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

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Original article
Effectiveness of foot orthoses for the prevention of lower limb overuse injuries in naval recruits: a randomised controlled trial
  1. Daniel R Bonanno1,2,
  2. George S Murley1,2,
  3. Shannon E Munteanu1,2,
  4. Karl B Landorf1,2,3,
  5. Hylton B Menz1,2
  1. 1 Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
  2. 2 La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
  3. 3 Department of Allied Health, Melbourne Health, Parkville, Victoria, Australia
  1. Correspondence to Mr Daniel R Bonanno, Discipline of Podiatry, School of Allied Health, La Trobe University, Melbourne, Victoria 3086, Australia; d.bonanno{at}latrobe.edu.au

Abstract

Objectives To evaluate the effectiveness of prefabricated foot orthoses for the prevention of lower limb overuse injuries in naval recruits.

Methods This study was a participant-blinded and assessor-blinded, parallel-group randomised controlled trial. Three-hundred and six participants aged 17–50 years who undertook 11 weeks of initial defence training at the Royal Australian Navy Recruit School (Cerberus, Australia) were randomised to a control group (flat insoles, n=153) or an intervention group (contoured, prefabricated foot orthoses, n=153). The combined incidence of medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy and plantar fasciitis/plantar heel pain during the 11-week training period were compared using incidence rate ratios (IRR). Data were analysed using the intention-to-treat principle.

Results Sixty-seven injuries (21.9%) were recorded. The control and intervention group sustained 40 (26.1%) and 27 (17.6%) injuries, respectively (IRR 0.66, 95% CI 0.39 to 1.11, p=0.098). This corresponds to a 34% reduction in risk of developing medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy or plantar fasciitis/plantar heel for the intervention group compared with the control group. Participants in the prefabricated orthoses group were more likely to report at least one adverse event (20.3% vs 12.4%; relative risk (RR) 1.63, 95% CI 0.96 to 2.76; p=0.068; number needed to harm 13, 95% CI 6 to 253). The most common adverse events were foot blisters (n=20, 6.6%), arch pain (n=10, 3.3%) and shin pain (n=8, 2.6%).

Conclusion Prefabricated foot orthoses may be beneficial for reducing the incidence of lower limb injury in naval recruits undertaking defence training.

Trial registration number Australian New Zealand Clinical Trials Registry: ACTRN12615000024549.

  • orthotics
  • injury prevention
  • foot injuries
  • overuse injury
  • lower limb

https://doi.org/10.1136/bjsports-2017-098273

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    Footnotes

    • Handling editor Karim M Khan

    • Contributors DRB and GSM: responsible for acquisition of data and can take responsibility for the integrity of the data. DRB and HBM: involved in statistical analysis and interpretation of data. DRB: responsible for the preparation of the manuscript with all other authors involved in its review prior to submission for publication. All authors: were involved in study concept and design; read and approved the final manuscript.

    • Funding La Trobe University Sport, Exercise and Rehabilitation Research Focus Area.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Australian Defence Human Research Ethics Committee (764-14) and the La Trobe University Faculty Human Ethics Committee (FHEC 14/250).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Unpublished data are available upon request subject to ethical approval.