Changes in gait economy between full-contact custom-made foot orthoses and prefabricated inserts in patients with musculoskeletal pain: a randomized clinical trial.

Background: Specific kinematic and kinetic outcomes have been used to detect biomechanical change while wearing foot orthoses; however, few studies demonstrate consistent effects. We sought to observe changes in walking economy in patients with musculoskeletal pain across 10 weeks while wearing custom-made foot orthoses and prefabricated shoe inserts.

Methods: In this crossover randomized controlled trial, 40 participants wore custom-made orthoses and prefabricated inserts for 4 weeks each, consecutively. The path length ratio was used to quantify walking economy by comparing the undulating path of a point in the pelvis with its direct path averaged across multiple strides.

Results: For the prefab-custom group (n=27), significant decreases in path length ratio (improved economy of gait) were noted at the initial introduction of prefabricated inserts (P= .02) and custom orthoses (P= .02) but maintained a trend toward improved economy only while wearing custom orthoses (P= .08). For the custom-prefab group (n=13), there was worsening of the path length ratio that was significant after removing the custom-made orthoses for 4 weeks (P= .01).

Conclusion: For patients with lower-extremity musculoskeletal pain, immediate improvements in economy of gait can be expected with both interventions. It seems, however, that only the custom-made orthoses maintain economy of gait for 4 weeks. Patients who begin wearing custom-made orthoses and then wear prefabricated insoles can expect a decrease in economy of gait.