Sports Medicine Research: In the Lab & In the Field: Orthoses Clinically Reduce Lower Extremity Injuries (Sports Med Res)


Wednesday, December 20, 2017

Orthoses Clinically Reduce Lower Extremity Injuries

Effectiveness of foot orthoses for the prevention of lower limb overuse injuries in naval recruits: a randomised controlled trial

Bonnano DR, Murley GS, Munteanu SE, Landorf KB, & Menz HB. Br J Sports Med. 2017; Online Ahead of Print December 9, 2017.  

Take Home Message: Prefabricated orthoses may reduce the risk of chronic lower extremity injury during a naval recruit training program.
Foot structure and function play a large role in overuse lower extremity injuries.  As clinicians, it may be valuable to use exercises or external devices – such as orthotics – to prevent these injuries.  Hence, these authors conducted a double-blind randomized controlled clinical trial to compare the incidence of chronic lower extremity injuries between approximately 150 naval recruits who received prefabricated orthotics to about 150 who had flat insoles during an 11-weeks training period. The participants and assessors were unaware of the type of insole/orthosis that each person received. The authors defined a chronic lower extremity injury as the diagnosis of medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy and plantar fasciitis/plantar heel pain. There were 67 chronic lower limb injuries reported during the 11-week training period. The group with prefabricated orthoses had ~8% less injuries than the group with flat insoles (26 vs 18%), which represents ~34% relative reduction in risk.  The authors also reported that there were no differences between insoles for pain, perceived use, lost training days, and mental health status. However, the group with prefabricated orthoses were more likely to report an adverse event (20 versus 12%); including blisters, arch pain, or shin pain.

The use of prefabricated orthotics seemed to reduce the overall incidence of chronic lower extremity injuries during an 11-week training program for naval recruits.  These findings should be interpreted with caution since the results were not statistically significant. However, it would still appear that some clinically meaningful reduction in risk was found with a relatively low-cost intervention.  It would have been interesting to see who had a history of acute and chronic lower extremity injuries coming in to the training program.  The recruits were similar at baseline on many factors; however, it would also be interesting to further consider biomechanical gait or landing characteristics to see if these influenced the outcomes.  The authors presented who had a supinated, neutral, or pronated foot; however, there is no subanalyses within these smaller groups.  I am left wondering if pronated feet respond better to orthotics versus people with supinated feet in comparison to the flat insoles group.  Finally – if the recruits were fitted with custom-insoles it might be worth seeing how this would affect injury incidence.  Ultimately, the study offers support for the use of a low-cost prefabricated orthotic for reducing the risk of chronic lower extremity injuries.

Questions for Discussion:  Are you currently advising any patients to use orthotics, or have you considered this in the past?  How do you assess who should use orthotics?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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