Foot Orthoses for Low Back Pain

NewsBot · May 7, 2013

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Foot orthoses for the management of low back pain: a qualitative approach capturing the patient's perspective
Anita E Williams, Lindsay A Hill and Christopher J Nester
Journal of Foot and Ankle Research 2013, 6:17

Background
The onset of non specific low back pain is associated with heavy lifting, age, female gender, and poor general health, with psychological factors being predictors of it becoming chronic. Additionally, it is thought that altered lower limb biomechanics are a contributory factor, with foot orthoses increasingly being considered as an appropriate intervention by physiotherapists and podiatrists. However, research into the effect of foot orthoses is inconclusive, primarily focusing on the biomechanical effect and not the symptomatic relief from the patient's perspective. The aim of this study was to explore the breadth of patients' experiences of being provided with foot orthoses and to evaluate any changes in their back pain following this experience.

Method
Following ethical approval, participants (n = 25) with non-specific low back pain with associated altered lower limb biomechanics were provided with customised foot orthoses. At 16 weeks after being provided with the foot orthoses, conversational style interviews were carried out with each patient. An interpretivistic phenomenological approach was adopted for the data collection and analysis.

Results
For these participants, foot orthoses appeared to be effective. However, the main influence on this outcome was the consultation process and a patient focussed approach. The consultation was an opportunity for fostering mutual understanding, with verbal and visual explanation reassuring the patient and this influenced the patient's beliefs, their engagement with the foot orthoses (physical) and their experience of low back pain (psychological).

Conclusion
Clinicians need to adopt 'psychologically informed practice' in relation to the provision of foot orthoses. Likewise, researchers should consider all the influencing factors found in this study, both in relation to their study protocol and the outcomes they plan to measure.
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Admin2 · May 7, 2013

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terigreen · May 8, 2013

We been using heat moldable, direct contact orthotics for several years and find that patients tell us how much it has helped their backs.
Thanks for a great article
Teri Green
Atlas Biomechanics

NewsBot · Jun 1, 2013

This clinical trial was just registered;
Efficacy of Foot Orthotics in Veterans With Chronic Lower Back Pain
Foot Levelers, Inc.
New York Chiropractic College

A randomized sham controlled trial evaluating the efficacy of the use of custom foot orthotics in veterans suffering from chronic lower back pain. The current study hypothesizes that those veterans with chronic lower back pain who receive the custom foot orthotics will show greater improvements in pain and disability associated with the chronic lower back pain than those who receive the sham orthotic.
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NewsBot · Mar 18, 2014

This clinical trial was just registered:

Orthotic Use for Chronic Low Back Pain

The goal of this randomized clinical study is to assess pain and dysfunction in 225 volunteer subjects who have chronic low back pain.

The hypothesis of this study is that custom-made shoe will improve patients' low back pain and dysfunction. Additionally, custom-made shoe orthotics plus chiropractic treatment will further improve patients' low back pain and dysfunction while maintaining that improvement during the one year study follow-up period.

Specific Aims:

To determine the changes in perceived pain levels (Numeric Pain Rating Scale) and dysfunction (Oswestry Disability Index) in patients with chronic low back pain after six weeks of custom-made shoe orthotic use with or without chiropractic care as compared to no care.
To determine the changes in perceived pain levels and dysfunction in patients with chronic low back pain after twelve weeks of custom-made shoe orthotic use.
To determine the changes in perceived pain levels and dysfunction at 3, 6, and 12 months following the 12 week treatment period.
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NewsBot · May 1, 2014

The effectiveness of shoe insoles for the prevention and treatment of low back pain: a systematic review and meta-analysis of randomised controlled trials.
Chuter V, Spink M, Searle A, Ho A.
BMC Musculoskelet Disord. 2014 Apr 29;15(1):140.

