Shoe Insoles for Preventing, Treating Low Back Pain
Shoe Insoles for Preventing, Treating Low Back Pain
Low back pain (LBP) is estimated to affect up to 80% of adults and has significant associated socioeconomic and healthcare cost. While the majority of acute episodes resolve within a six week time-frame, approximately 10% of cases progress to a chronic stage where symptoms remain present for three months or more. Recurrence rates of LBP are high, with up to 44% of LBP sufferers experiencing a return of symptoms within a year, and 85% a recurrence over their life-time. In up to 85% of LBP cases the mechanism of the pain is poorly understood and is classified as non-specific, i.e. of unknown origin. The combination of unknown aetiology and high rates of recurrence make effective treatment difficult and the outcomes of specific interventions have been shown to be variable.
Foot function has been suggested to be an aetiological mechanism for the development of LBP. Excessive foot pronation is proposed to produce prolonged internal rotation of the lower limb and disrupt sagittal plane forward progression of the body during gait. This causes significant strain at the sacroiliac and lumbosacral joints contributing to the development of LBP. A rigid high arched foot type has also been associated with the development of LBP. This foot type diminishes the capacity for shock absorption by the foot and so pre-disposes to shock-induced pathology in the lower back. In the presence of excessive or prolonged foot pronation, orthoses have traditionally been prescribed to reduce the extent and velocity of foot movement, correcting lower limb function and proximal posture. In a rigid high arched foot type, shock-absorbing insoles are proposed to reduce the more proximal propagation of shock, subsequently reducing LBP.
Anecdotal evidence of significant short and long term pain reduction following intervention with customised foot orthoses and prefabricated insoles supports the role of functional foot devices in the treatment and prevention of LBP.
However these findings are not supported by previous systematic reviews and foot orthoses and insoles are currently not considered in international and national clinical guidelines for the management of non-specific LBP. Given the common use of insoles to treat LBP and the lack of clear guidelines for use in clinical practice, further investigation is warranted. The aim of this analysis is to systematically review the current literature to determine for people with LBP or at risk of developing LBP, if insoles are effective in preventing or reducing LBP, compared to a sham or control treatment, and to evaluate study findings by meta-analysis where appropriate.
Background
Low back pain (LBP) is estimated to affect up to 80% of adults and has significant associated socioeconomic and healthcare cost. While the majority of acute episodes resolve within a six week time-frame, approximately 10% of cases progress to a chronic stage where symptoms remain present for three months or more. Recurrence rates of LBP are high, with up to 44% of LBP sufferers experiencing a return of symptoms within a year, and 85% a recurrence over their life-time. In up to 85% of LBP cases the mechanism of the pain is poorly understood and is classified as non-specific, i.e. of unknown origin. The combination of unknown aetiology and high rates of recurrence make effective treatment difficult and the outcomes of specific interventions have been shown to be variable.
Foot function has been suggested to be an aetiological mechanism for the development of LBP. Excessive foot pronation is proposed to produce prolonged internal rotation of the lower limb and disrupt sagittal plane forward progression of the body during gait. This causes significant strain at the sacroiliac and lumbosacral joints contributing to the development of LBP. A rigid high arched foot type has also been associated with the development of LBP. This foot type diminishes the capacity for shock absorption by the foot and so pre-disposes to shock-induced pathology in the lower back. In the presence of excessive or prolonged foot pronation, orthoses have traditionally been prescribed to reduce the extent and velocity of foot movement, correcting lower limb function and proximal posture. In a rigid high arched foot type, shock-absorbing insoles are proposed to reduce the more proximal propagation of shock, subsequently reducing LBP.
Anecdotal evidence of significant short and long term pain reduction following intervention with customised foot orthoses and prefabricated insoles supports the role of functional foot devices in the treatment and prevention of LBP.
However these findings are not supported by previous systematic reviews and foot orthoses and insoles are currently not considered in international and national clinical guidelines for the management of non-specific LBP. Given the common use of insoles to treat LBP and the lack of clear guidelines for use in clinical practice, further investigation is warranted. The aim of this analysis is to systematically review the current literature to determine for people with LBP or at risk of developing LBP, if insoles are effective in preventing or reducing LBP, compared to a sham or control treatment, and to evaluate study findings by meta-analysis where appropriate.
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