02/13/2014    Larry Huppin, DPM

Most Effective Treatment for Plantar Fasciitis (Chuck Ross, DPM)

From a mechanical standpoint, there is evidence to
indicate that our primary goal when treating
plantar fasciitis is to reduce tension on the
fascia. In the late 1990s, Geza Kogler performed a
series of cadaver studies looking specifically at
what caused increased load on the fascia.

A 1999 study showed that valgus wedging of the
forefoot decreased plantar aponeurosis tension
while varus forefoot wedging increased tension. A
1996 study showed that fascia tension was
decreased when orthoses conformed closer to the
arch of the foot, particularly when “the surface
contours of their medial and central regions and
the angles related to their arch shape were more
acute.”

In a 1991 study, Scherer noted that heel pain
syndrome had a strong correlation with supination
of the long axis of the subtalar joint (thus
increasing plantar fascia tension). It was noted
that this was related to three foot types – the
valgus forefoot, the plantarflexed first ray and
the everted heel.

Based on these studies,for plantar fasciitis
patients we recommend pre-fabricated or custom
orthoses that act to evert the forefoot by
incorporating intrinsic balancing of any valgus
forefoot position and consideration of valgus
forefoot extensions. In addition, the orthoses can
be prescribed with minimum cast fill so that they
conform close to the arch of the foot. If the heel
everts past perpendicular during gait then we also
recommend a deep heel cup and the use of a medial
heel skive in order to limit heel eversion and
subsequent midtarsal supination.

There are prefabricated orthoses that incorporate
valgus forefoot correction and medial heel skive
and these are the ones we recommend when treating
plantar fasciitis.

· Kogler GF, et.al. “The Influence of Medial and
Lateral Placement of Orthotic Wedges on Loading of
the Plantar Aponeurosis. In vitro study.” JBJS.
1999.
· Kogler et. al. Biomechanics of longitudinal
arch support mechanisms in foot orthoses and their
effect on plantar aponeurosis strain. Clinical
Biomechanics. 1996
· Scherer, et. al. Heel Pain Syndrome:
Pathomechanics and Non-surgical Treatment. JAPMA,
1991

Disclosure: I am the medial director at ProLab
Orthotics.

Larry Huppin, DPM, Seattle, WA, lhuppin@gmail.com

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