What type of brace can help alleviate foot pain associated with conditions like plantar fasciitis or flat feet?

Foot Braces for Plantar Fasciitis and Flat Feet

For plantar fasciitis and flat feet, custom orthotic devices provide superior support compared to over-the-counter options and should be the primary brace recommendation, particularly for patients with foot deformities. 1

Types of Braces for Foot Pain

Orthotic Devices

1. Custom Orthotic Devices

   • Provide better support than over-the-counter options
   • Recommended for patients with foot deformities or pre-ulcerative lesions 1
   • More effective in reducing arch height drop in flat-footed individuals with plantar fasciitis 2
   • Studies show 62% pain reduction at 52 weeks with foot orthoses compared to 48% with night splints alone 3

2. Prefabricated Orthotic Types

   • Foam-covered rigid self-supporting plastic orthotics (PO) are superior for pain reduction compared to soft supportive foam orthotics (FO) 4
   • Thin, non-supportive orthotics show no significant effect on pain relief 4
   • Over-the-counter heel cushions and arch supports are recommended as initial treatment 1

Night Splints

• Help maintain dorsiflexion during sleep to prevent morning pain 1
• Effective for short-term and long-term treatment of plantar fasciitis 3
• Lower compliance compared to orthotic devices (only 1 of 28 patients still using night splints at 12 months versus 19 of 23 still using foot orthoses) 3

Immobilization Devices

• Fixed-ankle walker-type devices can be considered during activity for severe cases 1
• Non-removable knee-high offloading devices are first choice for patients with diabetic foot complications 1

Treatment Algorithm for Foot Pain

For Plantar Fasciitis:

1. First-line treatment:

   • Custom orthotic devices or prefabricated rigid self-supporting plastic orthotics 1, 4
   • Regular calf-muscle stretching and plantar fascia-specific stretching 1
   • Supportive shoes with adequate arch support 1

2. If pain persists:

   • Add night splinting to maintain dorsiflexion during sleep 1, 3
   • Consider immobilization with fixed-ankle walker-type device during activity 1

For Flat Feet:

1. First-line treatment:

   • Custom orthotic devices that provide arch support 2
   • 3D-printed custom orthotics are equally effective as traditionally-made orthotics in changing lower limb biomechanics 2

2. For severe cases:

   • Rigid orthotic devices that control excessive pronation 2

Clinical Pearls and Pitfalls

Pearls:

• Patients should avoid walking barefoot, in socks only, or in thin-soled slippers 1
• Combining foot orthoses with night splints may provide additional benefit for recalcitrant cases 3
• Response to treatment should be evaluated every 4-6 weeks 1

Pitfalls:

• Thin, non-supportive orthotics show no significant effect on pain relief and should be avoided 4
• Night splints have poor long-term compliance despite effectiveness 3
• Modified shoes are conditionally recommended against in patients with knee and/or hip OA, suggesting careful consideration when recommending footwear modifications 5

Special Considerations

• For patients with both foot and knee pain, consider that lateral and medial wedged insoles are conditionally recommended against in patients with knee and/or hip OA 5
• For patients with diabetic foot complications, non-removable knee-high offloading devices are the first choice 1

By following this evidence-based approach to selecting appropriate foot braces, clinicians can effectively manage foot pain associated with plantar fasciitis and flat feet, improving patient outcomes and quality of life.