Why are some orthotics so effective and others not?

We often see patients who have chronic heel pain and often this is plantar fasciitis.  Often those patients that have heel pain and plantar fasciitis have a very thin plantar fat pad.  The problem may have started with an injury or even a stone bruise.  But, by the time they come in the problems include significant thickening of the plantar fascia that we can verify with diagnostic ultrasound imaging, we can also verify that the plantar fat pad is thinner than it should be and therefore more long-term vulnerability.
 
So how to we treat this problem.  This is primarily a mechanical problem but also has an inflammatory component for many people.  As far as the mechanical component of the problem goes, avoiding going barefoot and wearing very good shoes, a night splint, bracing taping are all helpful.  But the most important mainstay of treatment for chronic plantar fasciitis is proper orthotics combined with good shoes.
 
For our patients with plantar fasciitis, I often include special modifications to the orthotic prescription.  This may include a very deep heel cup in the bottom of the polypropylene shell of the orthotic.  In the center of the heel cup I often have an aperture or hole that is filled with silicone gel and then backfilled with poron which is a special shock absorbing foam as a top layer.  This is then covered with Spenco which the type of neoprene.  In addition, the orthotic fits the foot perfectly and holds the foot in its ideal mechanical position.  This decreases the longitudinal tension within the plantar fascia itself.  Remember that the plantar fascia goes from the heel to the base of the great toe (and first metatarsal) and across the rest of the forefoot.  It is very effective to allow the first metatarsal head to go down (plantarflex).  This decreases the longitudinal tension within the plantar fascia.  This modification can include a first metatarsal cutout and reverse Morton's extension.
 
At Issaquah Foot & Ankle Specialists, our goal is to help our patients to heal as quickly as possible.  We do whatever we can to enhance and speed up the healing process.  If you have plantar fasciitis and heel pain, we are happy to help you.  We have patients who come in from all over Washington State and the Northwest.