Foot Insoles in the Medical Literature

Foot Insoles and Patient Satisfaction:

Several studies have been performed with the intent to establish satisfaction experienced by patients pertaining to the comfort level and overall effectiveness in their use of orthotic devices. The findings are as follows:

2004: Of 275 patients using foot Insoles for over 1 year most experienced 60-100% relief of symptoms. Of the 275 patients surveyed 9% experienced no relief of symptoms.
Walter JH, Ng G, Stoitz JJ: Survey: A patient satisfaction survey on prescription custom-molded foot orthoses. JAPMA, 94:363-367, 2004.

1993: 520 participants were questioned and 83% were found to have experienced relief of symptoms while 95% of participants experienced complete or near complete resolution of their foot problems from the use of Insoles.
Moraros J, Hodge W: Orthotic survey: Preliminary results. JAPMA, 83:139-148, 1993

1988: Of 81 patients who were questioned, 91% reported being “satisfied with orthoses”. Out of those patients 52% “wouldn’t leave home without them”.
Donnatelli R, Hurlbert C, et al: Biomechanical foot Insoles: A retrospective study. J Ortho Sp Phys Ther, 10:205-212, 1988.

Foot Insoles and Plantar Fasciitis

Several studies were performed to determine the effect that the introduction of ortheses has in treating plantar fasciitis, heel spur syndrome, heel pain and arch pain.

2002: Researchers discovered that when foot orthoses were used to treat plantar fasciitis in this demographic a 75% reduction in the level of disability and a 66% reduction in the level of pain were experienced.
Gross MT, Byers JM, Krafft JL, Lackey EJ, Melton KM: The impact of custom semi-rigid foot Insoles on pain and disability for individuals with plantar fasciitis. J Ortho Sp Phys Ther, 32:149-157, 2002.

2004: This review suggested that foot Insoles reduce pain levels and disability from plantar fasciitis.
Karl B. Landorf, Anne-Maree Keenan, and Robert D. Herbert Effectiveness of Different Types of Foot Orthoses for the Treatment of Plantar Fasciitis, J Am Podiatr Med Assoc 2004 94: 542-549

1991: This long-term study compared the use of Insoles with and without steroidal or non-steroidal injections on 84 patients experiencing heel pain. Of these subjects, 98 had pain in both heels. When the study was complete 89% of patients using Insoles without steroids either experienced a complete reduction in pain or a minimum 80% relief of their pain; 7% of participants experienced only minimal relief, and 4% experienced of participants experienced no relief at all. It took approximately 5.4 weeks for peak relief to occur.
Scherer, PR, et al. Heel spur syndrome, pathomechanics and non-surgical treatment. JAMA, 1991; 81:68-72

1998: This study concluded that of 85 patients using orthotic devices to treat plantar fasciitis for 12 weeks 70% of all patients experienced good or excellent reduction in symptoms whereas only 30% of patients using generic visco-elastic heel inserts experienced good or excellent reduction on symptoms.
Lynch DM, Goforth WP, Conservative treatment of plantar fasciitis. A prospective study. J Am Podiatr Med Assoc. 1998 Aug; 88(8):375-80.

1999: This study aimed to establish that the addition of appropriate orthotic devices to the shoe reduces pressure on the plantar fascia. An article published in 1996 by the same team of researchers concluded that custom UCBL ortheses greatly reduce pressure on the plantar aponeurosis in all patients. (P

2002: When custom Insoles were tested on participants experiencing plantar fasciitis a 75% drop in disability was observed, as was a 66% drop in pain experienced. This study was pivotal in measuring the how effective the use of custom Insoles could be in the treatment of foot and heel pain. Gross, MT, Byers, JM, Krafft, JL, Lackey, EJ, Melton, KM.
The impact of custom semi-rigid orthoses on pain and disability for individuals with plantar fasciitis. Journal of Orthopaedic and Sports Physical Therapy 2002; 32:149-157.

Ball-of-Foot Pain (Metatarsal) Pain and the Use of Insoles

Reducing pain in the ball of foot relies on a decrease in pressure on the ball-of-foot metatarsal. The usage of orthotic devices has proved to have significant impact in the reduction of pressure, and therefore pain. Many journals have been written outlining the use of ortheses for metatarsal pain with the focus on the impact that orthotic placement has in the quality and quantity of results.
Aligning anatomical structure from spiral X-ray computed tomography with plantar pressure data.Hastings MK, Commean PK, Smith KE, Pilgram TK, Mueller MJ.Clin Biomech (Bristol, Avon). 2003 Nov;18(9):877-82.

