Bill Vicenzino (1), Thomas G. McPoil (1, 2), Aoife Stephenson (1), Sanjoy K. Paul (3)
1) University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, Brisbane, Queensland, Australia
2) Regis University, Rueckert-Hartman College for Health Professions, Denver, Colorado, United States of America
3) QIMR Berghofer Medical Research Institute, Brisbane, Herston, Queensland, Australia
Plantar heel pain that is present on first step out of bed in the morning or after a prolonged period of sitting is emblematic of a clinical diagnosis of plantar fasciitis. It predominantly occurs in fifth to seventh decades of life, and is estimated to affect 1 in 10 people over a lifetime, cost a quarter of a billion dollars per year in the United States and lead many to consult a physician or other health care practitioner.
Commonly recommended non-surgical treatments include ice, oral medication, stretching, orthoses, physical therapy, night splints, extracorporeal shock wave therapy and steroid injections. In-shoe orthoses, either pre-fabricated or custom made are generally favored before the use of more invasive treatments like steroid injections. However, the effectiveness of other common treatment approaches, including sandals shaped like orthoses, is not yet known.
Footwear companies are increasingly incorporating aspects of foot orthoses within readily available foot wear and directly marketing to the general public without evidence of efficacy or physician consultation. An example of this is the use of contoured slip-on sandals to manage a myriad of lower limb ailments, including plantar heel pain. Conceivably a contoured sandal, which is quicker and easier to slip on than an orthosis in a closed in shoe, that has the properties of in-shoe foot orthosis might confer advantages such as reducing first step pain and would be better tolerated in hot environments where closed-in footwear with orthoses is uncomfortable.
The objective of this study was to evaluate the efficacy of a readily available contoured sandal in the management of plantar heel pain by comparing it to a non-contoured flat flip-flop and a contoured shoe insert. We hypothesised that the contoured sandal would be more efficacious than the non-contoured flat flip-flop, and similar to a contoured shoe insert.
To investigate efficacy of a contoured sandal being marketed for plantar heel pain with comparison to a flat flip-flop and contoured in-shoe insert/orthosis.
150 volunteers aged 50 (SD: 12) years with plantar heel pain (>4 weeks) were enrolled after responding to advertisements and eligibility determined by telephone and at first visit. Participants were randomly allocated to receive commercially available contoured sandals (n = 49), flat flip-flops (n = 50) or over the counter, pre-fabricated full-length foot orthotics (n = 51). Primary outcomes were a 15-point Global Rating of Change scale (GROC: 1 = a very great deal worse, 15 = a very great deal better), 13 to 15 representing an improvement and the 20-item Lower Extremity Function Scale (LEFS) on which participants rate 20 common weight bearing activities and activities of daily living on a 5-point scale (0 = extreme difficulty, 4 = no difficulty). Secondary outcomes were worst level of heel pain in the preceding week, and the foot and ankle ability measure. Outcomes were collected blind to allocation.
Analyses were done on an intention to treat basis with 12 weeks being the primary outcome time of interest.
The contoured sandal was 68% more likely to report improvement in terms of GROC compared to flat flip-flop. On the LEFS the contoured sandal was 61% more likely than flat flipflop to report improvement. The secondary outcomes in the main reflected the primary outcomes, and there were no differences between contoured sandal and shoe insert.
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