of foot orthoses for the prevention of lower limb overuse injuries in naval
recruits: a randomised controlled trial
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.
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?
by: Nicole Cattano
by: Jeffrey Driban