Supplementary Readings:
Optimum position of metatarsal pad in metatarsalgia for pressure relief. Hsi WL, Kang JH, Lee XX. Department of Rehabilitation, National Taiwan University Hospital, Taipei, Republic of China. Am J Phys Med Rehabil. 2005 Jul; 84(7):514-20.

A quantitative assessment of the effect of metatarsal pads on plantar pressures.
Holmes GB Jr, Timmerman L. Foot Ankle. 1990 Dec; 11(3):141-5.Related Articles, Links

Multistep measurement of plantar pressure alterations using metatarsal pads.
Chang AH, Abu-Faraj ZU, Harris GF, Nery J, Shereff MJ. Department of Orthopaedic Surgery, Medical College of Wisconsin, Foot Ankle Int. 1994 Dec;15(12):654-60.

Ankle Sprains and Foot Insoles

Treating chronic or severe ankle sprains with orthoses has become standard practice. Studies show that orthotic devices relieve most of the pressure straining ankle ligaments by corrections to the posture (postural sway in particular) and a reduction of unnecessary and damaging movement in injured and/or inflamed ankle joints and tendons.
Guskiewicz KM, Perrin DH: Effects of Insoles on postural sway following inversion ankle sprain. J Orthop Sp Phys Ther, 23:326-331, 1996.

Knee Pain and Foot Insoles

Reducing knee pain through the use of orthoses has been standard practice for decades but recent have studies have finally confirmed the degree to which relief is experienced through the use of orthotic devices. The same studies also alluded to the possible mechanics involved in knee pain and foot Insoles.

2003: Of 102 athletes suffering patellofemoral distress 76.5% reported notable improvements of overall symptoms and 2% of athletes no longer experienced pain within 2-4 weeks of custom foot Insoles usage.
Saxena A, Haddad J: The effect of foot orthoses on patellofemoral pain syndrome. 93:264-271, 2003.

2004: Internal rotation and adduction in the knees of runners were seriously reduced in this study, which tracked the use of foot Insoles to positively affect the kinetics of the foot and lower leg: 30 runners with knee problems were outfitted with foot Insoles with a five degree wedge height in the heel. After 6 weeks all of the runners reported reduced discomfort and 28 runners found the Insoles comfortable.
Russel Rubin and Hylton B. Menz. Use of Laterally Wedged Custom Foot Orthoses to Reduce Pain Associated with Medial Knee Osteoarthritis: A Preliminary Investigation. JAMA, 2005 95: 347-352.

Foot Insoles and Back Pain

Back pain suffers who use custom foot Insoles report a significant reduction in pain symptoms.
1999: Participants experienced double the relief for twice as long when using foot Insoles to treat back pain compared to participants using traditional back pain treatments. This was a groundbreaking study in terms of the link between foot Insoles and back pain reduction.
Dananberg HJ, Guiliano M: Chronic low-back pain and its response to custom-made foot orthoses. 89:109-117, 1999

Treating Flat Foot with Insoles

Having flat feet does not always cause physiological problems and pain, but it is a common precursor to these conditions and when difficulties do arise as a result of this condition they are often some of the most severe and difficult to treat cases in podiatry. Fortunately, treating flat foot with orthotic devices has proven extremely effective.
Blake RL, Ferguson H: Foot orthoses for the severe flatfoot in sports. JAPMA, 81:549, 1991.

Pediatric flatfoot: evaluation and management. Sullivan JA. J Am Acad Orthop Surg. 1999 Jan;7(1):44-53. Department of Orthopedic Surgery and Rehabilitation, University of Oklahoma College of Medicine, Oklahoma City 73126-0307, USA.

Rome K, Brown CL: Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet. Clin Rehab, 18:624-630, 2004

Note: An injured, weak or fully ruptured posterior tibialis tendon often causes flat feet and it is extremely difficult to treat. Sub-par development or functioning of the posterior tibialis can cause “adult acquired flatfoot”, and it is usually a precursor to a flattening of the foot, or feet, as time passes. This particular condition must be treated before it progresses and causes severe problems.
Kirby KA: Conservative treatment of posterior tibial dysfunction. Podiatry Management, 19:73-82, 2000.

