A combination of rocker sole shoes and custom-made foot orthoses had greater immediate therapeutic effects on patients with unilateral plantar fasciitis compared with individually prescribed treatments, according to a study recently published in Clinical Biomechanics.

“We have observed that early-stage and mild plantar fasciitis was commonly treated conservatively by prescribing stretching exercises, inserts and orthoses,” Daniel Tik-Pui Fong, PhD, research assistant professor, Sport Performance and Biomechanics Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine at The Chinese University of Hong Kong, told O&P Business News. “There were many studies showing the effect in pain relief after prescribing orthoses or rocker shoes, but no studies have reported the therapeutic effect of combined treatment with rocker shoes plus custom-made orthoses. We attempted to evaluate its effect, not only with clinical outcome like subjective pain relief score, but also scientifically with clinical biomechanics technique.”


Fifteen patients with unilateral plantar fasciitis performed walking trials consisting of an unshod condition and four shod conditions using baseline shoes with flat insoles, baseline shoes with custom-made foot orthoses, rocker shoes with flat insoles and rocker shoes with custom-made foot orthoses. Outcome measures included immediate heel pain intensity levels as reflected by visual analog scale pain ratings, as well as the corresponding dynamic plantar pressure redistribution patterns as evaluated by a pressure insole system.

Researchers found a significantly lower visual analog scale pain score when patients used a combination of rocker shoes and foot orthoses vs. rocker shoes or foot orthoses alone. Baseline shoes also significantly reduced the greatest amount of medial heel peak pressure without overloading other plantar regions compared with rocker shoes or foot orthoses, according to study results.

“The results somewhat justified this conservative treatment modality which has been practiced for 60 years without scientific evaluation,” Fong said. “Podiatrists could try prescribing this combined treatment if a patient is persistently unsatisfactory with a single rocker shoe or foot orthoses treatment.”

Past, future studies

Previously, Fong and colleagues have investigated the effect of inserts with medial arch-heel support in reducing ankle eversion in children, showing that the inserts effectively restored normal eversion range in 85% of pronators during running, but not in standing or walking.

Research has also demonstrated how patients can reduce heel strike and perform greater tow grip to adapt and walk on slippery surfaces without a slip. However, Fong and colleagues did not investigate if the gentler heel strike in walking with rocker shoe and custom-made foot orthoses could reduce the likelihood of a slip.

According to the researchers, further studies on a combination of rocker shoes and foot orthoses are warranted.

“Only the immediate effect of a combination of rocker shoes and foot orthoses was evaluated by using a subjective visual analogue scale pain score. Because of the meaningful findings, further studies on its efficacy in the treatment of plantar fasciitis are justified,” the researchers concluded. “In future studies, randomized controlled trials should also be conducted to assess the long-term effects of the combined prescription of rocker sole shoe and custom-made foot orthoses.”— by Casey Murphy

For more information:
Fong DTP. Clin Biomech. 2012;27:1072-1077.

Disclosure: Fong has no relevant financial disclosures.

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