Foot Orthoses in Lower Limb Overuse Conditions: A Systematic Review and Meta-Analysis--Critical Appraisal and Commentary (Evidence-Based Practice) (Report‪)‬

COMMENTARY Lower limb overuse injuries commonly are seen by certified athletic trainers across sports and competitive levels. The use of foot orthoses for the prevention or treatment of these injuries is recommended in standard athletic training textbooks. (1) Underpinning the use of foot orthoses is a theoretical model that links abnormal foot motion with excessive tissue stresses in the foot, leg, knee, hip, and spine that, over time, lead to tissue breakdown and pain. (2) Limited evidence has demonstrated the effect of foot orthoses on lower limb kinetics. (3) Eickhoff et ala reported athletes' subjective descriptions of decreased lower limb pain with the use of foot orthoses. The authors (5) of a systematic review on the use of custom orthotics for loot pain concluded that gold-level evidence (a well-conducted randomized controlled trial [RCT] powered to find a 20% relative difference) supports the use of orthotic devices to treat painful pes cavus and that silver-level evidence (an RCT with less than 20% relative difference, a nonrandomized trial, or a well-conducted case-control study) supports their use to treat plantar fasciitis. To promote evidence-based clinical decision making, Collins et al (6) performed this systematic review of RCTs, in which they examined the efficacy of using foot orthoses to manage lower limb overuse injuries.