Effectiveness of custom-made foot orthoses for treating forefoot pain: a systematic review

Abstract

Purpose

Pain in and around the metatarsal heads, the metatarsal phalangeal joints and the surrounding soft tissues is called metatarsalgia. Non-operative treatment of metatarsalgia includes foot orthoses. Foot orthoses may be classified as standard or custom-made. A systematic review was carried out to determine whether custom-made foot orthoses are effective for treating forefoot pain.

Methods

The MEDLINE, CINAHL, The Cochrane Library and PEDro databases were searched for relevant articles reporting patients undergoing treatment for forefoot pain by means of custom-made foot orthoses. Two reviewers independently reviewed all titles and abstracts and extracted the available data. The study eligibility criteria were randomised controlled clinical trials that included participants with forefoot pain treated with custom-made foot orthoses and that reported levels of forefoot pain after the use of orthoses. The data consisted of patient demographics, pathologies related to forefoot pain, type of foot orthoses used, follow-up period and clinical outcomes.

Results

Nine studies were selected which had a total of 487 participants. The pathologies evaluated were rheumatoid arthritis, hallux abductus valgus and isolated and secondary metatarsalgia. The use of custom-made foot orthoses was the intervention that exerted the most significant reduction of the level of pain in the forefoot in most of the studies.

Conclusions

The use of custom-made foot orthoses improved the level of forefoot pain in rheumatoid arthritis, hallux abductus valgus and secondary metatarsalgia as it increases sole pressures.

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Author information

Affiliations

Authors

Corresponding author

Correspondence to María Reina-Bueno.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Appendix 1

Appendix 1

Search strategies applied in the different databases consulted:

MEDLINE con PubMed

  1. 1.

    foot [MeSH Terms]

  2. 2.

    forefoot, human [MeSH Terms]

  3. 3.

    foot bones [MeSH Terms]

  4. 4.

    foot joints [MeSH Terms]

  5. 5.

    sesamoid bones [MeSH Terms]

  6. 6.

    pain [MeSH Terms]

  7. 7.

    pain* [Text Word]

  8. 8.

    OR/1-5

  9. 9.

    OR/6-7

  10. 10.

    8 AND 9

  11. 11.

    foot injuries [MeSH Terms]

  12. 12.

    foot diseases [MeSH Terms]

  13. 13.

    foot deformities [MeSH Terms]

  14. 14.

    arthritis [MeSH Terms]

  15. 15.

    arthrosis [Text Word]

  16. 16.

    tendinopathy [MeSH Terms]

  17. 17.

    fractures, bone [MeSH Terms]

  18. 18.

    neuroma [MeSH Terms]

  19. 19.

    sesamoiditis [Text Word]

  20. 20.

    morton neuroma [Text Word] OR mortons neuroma [Text Word] OR intermetatarsal neuroma [Text Word]

  21. 21.

    OR/14-19

  22. 22.

    8 AND 21

  23. 23.

    OR/11-13, 20

  24. 24.

    OR/10, 22-23

  25. 25.

    orthotic devices [MeSH Terms]

  26. 26.

    insole* [Text Word]

  27. 27.

    in-sole* [Text Word]

  28. 28.

    innersole* [Text Word]

  29. 29.

    in-shoe [Text Word]

  30. 30.

    sole [Text Word] OR soles [Text Word]

  31. 31.

    orthos* [Text Word]

  32. 32.

    orthotic* [Text Word]

  33. 33.

    orthopedic* [Text Word]

  34. 34.

    orthopaedic [Text Word]

  35. 35.

    OR/25-34

  36. 36.

    24 AND 35

  37. 37.

    randomized controlled trial [Publication Type]

  38. 38.

    controlled clinical trial [Publication Type]

  39. 39.

    randomized [Title/Abstract]

  40. 40.

    placebo [Title/Abstract]

  41. 41.

    clinical trials as topic [mh:noexp]

  42. 42.

    randomly [Title/Abstract]

  43. 43.

    trial [Title]

  44. 44.

    OR/37-43

  45. 45.

    animals [MeSH Terms] NOT humans [MeSH Terms]

  46. 46.

    44 NOT 45

  47. 47.

    36 AND 46

CINAHL

  1. 1.

    Foot [MeSH Terms]

  2. 2.

    forefoot

  3. 3.

    Foot Bones [MeSH Terms]

  4. 4.

    foot joint OR foot joints

  5. 5.