BACKGROUND:
Low back pain (LBP) is a significant public health problem in Western industrialised countries and has been reported to affect up to 80% of adults at some stage in their lives. It is associated with high health care utilisation costs, disability, work loss and restriction of social activities. An intervention of foot orthoses or insoles has been suggested to reduce the risk of developing LBP and be an effective treatment strategy for people suffering from LBP. However, despite the common usage of orthoses and insoles, there is a lack of clear guidelines for their use in relation to LBP. The aim of this review is to investigate the effectiveness of foot orthoses and insoles in the prevention and treatment of non specific LBP.
METHODS:
A systematic search of MEDLINE, CINAHL, EMBASE and The Cochrane Library was conducted in May 2013. Two authors independently reviewed and selected relevant randomised controlled trials. Quality was evaluated using the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist. Meta-analysis of study data were conducted where possible.
RESULTS:
Eleven trials were included: five trials investigated the treatment of LBP (n = 293) and six trials examined the prevention of LBP (n = 2379) through the use of foot orthoses or insoles. Meta-analysis showed no significant effect in favour of the foot orthoses or insoles for either the treatment trials (standardised mean difference (SMD) -0.74, CI 95%: -1.5 to 0.03) or the prevention trials (relative risk (RR) 0.78, CI 95%: 0.50 to 1.23).
CONCLUSIONS:
There is insufficient evidence to support the use of insoles or foot orthoses as either a treatment for LBP or in the prevention of LBP. The small number, moderate methodological quality and the high heterogeneity of the available trials reduce the strength of current findings. Future research should concentrate on identification of LBP patients most suited to foot orthoses or insole treatment, as there is some evidence that trials structured along these lines have a greater effect on reducing LBP.
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NewsBot · Dec 15, 2015

Foot orthoses improve kinematic measurement in young women with biomechanical abnormality
Maria Regina Rachmawati, Angela BM Tulaar, Muctarudin Mansyur, Ferial Hadipoetro Idris, Ismail Ismail, Ratna Darjanti Haryadi
Universa Medicina; Vol 34, No 2 (2015)

BACKGROUND
Foot pronation causes biomechanical abnormalities in the form of functional leg-length disparity. Foot orthoses are often used in the treatment of abnormal pronation. The aim of the study was to evaluate the effect of foot orthoses on abnormal kinematic chain the differences of pelvic height, step length, and walking distance on walking test in young women with biomechanical abnormality.

METHODS
A randomized double blind controlled clinical trial was conducted on 27 young adult women having abnormal biomechanical abnormalities. By random allocation the subjects were divided into the intervention group (14 subjects) receiving correction of foot pronation using foot orthoses, and the control group (13 subjects) receiving no orthoses. Before and during use of foot orthoses, we determined pelvic height difference (mm), step length difference (cm), and walking distance at maximal walking speed for 15 minutes.

RESULTS
Correction of foot pronation resulted in decreased pelvic height difference from 4.7 ? 2.1 mm to 1.7 ? 1.3 mm (p<0.001) and in a reduction in step length difference, from 4.9 ? 2.9 cm to 2.1 ? 1.5 cm (p=0.002). Walking test distance of the intervention group was 1318.5 ? 46.3 m, as compared with that of the control group of 1233 ? 114.7 m (p = 0.05). Walking distance of the intervention group rose steadily in the second test to 1369.3 ? 27 m, and in the third test to 1382.14 ? 10.5 m (p<0.001).

CONCLUSIONS
Foot orthoses improved the kinematic chain, resulting in a more symmetrical pelvic height, reduced step length difference, and increased functional walking ability.
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drhunt1 · Dec 17, 2015

In my expanded study of Growing Pains in children, and RLS in adults, I videotaped an interview with a Board certified prosthetist/orthotist that admitted his back and knee pain had responded to orthotics that extended the varus correction to the end of the toes. To my knowledge, I appear to be the only US Podiatrist that is prescribing and/or advocating this correction. A shortened version of this project was published recently:

http://www.podiatrym.com/Biomechanics_Footwear_Sports_Podiatry2.cfm?id=1632

The two pics show an exaggerated view of the correction. While many are advocating for the exact opposite, ie., a valgus wedge extension, my experience has been most satisfactory ordering the varus extension.

