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A new article from LE Review looks at the role of CFO’s for treating PF:
The majority of past research has viewed PF as an inflammatory disorder thought to result from microtearing of the plantar fascia. New evidence, however, shows no inflammatory properties present in histological studies of individuals with chronic PF, but, rather, suggests PF is a degenerative condition affecting the collagen fibers.6,7 This new evidence may cause practitioners to reconsider anti-inflammatory pharmaceutical management of chronic cases, which has traditionally been the first line of treatment.6
6. De Vera Barredo R, Menna D, Farris JW. An evaluation of research evidence for selected physical therapy interventions for plantar fasciitis. J Phys Ther Sci 2007;(19):41-56.
I feel they made a glaring error in not distinguishing between acute and chronic PF. Would anyone argue that acute PF exhibits an inflammatory component and that one of the primary goals of treatment in acute PF is reducing inflammation?
Would anyone argue that chronic PF exhibits degenerative changes as mentioned, lacks an inflammatory component and is a progressive, degenerative disorder? What about the subacute patient?
Distinguishing what stage of PF, fasciosis vs. fasciitis, the patient is in is paramount to appropriate treatment and outcomes.
Lacking in the literature at this time are illumination of two factors—the most effective material type for the orthosis and optimal positioning of the orthosis. Ethylene vinyl acetate (EVA), rubber, vinyl, thermoplastic, leather, PPT, silicone, felt, Polydur plastic, viscoelastic, and many other materials have been utilized to fabricate foot orthoses for treating plantar fasciitis.1,3,13,21,22,26,27 To our knowledge, there are no studies comparing orthotic materials with regard to clinical effectiveness or cost effectiveness. Nor, to our knowledge, is there any research that looks at the foot being casted in a position other than subtalar neutral.
No epiphany here, I’m sure various materials provide various benefits and should probably be chosen in a CFO based on more than what is subjectively “best” for PF, right? In the vein of here we go again, referencing casting position rather than the kinetics and kinematics causative in producing the biomechanical factors contributing to the onset of PF and how to mediate those in vivo with CFO’s (or prefabs for that matter) gets shuffled aside.
"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright
Re: Plantar Fasciitis; A New Take on Custom Orthoses
You probably right re the acute vs chronic plantar fasciitis - there are probably other types as well.
I do have an issue re material choice; prefab vs custom etc - the focus is on all the wrong things. As I talked in this thread, its all about being able to deliver something that reduces the load in the plantar fascia - that may be gait retraining; strapping; or particular design features in the foot orthotic - who cares what material the orthotic is made out of or if its prefab or custom, as long as the design features reduce the load in the plantar fascia?
__________________ Craig Payne
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