The effectiveness of custom foot orthotics in treating chronic low back pain: A critically appraised topic

Clinical Scenario: Chronic low back pain is one of the most common causes of pain and disability. Currently, there is a need for more effective interventions to treat low back pain. Clinical Question: Does the use of custom foot orthotics improve self-reported measures of pain and function in adults with chronic low back pain? Summary of Key Findings: A comprehensive and systematic search was conducted for studies of level 2 evidence or higher that pertained to the clinical question. The search yielded 11 studies, of which one randomized control trial and two prospective cohorts fit the inclusion and exclusion criteria. The articles examined the effectiveness of custom foot orthotics in isolation compared with no treatment as well as custom foot orthotics in combination with usual care compared with usual care alone. The included studies all demonstrated that the use of custom foot orthotics reduce chronic low back pain after seven weeks of use. One included study was considered high-quality evidence while two were deemed low-quality evidence using the PEDro. Clinical Bottom Line: There is moderate evidence to support the use of custom foot orthotics to improve self-reported measures in adults with chronic low back pain after seven weeks of use. Strength of Recommendation: The Strength of Recommendation Taxonomy recommends a grade of B for consistent limited-quality patient-oriented evidence.