Clinical efficacy and cost-effectiveness of bespoke compared with over-the-counter foot orthoses for plantar heel pain

This study evaluated the clinical effectiveness and cost-effectiveness of two different types of foot orthoses used to treat plantar heel pain. Forty-eight patients were randomly assigned to receive either a functional or an accommodative orthosis. General (EuroQol) and specific (Foot Health Status Questionnaire) health-status measures were used. Data were also collected using economic questionnaires relating to National Health Service costs for podia-try, other health-service costs, and patient costs. Data were measured at baseline and at 4- and 8-week intervals. Thirty-five patients completed the study. The results demonstrated a significant decrease in foot pain and a significant increase in foot function with the functional foot orthoses over the 8-week trial. The accommodative foot orthoses demonstrated a significant reduction in foot pain only at 4 weeks. The cost-effectiveness analysis demonstrated that functional orthoses, although initially more expensive, result in a better quality of life. Use of functional orthoses resulted in an increased cost of £17.99 ($32.74) per patient, leading to an incremental cost per quality-adjusted life year of £1,650 ($3,003) for functional orthoses. (J Am Podiatr Med Assoc 94(3): 229–238, 2004)

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Self-management advice, exercise and foot orthoses for plantar heel pain: the TREADON pilot and feasibility randomised trial

Pilot and Feasibility Studies ◽

10.1186/s40814-021-00808-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Linda S. Chesterton ◽

Martin J. Thomas ◽

Gordon Hendry ◽

Ying Chen ◽

David Goddin ◽

...

Keyword(s):

General Practice ◽

Cost Effectiveness ◽

Sample Size ◽

Heel Pain ◽

Self Management ◽

Foot Orthoses ◽

Main Trial ◽

Plantar Heel Pain ◽

Pain Subscale ◽

Management Advice

Abstract Background Plantar heel pain (PHP) is common and impacts negatively on physical function and quality of life. Initial treatment usually comprises analgesia and self-management advice (SMA), with referral to a physiotherapist or podiatrist recommended only when symptoms persist. Systematic reviews highlight limitations of existing evidence for the effectiveness of exercises and orthoses. The objective of the TREADON pilot and feasibility trial was to inform the design of a future main trial to compare the clinical and cost-effectiveness of self-management advice (SMA), individualised exercises and foot orthoses for PHP. Methods This was a four-arm randomised feasibility and pilot trial with 12-week follow-up. Adults aged ≥ 18 years with PHP were identified from primary care by general practice consultation, retrospective general practice medical record review or a population survey. Participants were randomised to either (i) SMA, (ii) SMA plus individualised exercises (SMA-exercises), (iii) SMA plus prefabricated foot orthoses (SMA-orthoses) or (iv) SMA plus combined individualised exercises and prefabricated foot orthoses (SMA-combined). Feasibility outcomes were recruitment; retention; intervention adherence, credibility and satisfaction; performance of three potential primary outcome measures (pain numeric rating scale (NRS), Foot Function Index-pain subscale (FFI-pain), Manchester Foot Pain and Disability Index-pain subscale (MFPDI-pain)); and parameters for informing the main trial sample size calculation. Results Eighty-two participants were recruited. All three identification methods met the target number of participants. Retention at 12 weeks was 67%. All interventions were successfully delivered as per protocol. Adherence (range over 12 weeks 64–100%) and credibility (93%) were highest in the SMA-combined arm. Satisfaction with treatment was higher for the three clinician-supported interventions (SMA 29%, SMA-exercises 72%, SMA-orthoses 71%, SMA-combined 73%). Responsiveness (baseline to 12 weeks) was higher for FFI-pain (standardised response mean 0.96) and pain NRS (1.04) than MFPDI-pain (0.57). Conservative sample size parameter estimates for standard deviation were pain NRS 2.5, FFI-pain 25 and MFPDI-pain 4, and baseline-outcome correlations were 0.5–0.6, 0.4 and < 0.3, respectively. Conclusions We demonstrated the feasibility of conducting a future main randomised clinical trial comparing the clinical and cost-effectiveness of SMA, exercises and/or foot orthoses for PHP. Trial registration number ISRCTN 12160508. Prospectively registered 5th July 2016.

