ReviewFoot orthotics for low back pain: The state of our understanding and recommendations for future research
Introduction
There is wide spread clinical use of foot orthotics in the developed nations to treat a variety of musculoskeletal conditions. Surveys indicate both chiropractors and podiatrists have high rates of utilization [1], [2], [3] and patients report high levels of compliance and satisfaction [4]. Industry analysts have estimated the world-wide market for orthotic devices to be 4.7 billion USD for 2015 [5]. Previous recommendations regarding the use of orthotic intervention as a treatment for those with low back pain (LBP) are varied. The United States Veterans Administration recommends the use of orthotics for treatment of those with work related LBP [6], yet the European Guidelines for the Management of Chronic Non-Specific Low Back Pain does not mention foot orthotics [7].
The purpose of this article is to highlight the current state of knowledge regarding the clinical use of foot orthotics to treat and/or prevent the occurrence of LBP, and to review the biomechanical mechanisms underlying the effectiveness of such treatment. We also have identified gaps in the literature that exist based on the findings of studies on foot orthotics. A summary of the most influential studies conducted during the past decade is provided and recommendations that may prove useful in directing future clinical research initiatives involving foot orthotics for back pain is suggested.
Section snippets
Methods
The biomedical literature was searched to identify key articles that reveal the current state of knowledge on the benefits of foot orthotics for LBP related to biomechanical mechanisms and clinical outcomes. Database searches were conducted using PubMed, EBSCO, GALE, Google Scholar, and clinicaltrials.gov. The following search terms were used for each database (“foot orthotics”, insoles, “foot orthoses”, “shoe inserts”, excluding “foot ankle”). In addition, reference lists from key articles
Biomechanical mechanisms of foot orthotics for LBP
The high impact forces and repetitive stress associated with heel strike during gait has been implicated as a contributing factor in the development of both lower limb pain and LBP [9]. The added shock absorption properties of orthotics have been proposed as a significant source of pain relief. An early study of viscoelastic insoles showed a decrease of 42% in the peak vertical impact forces at heel strike [10]. Subsequent studies found strikingly positive effects of shock absorbing insoles
Meta-analyses and RCTs on foot orthotics for the prevention of back pain
Two meta-analyses of foot orthotic intervention used both in the treatment and prevention of LBP have been published [50], [51]. When regarding the use of orthotics in for the prevention of LBP the Chuter et al. meta-analysis revealed a 22% reduction in the risk of developing LBP with the use of orthotics compared to the control group, however this seemingly large decreased risk was not statistically significant [50]. Similarly, Sahar et al. found no significant change in the pooled Risk Ratio
Meta-analyses and RCTs on foot orthotics for the treatment of back pain
Chuter et al. assessed studies on the treatment of LBP (5 studies) and found a positive outcome trend in those using orthotics vs. those in a control group [50]. However, not all studies included in the analysis found statistically significant improvements, and the clinical significance of these this trend was not addressed. It was noted that the most significant treatment effect was found in a study that limited the subject population to those with a pronated standing foot posture [19]. It was
Conclusions
Based upon the critical evaluation of the current research on foot orthotics related to biomechanical mechanisms and clinical outcomes, recommendations for future research to address the evidence-practice gaps on the benefits of foot orthotics for LBP include:
- (1)
Mechanistic studies focused on clinical outcomes and that make use of dynamic characterization of foot function at baseline.
- (2)
Controlled and systematic alteration of orthotic interventions based on this characterization.
- (3)
Utilization of
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