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Clinician Article

Effectiveness of Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain: The SOOTHE Randomized Clinical Trial.



  • Whittaker GA
  • Munteanu SE
  • Menz HB
  • Gerrard JM
  • Elzarka A
  • Landorf KB
J Orthop Sports Phys Ther. 2019 Jul;49(7):491-500. doi: 10.2519/jospt.2019.8807. Epub 2019 May 26. (Original)
PMID: 31130060
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Special Interest - Pain -- Physician
    Relevance - 6/7
    Newsworthiness - 5/7
  • Surgery - Orthopaedics
    Relevance - 6/7
    Newsworthiness - 5/7

Abstract

BACKGROUND: Plantar heel pain is a common foot complaint that causes significant disability and poorer health-related quality of life. Foot orthoses and corticosteroid injection are effective treatments for plantar heel pain; however, it is unclear whether one is more effective than the other.

OBJECTIVE: The aim of this trial was to compare the effectiveness of foot orthoses and corticosteroid injection for plantar heel pain.

METHODS: In this parallel-group, assessor-blinded, randomized clinical trial, participants received prefabricated, arch-contouring foot orthoses or a single ultrasound-guided corticosteroid injection. The primary outcome measure was the foot pain subscale of the Foot Health Status Questionnaire at 4 and 12 weeks.

RESULTS: One hundred three participants aged 21 to 72 years (63 female) with plantar heel pain were recruited from the community and received an intervention. For the primary outcome of foot pain, corticosteroid injection was more effective at week 4 (adjusted mean difference, 8.2 points; 95% confidence interval: 0.6, 15.8 points). However, foot orthoses were more effective at week 12 (adjusted mean difference, 8.5 points; 95% confidence interval: 0.2, 16.8 points). Although these findings were statistically significant, the differences between the interventions did not meet the previously calculated minimal important difference value of 12.5 points.

CONCLUSION: Corticosteroid injection is more effective than foot orthoses at week 4, but this effect does not last; and appropriately contoured foot orthoses are more effective than corticosteroid injection at week 12. However, patients may not notice a clinically worthwhile difference between the interventions.

LEVEL OF EVIDENCE: Therapy, level 1b. J Orthop Sports Phys Ther 2019;49(7):491-500. Epub 26 May 2019. doi:10.2519/jospt.2019.8807.


Clinical Comments

General Internal Medicine-Primary Care(US)

Satisfactory treatment of heel pain due to plantar fasciitis remains an enigma. In this study, comparing corticosteroid injection to foot orthoses indicated clinical improvement for the injection at week 4 after treatment, while the orthosis group had reduced symptoms at week 12. These results reflect those of general clinical practice. Interestingly, the study participants had already been symptomatic for 6 months while many patients seek help in an earlier stage of the illness. In any case, clinical practice will probably not be changed substantially as a result of this study.

Surgery - Orthopaedics

This RCT compares the effectiveness of prefabricated, arch-contouring foot orthoses and a single ultrasound-guided corticosteroid injection for plantar heel pain. For the primary outcome of foot pain measured using the subscale of the Foot Health Status Questionnaire, corticosteroid injection was more effective at week 4, while foot orthoses were more effective at week 12. Although these findings were statistically significant, the differences between the interventions were less than the previously calculated minimal important difference value of 12.5 points, indicating that the difference may not be clinically meaningful. In conclusion, corticosteroid injection is more effective than foot orthoses at week 4, but this effect does not last. Moreover, appropriately contoured foot orthoses are more effective than corticosteroid injection at week 12. However, patients may not notice a clinically worthwhile difference between the interventions.

Surgery - Orthopaedics

This study is worth reading and has important clinical implications.

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