Foot Insoles and High Arches

High arches often cause debilitating pain in the feet that eventually leads to reduced use— and improper functioning—of the foot. The introduction of custom Insoles, however, is often effective when used to treat this type of foot structure.
Burns J, Crosble J. Effective Orthotic Therapy for the Painful Cavus Foot. J Am Pod Med Assoc. 96:3: 205 – 211. 2006

Schwend RM, Drennan JC. Cavus foot deformity in children. : J Am Acad Orthop Surg. 2003 May-Jun;11(3):201-11.

Foot Insoles and Runners

Proper treatment of running injuries with foot Insoles alone has been estimated by researchers to be effective 50-90% of the time.
D’Ambrosia, 1985; Dugan & D’Ambrosia, 1986; Eggold, 1981; Kilmartin & Wallace,1994.

1985: Foot orthotic devices were “definitely helped” 70% of 180 patients tested, all of whom were suffering from sports related injuries.
Blake RL, Denton JA: Functional foot orthoses for athletic injuries: A retrospective study. JAPMA, 75:359-362, 1985.

1991: Foot Insoles used in the treatment of runners allowed ‘significant improvement’ to ‘total resolution’ to occur in the total level of symptoms in 76% of 500 injured long-distance runners.
Davlin LB, Evanski PM: Effectiveness of orthotic shoe inserts in the long distance runner. Am. J. Sports Med., 19:409-412, 1991.

Supplementary Resources

Dugan RC, D’Ambrosia RD: The effect of Insoles on the treatment of selected running injuries. Foot Ankle, 6:313, 1986.

MacLean CL, Hamill J: Short and long-term influence of a custom foot orthotic intervention on lower extremity dynamics in injured runners. Annual ISB Meeting, Cleveland, September 2005.

Baitch SP, Blake RL, Fineagan PL, Senatore J: Biomechanical analysis of running with 25 degree inverted orthotic devices. JAPMA, 81:647-652, 1991.

Mundermann A, Nigg BM, Humble RN, Stefanyshyn DJ: Orthotic comfort is related to kinematics, kinetics, and EMG in recreational runners. Med Sci Sports Exercise, 35:1710-1719, 2003b

Smith LS, Clarke TE, Hamill CL, Santopietro F: The effects of soft and semi-rigid orthoses upon rear foot movement in running. JAPMA, 76:227-232, 1986.

Williams DS, McClay-Davis I, Baitch SP: Effect of inverted orthoses on lower extremity mechanics in runners. Med. Sci. Sports Exerc. 35:2060-2068, 2003.

Foot Insoles and Foot Pressure

Excessive pressure and tension in the feet can result in the development of ball-of-the-foot and heel pain. Several studies have determined that using foot Insoles decreases pressure and tension which then provides a positive reduction in disability and pain in the feet and lower legs.
1998: Researchers demonstrate the effectiveness of foot Insoles in the reduction of pressure on the plantar fascia which thus reduced pressure on the injured portions of the foot. Researchers also demonstrated the substantial degree to which foot Insoles reduced the pain levels in 42 subjects suffering from metatarsalgia.
Postema et al.1998.

2000: Both normal participants and those suffering from rheumatoid arthritis experienced significantly lower levels of plantar tension while wearing foot Insoles.
Li CY, Imaishi K, Shiba N, Tagawa Y, Maeda T, Matsuo S, Goto T, Yamanaka K: Biomechanical evaluation of foot pressure and loading force during gait in rheumotod arthritic patients with and without foot orthoses. Kurume Med J, 47:211-217, 2000.

2001: The introduction of foot Insoles was shown to greatly reduce peak pressure in 30% of the 81% of patients suffering from Type II diabetes who were involved in this study.
Lobmann R, Kayser R, Kasten G, Kasten U, Kluge K, Neumann W, Lehnert H: Effects of preventative footwear on foot pressure as determined by pedobarography in diabetic patients: a prospective study. Diabet Med, 18:314-319, 2001.

2003: Peak pressure and pressure-time integrals proved to be much lower in 34 adolescents afflicted with Type I diabetes.
Duffin AC, Kidd R, Chan A, Donaghue KC: High plantar pressure and callus in diabetic adolescents. Incidence and treatment. JAPMA, 93:214-220, 2003.

2005: The use of 3 dimensional foot models in the testing of various foot orthotic constructs allowed researchers to prove that shape has more bearing than flexibility levels in the reduction of peak plantar pain.
Cheung JT, Zhang M: A 3-dimensional finite element model of the human foot and ankle for insole design. Arch Phys Med Rehabil, 86:353-358, 2005.

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