What's the role of cut-out heel pads or horseshoe pads in the treatment of plantar fasciitis? From a historical perspective, it's really kind of an interesting story.
The use of a cut-out heel pad or horseshoe pad dates back to the days when we believed that the primary contributing factor to heel pain was a spur on the bottom of the heel. Popular belief was that standing on the spur resulted in pain. Cut-out pads were used to pocket the bottom of the heel. The thought being that the cut-out would cradle the heel spur and off-load direct pressure to the heel spur. But I think today most clinicians will agree that the concept of a heel spur being the primary cause of pain is old school. What actually causes plantar heel pain is a functional problem that occurs with weight-bearing. The arch of the foot is supported by an inelastic tissue called the plantar fascia. When weight is applied to the foot, the arch drops and the plantar fascia is put under load. If the load applied to the plantar fascia is too great, the fascia will tug and pull on its' insertion on the plantar heel resulting in pain. This pain is what we call plantar fasciitis.
Cut-out heel pads and horseshoe pads have traditionally been used to act as a pocket to off-load that symptomatic heel spur. So if the primary problem isn't the spur, then why are we still using a horseshoe pad?
Well, some traditions are hard to break. But interestingly, there's still a role for these unique kinds of pads. A firm horseshoe pad can act as a heel lift. And as you know after reading our knowledge base article on plantar fasciitis, using a heel lift is one of the first steps to do when treating plantar fasciitis. Also, the cut-out pads will take direct pressure away from the pain on the bottom of the foot. Although this off-loading of the pain isn't really a therapeutic measure, it can still help with the pain found in cases of plantar fasciitis. Off-loading with a horseshoe pad doesn't really seem to help so much for that sharp tearing pain you feel when you first stand, but does seem to help with the pain found by the end of the day. That dull, achy pain found with standing.
As a clinician, you do have to laugh at yourself sometimes, particularly when you do something that works but you didn't really understand why it worked. That's exactly what happened from a historical standpoint with doctors treating heel pain. But hey, if it makes your patient feel better, no need to be analytical about it. Just keep doing it.
Jeffrey A. Oster, DPM