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Feasibility study to evaluate the clinical and cost effectiveness of foot orthoses in the management of plantar heel pain

http://isrctn.org/> ◽

10.1186/isrctn73264439 ◽

2012 ◽

Author(s):

Keith Rome

Keyword(s):

Cost Effectiveness ◽

Feasibility Study ◽

Heel Pain ◽

Foot Orthoses ◽

Plantar Heel Pain

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Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-097892 ◽

2018 ◽

Vol 52 (16) ◽

pp. 1040-1046 ◽

Cited By ~ 13

Author(s):

Nadine Rasenberg ◽

Henrik Riel ◽

Michael S Rathleff ◽

Sita M A Bierma-Zeinstra ◽

Marienke van Middelkoop

Keyword(s):

Systematic Review ◽

Conservative Treatment ◽

Meta Analysis ◽

Heel Pain ◽

Controlled Trials ◽

Cochrane Central Register ◽

Foot Orthoses ◽

Short Term ◽

Eligibility Criteria ◽

Plantar Heel Pain

BackgroundPlantar heel pain (PHP) is common. Foot orthoses are often applied as treatment for PHP, even though there is little evidence to support this.ObjectiveTo investigate the effects of different orthoses on pain, function and self-reported recovery in patients with PHP and compare them with other conservative interventions.DesignSystematic review and meta-analysis.Data sourcesA systematic literature search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL and Google Scholar up to January 2017.Eligibility criteria for selecting studiesRandomised controlled trials comparing foot orthoses with a control (defined as no intervention, sham or other type of conservative treatment) reporting on pain, function or self-reported recovery in patients with PHP.ResultsTwenty studies investigating eight different types of foot orthoses were included in the review. Most studies were of high quality. Pooled data from six studies showed no difference between prefabricated orthoses and sham orthoses for pain at short term (mean difference (MD) of 0.26 (95% CI −0.09 to 0.60)). No difference was found between sham orthoses and custom orthoses for pain at short term (MD 0.22 (95% CI −0.05 to 0.50)), nor was there a difference between prefabricated orthoses and custom orthoses for pain at short term (MD 0.03 (95% CI −0.15 to 0.22)). For the majority of other interventions, no significant differences were found.ConclusionsFoot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with PHP.PROSPERO registration numberCRD42015029659.

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Should foot orthoses be used for plantar heel pain?

British Journal of Sports Medicine ◽

10.1136/bjsports-2018-099426 ◽

2018 ◽

Vol 52 (19) ◽

pp. 1224-1225 ◽

Cited By ~ 2

Author(s):

Glen A Whittaker ◽

Shannon E Munteanu ◽

Hylton B Menz ◽

Karl B Landorf

Keyword(s):

Heel Pain ◽

Foot Orthoses ◽

Plantar Heel Pain

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Corticosteroid injections compared to foot orthoses for plantar heel pain: protocol for the SOOTHE heel pain randomised trial

Contemporary Clinical Trials Communications ◽

10.1016/j.conctc.2016.11.003 ◽

2017 ◽

Vol 5 ◽

pp. 1-11 ◽

Cited By ~ 3

Author(s):

Glen A. Whittaker ◽

Shannon E. Munteanu ◽

Hylton B. Menz ◽

Ayman Elzarka ◽

Karl B. Landorf

Keyword(s):

Randomised Trial ◽

Heel Pain ◽

Foot Orthoses ◽

Plantar Heel Pain ◽

Corticosteroid Injections

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Can short-term effectiveness of anti-pronation taping predict the long-term outcomes of customized foot orthoses: developing predictors to identify characteristics of patients with plantar heel pain likely to benefit from customized foot orthoses

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2648-3 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Fu-Lien Wu ◽

Yi-Fen Shih ◽

Si-Huei Lee ◽

Hong-Ji Luo ◽

Wendy Tzyy-Jiuan Wang

Keyword(s):

Heel Pain ◽

Foot Orthoses ◽

Long Term Outcomes ◽

Short Term ◽

Plantar Heel Pain

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Cost-Effectiveness of Two Dry Needling Interventions for Plantar Heel Pain: A Secondary Analysis of an RCT

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041777 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1777

Author(s):

Daniel Fernández ◽

Zaid Al-Boloushi ◽

Pablo Bellosta-López ◽

Pablo Herrero ◽

Manuel Gómez ◽

...

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Controlled Trial ◽

Secondary Analysis ◽

Heel Pain ◽

Dry Needling ◽

Cost Effectiveness Ratio ◽

Plantar Heel Pain ◽

Life Years

Plantar heel pain is a common cause of foot pain that affects patients’ quality of life and represents a significant cost for the healthcare system. Dry needling and percutaneous needle electrolysis are two minimally invasive treatments that were shown to be effective for the management of plantar heel pain. The aim of our study was to compare these two treatments in terms of health and economic consequences based on the results of a published randomized controlled trial. For this, we evaluated the costs from the point of view of the hospital and we carried out a cost-effectiveness study using quality of life as the main variable according to the Eq-5D-5L questionnaire. The cost of the complete treatment with dry needling (DN) was €178.86, while the percutaneous needle electrolysis (PNE) was €200.90. The quality of life of patients improved and was translated into +0.615 quality-adjusted life years (QALYs) for DN and +0.669 for PNE. PNE presented an average incremental cost-effectiveness ratio (ICER) of €411.34/QALY against DN. These results indicate that PNE had a better cost-effectiveness ratio for the treatment of plantar heel pain than DN.

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