Introduction: Plantar heel pain is one of the most common conditions affecting the foot. Foot orthoses are widely used to treat plantar heel pain, however previous meta-analyses have reported inconsistent findings regarding their effectiveness. Accordingly, there is a need to conduct a systematic review and meta-analysis on the effectiveness of foot orthoses for plantar heel pain.
Methods: Databases searched include Medline, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to July 2015. Studies must have used a randomised design, and investigated foot orthoses for plantar heel pain. Data extraction and risk-of-bias was performed by two independent reviewers. Cochrane risk-of-bias and the Grading Recommendations Assessment, Development, and Evaluation approach were used to assess the quality of studies. Outcomes evaluated were pain, function and ‘first-step’ pain. Endpoints were categorised as short (0 to 4 weeks), medium (5 to 12 weeks) or longer term (13 to 52 weeks). Mean difference or standardised mean difference and the 95% confidence intervals were calculated, and significant results were back-transformed to clinically meaningful measures.
Results: A total of 18 studies were included (1510 participants). Risk-of-bias assessment found 62% of studies were at high risk-of-bias. In the short term, there was very low quality evidence that foot orthoses do not reduce pain. In the medium term, there is moderate quality evidence that foot orthoses (SMD -0.27 [-0.48 to -0.06]) and customised foot orthoses specifically (SMD -0.28 [-0.55 to -0.01]) are more effective than sham foot orthoses at reducing pain, however neither of these findings met the reported value for minimal important difference. In the longer term, there is very low quality evidence that foot orthoses do not reduce pain. There was low to moderate quality evidence that foot orthoses have no effect on function in the short, medium or longer term. There was very low to low quality evidence that there are no differences between customised and prefabricated foot orthoses in any outcome at any endpoint.
Discussion: There is moderate quality evidence that foot orthoses are effective at reducing pain associated with plantar heel pain in the medium term, however it is uncertain if the effect is clinically meaningful for patients. In the short and longer term, foot orthoses do not reduce pain or improve function. Although, the longer term finding most likely reflects the course of plantar heel pain, which is one of natural resolution. Finally, there is no difference between customised and prefabricated foot orthoses.