05 Apr Orthotics for lower-limb and foot pain – Symptom relief not long-term cure.
“For every complex problem there is an answer that is clear, simple, and wrong”. – H.L. Mencken.
Orthotic shoe inserts have long been advocated for the management of pain and overuse injuries in the feet and lower limbs (Schuster, 1972). There are many anecdotal reports of ‘successful’ treatment, but definitions of ‘success’, and the failure to distinguish changes in gait from injury prevention or pain relief, and short from long-term effects lead to mixed conclusions of ‘benefit’.
In recent years, the mechanism proposed to underpin therapeutic effects of orthoses has been challenged i.e. the pronation control model (McPoil and Hunt, 1995; Nigg et al., 1999). Simultaneously the push towards evidence-based practice in health care means clinical decisions need to be based on high-quality research evidence (i.e. the pooled findings of randomised controlled trials, known as meta analyses). So what does such high-quality evidence suggest about the possible benefits of orthotics?
From the two most recent and comprehensive meta analyses (Collins et al., 2007; Hume et al., 2008) the evidence for the use of orthotics as a treatment suggests:
- At best, a trivial effect of treatment on patient perceived benefit or pain compared to control (up to 3 month intervention)
- No difference between custom made or prefabricated orthotics
- Little/no evidence for long-term relief from pain (longest follow up 12 months)
In summary, use of orthotics in a treatment program for sufferers of overuse conditions cannot be supported based on the available high-quality evidence. Users might possibly gain short-term pain relief at best. Perhaps it is time to treat the root cause of the problem rather than the symptoms.
Schuster RO: Podiatry and the foot of the athlete. J Am Podiatry Assoc. 62:465-468, 1972.
Collins N, Bisset L, McPoil T and Vicenzino B: Foot orthoses in lower limb overuse conditions: a systematics review and meta-analysis. Foot & Ank Int. 28:396-412, 2007.
Hume P, Hopkins W, Rome K, Maulder P, Coyle G and Nigg BM: Effectiveness of foot orthoses for treatment and prevention of lower limb injuries. Sports Med. 38:759-779.
McPoil TG and Hunt GC: Evaluation and management of foot and ankle disorders: present problems and future directions. J Orthop Sports Phys Ther. 21:381-388, 1995.
Nigg BM, Nurse MA and Stefanyshyn DJ. Shoe inserts and orthotics for sport and physical activities. Med Sci Sports Exerc. 31:S421-428, 1999.