How I prescribe for plantar fasciitis.

The different stages of prescription

 

 

 

 

Orthotic prescription is a very personal thing. There is a million ways to prescribe an orthotic with all of them having the same goal. I’m a believer in keeping the prescription as minimalistic as possible to achieve the result. A lot of people would disagree with this and try to prescribe the optimal orthotic according to the textbook for a person. One thing they forget though is that what the textbook says doesn’t always apply to real work scenarios though. Studies have been done under the perfect scenarios and everything is controlled. Unfortunately, that’s not reality and doesn’t always translate over. They also try and prescribe to achieve √≥ptimal biomechanics and structure. But, “what is optimal biomechanics. That’s why I have different stages of aggressiveness for my prescription. Also note that exercises are given to all of my plantar fasciitis patients. Strength exercises from the foot to the core as well as balance exercises.

 

 

Stage 1

1. I Start with a simple base shell with a simple rearfoot angle. Shoes play just as important a factor as orthotics. Getting them into a good runner that is suited for their foot type is imperative. This will give a huge amount of support and change. From there try using simple orthotics with a standard shell shape, an appropriate rearfoot angle, and possibly a small skive.

 

 

 

Stage 2

If there is little improvement after 3-week bedding in period then I increase the arch. I do this by applying a poron arch pad. 95% of cases are resolved by the end of stage 2. Patient compliance is the biggest factor in achieving this.

 

 

Stage 3

If there is little improvement after 1-2 weeks of the arch increase I will add a heel raise. This may be single leg if they have a leg length discrepancy or bilateral if they don’t. The reason for adding this now is that heel raises can cause the client’s heel to slip out of shoes, it causes extra bulk and weight to the orthotics, the shoes should already have a 10mm pitch to start. With leg length differences, if it is over 1-1.2 cm I may add a 4mm raise at the start. Usually, it will be added though after if pain issues have not been resolved.

 

 

Stage 4

The last stage is added a forefoot valgus extension. This as we know works to twist the foot and release of the fascia. The reason I use this last, is because I have found it has the biggest effect of changing mechanics and  increasing strain on joints and muscles further up the chain. This then can increase the risk of negative effects, such a knee pain, back pain, and more. It also makes the orthotics larger and so takes up more room in the toe box. This can make them more uncomfortable and increase the chance of the patient being uncompliant.

 

 

Stage 5

At this point, if your client has still not improved from orthotic therapy, exercise prescription, and other non-invasive treatments, I would refer you for surgical intervention. I’m not a great fan of cortisone due to the weakening of the fascia. I would refer for PRP if I was too for injection therapy.

 

 

Conclusion

Many people may not agree to with this method, and that’s ok. For me, I’ve found that keeping it simple is the key. Using a simple prescription to start reduces the risk of negative effects, increases comfort, increases compliance, helps them fit into shoes, increases the chance of them returning, and is all that is needed. I’ve also never used or had to use a heel aperture. If you see a Dr for a new medication, he won’t put you on the highest dose right away. He will stick you on a low dose, the monitor to see if it works, and minimize the risk of side effects. He will then review you and decide if the dose needs upping. This is how I think about my prescriptions.