A. Background Plantar fasciitis is the most common foot complaint in America, affecting approximately 10% of people during their life time.9 It can be a painful and debilitating condition which appears in both sedentary and active populations. A survey performed by the Foot and Ankle Special Interest Group of the Orthopedic Section, APTA, found that 100% of therapists reported PF as the most common foot condition seen in their clinic. 9 Approximately one million patients visit physicians for the diagnosis and treatment of plantar fasciitis.10 Chronic plantar fasciitis, previously thought to be an inflammatory condition caused by repetitive microtearing of the plantar fascia, is now thought to be a degenerative condition.5 The plantar aponeurosis, or fascia, functions to provide static support of the longitudinal arch and dynamic shock absorption. It consists of 3 bands: lateral, medial, and central. The central band originates from the medial tubercle of the calcaneus and travels across the metatarsal heads to the phalanx of each toe.9 In the acute stage, pain is commonly localized to the origin of the medial and central bands at the plantar surface of the calcaneus.6 This pain is usually classified as a sharp or knife-like pain upon initial standing. The pain occurs after a period of non-weight bearing and is often the worst in the morning. Those in the chronic stages may report pain as being dull and achy. Pain in this stage may also extend beyond the medial tubercle, extending into the central and lateral bands. Pain at this stage does not usually subside after a few minutes of walking as seen in the acute phase.6 Many factors contribute to the development of plantar fasciitis. Anatomy, biomechanics and environment are factors which contribute to the development of this condition.6 Pes planus, pes cavus feet, limited dorsiflexion, tight Achilles tendon, tight hamstrings and obesity fall beneath anatomical causations. Biomechanical factors include weak plantar flexor muscles and excessive subtalar joint pronation. Environmental factors include weight bearing activities, foot wear and trauma.6 Certain diseases also place an individual at increased risk. These may include diabetes, peripheral vascular neuropathy, Paget's disease, Reiter's syndrome, and other autoimmune and neurologic disorders.8 Diagnosis is mostly made upon clinical assessment and findings for classifying a patient with heel pain into the International Statistical Classification of Diseases and Related Health Problems category of plantar fasciitis and associated International Classification of Functioning Disability and Health impairment based category of heel pain.9 To date, there is no specific treatment of choice for patients with plantar fasciitis. Multiple studies have been conducted on various conservative treatment techniques but according to Crawford et al's Cochrane Review, "There is limited evidence upon which to base clinical practice." 1 The options include: modalities, manual therapy, stretching, taping, night splints, steroid injections and orthotic devices. Of all the previous interventions, there is strong evidence to support the use of orthotic devices to provide temporary relief of symptoms.9 Traditional orthotic devices are designed and casted with the subtalar and midtarsal joints in a neutral position. They are hypothesized to limit excessive pronation, optimize biomechanical loading of the foot, and off load the plantar fascia.10 Additionally, custom orthotics are costly and may require the specialty services of an orthotist to cast the individual. Despite the cost and time-intensive manufacturing process, custom orthotics are often worn for life and may prove to be ineffective after 3 months.9 A recent pilot study proposed the benefit of temporary foot orthoses casted in equinos position for plantar fasciitis treatment.2,3 As opposed to the traditional casting method of subtalar and midtarsal joints in neutral, the equinos position places the patient's foot in full plantar flexion and inversion. This casting position is hypothesized to put the plantar fascia in a slackened position, therefore reducing weight-bearing on the damaged tissue.2 Consequently, the aim of this randomized control trial is to identify the possible effectiveness of the temporary use of an inexpensive custom-made plantar fascia orthotic (PFO), fabricated in equinos position of the foot.