: The participants were adults aged 18 years or older (N=44) with heel pain and plantar fasciitis.

INTERVENTION: Participants received hard or soft customized orthotics.

MAIN OUTCOME MEASURES: Participants rated their pain intensity and pain interference before and after orthotic use using subscales from the Brief Pain Inventory. Function was similarly measured using the Late Life Function and Disability Instrument: Function component. Analyses of age, cost, and number of visits were also compared.

RESULTS: There was a reduction in pain intensity (P=.010) and pain interference (P<.001) but no change in function over time (P=.333), and no difference between the groups who received hard vs soft orthotics. Age had no effect on orthotic effectiveness. Soft orthotics were less expensive (P<.0001) and required fewer visits for fabrication (P<.0001).

CONCLUSION: Both soft and hard orthotics provided effective pain relief, but soft orthotics are less expensive.

Ratings
Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 5 / 7
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  Foot Pain   Plantar Fasciitis
Comments from MORE raters

Rehab Clinician (OT/PT) rater

The findings were that there were no differences between the outcomes for those with hard or soft orthotics. The conclusions were that both were effective. It is a rooky error to suggest those conclusions in the absence of a control group or other means of determining the natural course of the condition. All that can be reasonably concluded is that there was no difference between hard and soft orthotics. This has implications for which to use, but not whether to use them at all.

Rehab Clinician (OT/PT) rater

This is an interesting article with low-moderate quality evidence to demonstrate that orthotics might be helpful for heel pain, and could be useful as an adjunct treatment.
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