    Sesamoid Bones [MeSH Terms]

  6. 6.

    OR/1-5

  7. 7.

    Pain [MeSH Terms]

  8. 8.

    pain*

  9. 9.

    OR/7-8

  10. 10.

    6 AND 9

  11. 11.

    Foot Injuries [MeSH Terms]

  12. 12.

    Foot Diseases [MeSH Terms]

  13. 13.

    Foot Deformities [MeSH Terms]

  14. 14.

    OR/11-13

  15. 15.

    morton neuroma OR mortons neuroma OR intermetatarsal neuroma

  16. 16.

    OR/14-15

  17. 17.

    arthritis [MeSH Terms]

  18. 18.

    arthrosis

  19. 19.

    Tendinopathy [MeSH Terms]

  20. 20.

    Fractures [MeSH Terms]

  21. 21.

    Neuroma [MeSH Terms]

  22. 22.

    sesamoiditis

  23. 23.

    OR/17-22

  24. 24.

    6 AND 23

  25. 25.

    OR/16, 24

  26. 26.

    Orthoses [MeSH Terms]

  27. 27.

    insole*

  28. 28.

    in-sole*

  29. 29.

    innersole*

  30. 30.

    in- shoe

  31. 31.

    sole OR soles

  32. 32.

    orthos*

  33. 33.

    orthotic*

  34. 34.

    orthopedic*

  35. 35.

    orthopaedic

  36. 36.

    OR/26–35

  37. 37.

    25 AND 36

The Cochrane Library

  1. 1.

    MeSH descriptor: [Foot] explode all trees

  2. 2.

    MeSH descriptor: [Forefoot, Human] explode all trees

  3. 3.

    MeSH descriptor: [Foot Bones] explode all trees

  4. 4.

    MeSH descriptor: [Foot Joints] explode all trees

  5. 5.

    MeSH descriptor: [Foot Bones] explode all trees

  6. 6.

    MeSH descriptor: [Pain] explode all trees

  7. 7.

    pain*:ti,ab,kw

  8. 8.

    #1 or #2 or #3 or #4 or #5

  9. 9.

    #6 or #7

  10. 10.

    #8 and #9

  11. 11.

    MeSH descriptor: [Foot Injuries] explode all trees

  12. 12.

    MeSH descriptor: [Foot Diseases] explode all trees

  13. 13.

    MeSH descriptor: [Foot Deformities] explode all trees

  14. 14.

    MeSH descriptor: [Arthritis] explode all trees

  15. 15.

    arthrosis:ti,ab,kw

  16. 16.

    MeSH descriptor: [Tendinopathy] explode all trees

  17. 17.

    MeSH descriptor: [Fractures, Bone] explode all trees

  18. 18.

    MeSH descriptor: [Neuroma] explode all tres

  19. 19.

    sesamoiditis:ti,ab,kw

  20. 20.

    morton neuroma:ti,ab,kw or mortons neuroma:ti,ab,kw or intermetatarsal neuroma:ti,ab,kw

  21. 21.

    #14 or #15 or #16 or #17 or #18 or #19

  22. 22.

    #8 and #21

  23. 23.

    #11 or #12 or #13 or #20

  24. 24.

    #10 or #22 or #23

  25. 25.

    MeSH descriptor: [Orthotic Devices] explode all trees

  26. 26.

    insole*:ti,ab,kw

  27. 27.

    in-sole*:ti,ab,kw

  28. 28.

    innersole*:ti,ab,kw

  29. 29.

    in-shoe:ti,ab,kw

  30. 30.

    sole:ti,ab,kw or soles:ti,ab,kw

  31. 31.

    orthos*:ti,ab,kw

  32. 32.

    orthotic*:ti,ab,kw

  33. 33.

    orthopedic*:ti,ab,kw

  34. 34.

    orthopaedic:ti,ab,kw

  35. 35.

    #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 or #34

  36. 36.

    #24 and #35

PEDro

  • Therapy: “orthoses, taping, splinting”

  • Problema: “pain”

  • Body part: “foot and ankle”

  • Method: “clinical trial”

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Arias-Martín, I., Reina-Bueno, M. & Munuera-Martínez, P.V. Effectiveness of custom-made foot orthoses for treating forefoot pain: a systematic review. International Orthopaedics (SICOT) 42, 1865–1875 (2018). https://doi.org/10.1007/s00264-018-3817-y

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Keywords

  • Pain
  • Foot
  • Forefoot
  • Foot orthoses