Effectiveness of Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain

Submission note: A thesis submitted in total fulfilment of the requirement for the degree of Doctor of Philosophy to the Discipline of Podiatry, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.

Thesis with publications.

Plantar heel pain is a common condition that causes significant pain and poorer health-related quality of life. Many interventions are used to treat plantar heel pain, however there is uncertainty about which interventions are more effective. Two common interventions are foot orthoses and corticosteroid injection, yet studies to date have found inconsistent results regarding which is more effective. Therefore, the aim of this thesis is to compare the effectiveness of foot orthoses and corticosteroid injection for plantar heel pain. Two systematic reviews with meta-analyses were conducted to investigate the effectiveness of foot orthoses and corticosteroid injection. The findings from the systematic reviews then informed a randomised trial that evaluated the comparative effectiveness of these interventions. The foot orthoses systematic review included 19 randomised trials (n equals 1,660) and concluded that foot orthoses are an effective intervention, but this was not apparent until the medium term (7 to 12 weeks). The corticosteroid injection systematic review included 47 randomised trials (n equals 2,989) and concluded that corticosteroid injection is more effective than foot orthoses and autologous blood injection in the short term (0 to 6 weeks), but is not more effective than placebo injection. The randomised trial (n equals 103) found that corticosteroid injection is more effective than foot orthoses in the short term (week 4), and foot orthoses are more effective than corticosteroid injection in the medium term (week 12). Foot orthoses and corticosteroid injection are both effective interventions for plantar heel pain. However, when these interventions are directly compared, the time at which they are more effective differs. These temporal differences can be summarised in two points: 1. On average, corticosteroid injection produces a faster pain reduction than foot orthoses (up to 6 weeks). 2. On average, foot orthoses lead to greater pain reductions than corticosteroid injection in the medium term (at 12 weeks).