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Tuesday, October 5, 2010

Plantar Fasciitis/Heel Pain: Orthotic Modifications to Help


One of the beautiful Hawaiian sunsets I saw on my last vacation.

When treating plantar fasciitis/heel pain with custom or off the shelf orthotic devices, remember that the orthotic device must transfer the weight into the arch and off weight the heel to be successful. If you imagine that the average person takes 6,000 to 10,000 steps per day, the importance of successfully transferring body weight forward and cushioning the heel seems obvious. Yet, I see this rule broken every day in practice. If you have orthotic devices, and you are experiencing heel pain (whether from plantar fasciits, heel spurs, heel bursitis, poor fat pads, pinched nerves, or heel bone stress fractures), this general rule must be followed. Talk to the health care provider whom is ordering, or has ordered the device, to see if this is their goal as well. Evaluate the orthotic devices when you have them to see how they feel. Have them modified if your symptoms are not improving, and you feel only a little pressure in your arch, or too much pressure on your heel, or both.


Here you can see how an OTC (over the counter) orthotic device from Sole (http://www.yoursole.com/) can be modified with greater arch support to achieve this higher degree of transfer of body weight.



In this image the bottom of the orthotic device was first adjusted to decrease its rigidity in the heel (can even be done with plastic orthotics) and then soft Spenco (http://www.spenco.com/) used to further softer the heel area (normally done to the part against the foot).


Guess who I am rooting for to go all the way.


The rear foot post (also called extrinsic heel post) can be made out of soft material. The soft material, like birkocork shown here, will need to be replaced every 3 to 5 years, but gentler on the heel and knee/hip joints when the heel strikes the ground than the more durable plastic based posts. No top cover is better than the original Spenco (although a knockoff  called neolon is shown here). Between the top cover and the plastic when there is heel pain, more Spenco or Poron can be used.



Here is an example of a plastic post, placed on a plastic orthotic, and the right side is even worse with an additional plastic heel lift. No wonder the heel kept hurting. Think soft heel and supportive arch for the best results.



Adhesive backed gel sheets can now be used, normally 1/8", in the heel area, and then covered with Spenco to protect it. This is only for walking, but sure is cushy!! With sports, gel is too unstable a surface. You can order this from the link below.
http://www.healthmegamall.com/prodView-Alimed-Gel-Pad-Squares-and-Sheets-48220-Square-5mm-with-adhesive-2pk_p146289_aff1574.htm

So, with plantar fasciits/heel pain, the success or failure of your conservative treatment may rest on the ability of your orthotic devices to soften the heel and transfer weight into the arch successfully. Good luck!!


2 comments:

  1. Thank you Doctor for this great website and for the time that you put in here to help us get healthier! I'm a tennis player and have suffered tremendously for the past few months from plantar fasciitis, mostly I believe due to the side to side motions. I believe that I am now getting better due to 2 recent cortisone shots from my doctor, a taping of the arch, a new pair of very stable, unbending Adidas Barricade tennis shoes, and last but not least a Sofsole product that I believe doesn't get the credit that it deserves. It is the Sofsole Airr heel cup, which I use in the green women's version as the men's is too unwieldy. Fantastically soft in the middle and supported by a hard plastic casing on the outside, providing me with comfort, stability, and also as you suggest moving the weight of the heel gently forward towards the arch. For me at least this is truly a miracle device. Have you ever tried using it? I have many inserts, some moldable, a pair of orthotics, Tuli's waffle heel cups which are too flimsly, and soft heel pads but nothing gives me the combination of comfort, repositioning, and support that the Sofsole Airr cups do. I believe that they have stopped making them but they are, at least for me a Godsend! Any opinions on them? Thanks again!

    ReplyDelete
    Replies
    1. Thanks for your great comment and info. I will definitely have to check out this product. I always want to learn. Happy New Year. Rich

      Delete

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.