NewsBot · Dec 20, 2015

Foot orthotics for low back pain: The state of our understanding and recommendations for future research
Mark Owen Papuga, Jerrilyn Cambron
The Foot; Article in Press

Highlights
•A review the biomechanical mechanisms underlying the effectiveness of foot orthotic treatment.
•A review of the current state of knowledge regarding the clinical use of foot orthotics to treat and/or prevent the occurrence of Low Back Pain.
•A discussion of the most influential studies in the area of foot orthotic conducted during the past decade.
•Recommendations based on our review that may prove useful in directing future clinical research are provided.
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Purpose
The purpose of the article is to summarize the literature on the use of foot orthotics for low back pain and to make specific recommendations for future research.

Methods
Database searches were conducted using PubMed, EBSCO, GALE, Google Scholar, and clinicaltrials.gov. The biomedical literature was reviewed to determine the current state of knowledge on the benefits of foot orthotics for low back pain related to biomechanical mechanisms and clinical outcomes.

Results
It may be argued that foot orthotics are experimental, investigational, or unproven for low back pain due to lack of sufficient evidence for their clinical effectiveness. This conclusion is based upon lack of high quality randomized controlled trials (RCTs). However, there is extensive research on biomechanical mechanisms underlying the benefits of orthotics that may be used to address this gap. Additionally, promising pilot studies are beginning to emerge in the literature and ongoing large-scale RCTs are addressing effects of foot orthotics on chronic low back pain.

Conclusions
Based upon the critical evaluation of the current research on foot orthotics related to biomechanical mechanisms and clinical outcomes, recommendations for future research to address the evidence-practice gaps on the use of foot orthotics for low back pain are presented
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NewsBot · May 4, 2017

Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial.
Cambron JA et al
Arch Phys Med Rehabil. 2017 Apr 29. pii: S0003-9993(17)30262-9. doi: 10.1016/j.apmr.2017.03.028

OBJECTIVES:
To investigate the efficacy of shoe orthotics with and without chiropractic treatment for chronic low back pain as compared to no treatment.
DESIGN:
Randomized Controlled Trial SETTING: An integrative medicine teaching clinic at a Midwestern university.
PARTICIPANTS:
Two hundred and twenty-five adult subjects with symptomatic low back pain of 3 months or longer were recruited from a volunteer sample.
INTERVENTIONS:
Subjects were randomized into one of three treatment groups (Orthotics, Plus, and Wait-list Groups). The Orthotics Group received custom-made shoe orthotics The Plus Group received custom-made orthotics plus chiropractic manipulation, hot or cold packs, and manual soft tissue massage. The Wait-list Group received no care.
MAIN OUTCOME MEASURES:
The primary outcome measures were change in perceived back pain (Numeric Pain Rating Scale) and functional health status (Oswestry) after 6 weeks of study participation. Outcomes were also assessed after 12 weeks and then after an additional 3, 6, and 12 months.
RESULTS:
After six weeks, all three groups demonstrated significant within-group improvement in average back pain, but only the Orthotics and Plus Groups had significant within-group improvement in function. When compared to the Wait-list Group, the Orthotics Group demonstrated significantly greater improvements in pain (p<0.0001) and function (p=0.0068). The addition of chiropractic to orthotics treatment demonstrated significantly greater improvements in function (p=0.0278) when compared to orthotics alone, but no significant difference in pain (p=0.3431). Group differences at 12 weeks and later were not significant.
CONCLUSIONS:
Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared to no treatment. The addition of chiropractic care led to higher improvements in function.
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NewsBot · Aug 16, 2017

From LER:
Gaps remain in literature on insoles and back pain

NewsBot · Jan 30, 2018

THE CLINICAL EFFECTIVENESS OF FOOT ORTHOSES FOR
THE ALLEVIATION OF LOW BACK PAIN.
Hoare, Tamsin (2017)
Masters thesis, Queen Margaret University.

