Objective To investigate the effectiveness of foot orthoses for pain and function in adults with plantar heel pain.
Design Systematic review and meta-analysis. The primary outcome was pain or function categorised by duration of follow-up as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks).
Data sources Medline, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to June 2017.
Eligibility criteria for selecting studies Studies must have used a randomised parallel-group design and evaluated foot orthoses for plantar heel pain. At least one outcome measure for pain or function must have been reported.
Results A total of 19 trials (1660 participants) were included. In the short term, there was very low-quality evidence that foot orthoses do not reduce pain or improve function. In the medium term, there was moderate-quality evidence that foot orthoses were more effective than sham foot orthoses at reducing pain (standardised mean difference −0.27 (−0.48 to −0.06)). There was no improvement in function in the medium term. In the longer term, there was very low-quality evidence that foot orthoses do not reduce pain or improve function. A comparison of customised and prefabricated foot orthoses showed no difference at any time point.
Conclusion There is moderate-quality evidence that foot orthoses are effective at reducing pain in the medium term, however it is uncertain whether this is a clinically important change.
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Contributors All authors had full access to all of the study data and take responsibility for the integrity of the data and the accuracy of the data analysis. GAW is guarantor, designed the study, conducted the systematic search, study selection, quality appraisal, statistical analysis and interpretation, and prepared the manuscript. KBL designed the study, reviewed and interpreted the statistical analysis, and reviewed and approved the manuscript. SEM designed the study, reviewed the statistical analysis, and reviewed and approved the manuscript. HBM designed the study, and reviewed and approved the manuscript. JMT conducted the quality appraisal, and reviewed and approved the manuscript. CLR conducted the systematic search and study selection, and reviewed and approved the manuscript.
Funding GAW, JMT and CLR are recipients of Australian Government Research Training Program Scholarships. HBM is a National Health and Medical Research Fellow (ID: 1020925).
Competing interests KBL is an author of one of the randomised trials included in this review and has been an investigator on several trials that have evaluated foot orthoses, which have been supplied for free or at a reduced cost.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data are available from the lead author on request.
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