Vol 16, Issue 3

The Role of Footwear, Foot Orthosis and Training-Related Strategies in the Prevention of Bone Stress Injuries: A Systematic Review and Meta-Analysis

April 1, 2023 - By 

Authors

Alexandre Lavigne, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
Dominic Chicoine, The Running Clinic, Lac Beauport, Québec, Canada
Jean-François Esculier, The Running Clinic, Lac Beauport, Québec, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
François Desmeules, School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
Pierre Fremont, Département de réadaptation, Faculté de médecine, Université Laval, Québec, Québec, Canada
Blaise Dubois, The Running Clinic, Lac Beauport, Québec, Canada
International Journal of Exercise Science 16(3): 721-743, 2023.
DOI: 10.70252/ZNRS2138

Abstract

Objective: To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design: Systematic review and meta-analysis. Data sources: Four bibliographic databases (from inception until November 2021): Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL. Eligibility criteria: Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results: Eleven studies were included in this systematic review. When wearing foot orthoses, the risk ratio of developing a BSI on any lower extremity bone is 0.47 (95% CI 0.26 to 0.87; p = 0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p = 0.79). No meta-analyses could be performed for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion: This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence.

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