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Custom insoles versus sham and GP-led usual care in patients with plantar heel pain: results of the STAP-study - a randomised controlled trial
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    Letter in response to: Custom insoles versus sham and GP-led usual care in patients with plantar heel pain: results of the STAP-study-a randomised controlled trial
    • André Augusto Martines Teixeira Mendes, Physiotherapist, MSc , Professor, Faculty Anhanguera de Taubaté. Taubaté, São Paulo, Brazil.
    • Other Contributors:
      • Marcelo Cardoso de Souza, PT, PhD. Professor of Postgraduate Program in Rehabilitation Sciences – Federal Universi

    We read with great interest the study by Rasemberg and colleagues1 and appreciate the pragmatic research method illustrating the routine of clinicians in many countries. However, some points drew our attention and motivated this letter.
    A recent systematic review with meta-analysis2 investigated three types of insoles: customized, prefabricated, and sham. The authors included 19 trials (a total of 1,660 participants) and demonstrated that custom insoles did not reduce pain or improve function in the short-term. In the medium-term, the customized insoles were more effective than sham in reducing pain; however, with no improvements in function. In the long-term, the custom insoles did not reduce pain or improve the participants' function.
    At this point, we achieve the first question: what kind of customization did these studies address? When analyzing the studies included in this review, we noticed that customizations were based on Root's subtalar joint neutral theory, in which insoles should keep the subtalar joint aligned in a neutral position, and the internal longitudinal arch supported to optimize its height and control its descent during the mid-stance support phase. This does not seem ideal if we consider the foot mechanics and some particular movements, such as the windlass for impact absorption and propulsion of the foot3,4.
    When customizing an insole to keep both the foot and ankle in a neutral position, the clinician assumes that every...

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    Conflict of Interest:
    None declared.