Objective: To establish the effect of customised functional foot orthoses on patients’ pre-existing, idiopathic low back pain (LBP).
Design: A matched-subject randomised controlled trial designed to test the hypothesis that the use of functional foot orthoses is effective in alleviating chronic, idiopathic LBP. The experimental group will receive customised functional foot orthoses and the control will be a ‘wait-list’ group who will be monitored for 6 months prior to receiving the intervention.
Setting: Podiatry clinic in Ilkley, West Yorkshire with recruitment from the Leeds and Bradford Metropolitan District Council areas.
Participants: Initial recruitment of 60 participants with LBP who meet the inclusion criteria and have given their written informed consent to take part in the study. Allowing for withdrawals, a minimum final number of 40 participants is expected.
Intervention: The treatment group will receive customised standard functional foot orthoses, vacuum-formed from polypropylene by LBG Medical. Measurements: Changes in levels of perceived LBP will be measured using the Low Back Pain Rating Scale (LBPRS), the Million Visual Analog Scale (VAS), and functional health status will be measured using the Oswestry Disability Index (ODI) over an initial six month period for both the experimental and control group participants. After six months, the control group will receive the intervention and both groups will continue to be monitored; the experimental group for a minimum of six more months and the control group for twelve months, using the same measurements. Participants will complete the Global Perceived Effect (GPE) scale at the end of the trial in order to determine whether they consider their LBP to have changed since the start of the trial. Data analysis: Homogeneity between the control and experimental groups will be verified for the variables of age, height, weight and LBP at the start and end of the trial using the Student’s t-test. The p-values will then be calculated to determine whether there is a statistically significant difference between baseline and final scores. Statistical significance will be considered reached if p < 0.05. Homogeneity of Body Mass Index (BMI) and the Foot Postural Index (FPI-6) between the groups will be assessed using the Mann–Whitney U-test, and, for gender, the Pearson’s chi-squared test. The data obtained during the trial from the pain scales will be assessed using the Wilcoxon signed-ranks test. The data will be analysed using the SPSS statistics software package (IBM 2016). Conclusion: The proposed trial aims to address the short-comings of previous research into the alleviation of LBP with the use of functional foot orthoses and aims to support the hypothesis that customised functional foot orthoses significantly help to alleviate LBP in people who have biomechanical abnormalities.
Dissemination: The proposed trial will be registered with The International Committee of Medical Journal Editors (ICMJE 2017) and the editorial committees of relevant medical journals will be approached regarding publicatio
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NewsBot · Apr 6, 2019

This clinical trial was just registered:
Total Contact Insole for Chronic Nonspecific Low Back Pain (LBP) ((LBP))

Non-specific low back pain is a common condition. Insoles are one of the many treatment form for chronic nonspecific LBP. The investigators hypothesized the contact total insole group will present pain reduction and functional improvement.

The aim of this study is to assess the effectiveness of contact total insole for people with nonspecific chronic low back pain and the impact of this insole on function, quality of life, load distribution in the plantar region, gait variables and satisfaction with insole use.
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NewsBot · Jun 26, 2019

This clinical trial was just registered:
Effect Mechanism of Custom-made Foot Orthoses in Patients With Chronic Low Back Pain

Excessive foot pronation has been recognized as being linked to chronic low back pain (CLBP). The use of compensating custom-made foot orthoses has not been entirely explored as an effective therapy for CLBP Objective: to investigate the effects of wearing custom made foot orthoses compared to placebo orthoses in patients with pronated feet and chronic low back pain (CLBP).
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NewsBot · Nov 4, 2019

Foot Arch Support Effect on Lumbo-Pelvic Kinematics and Centre of Pressure Excursion During Stand-to-Sit Transfer in Different Foot Types
Fang-Chuan KuoDeng-Chuan CaiBen-Yi Liau
Journal of Medical and Biological Engineering: 30 October 2019

Foot misalignments are possible risk factors for injuries to the knee and lumbar spine during daily activity. This study identified the lumbo-pelvic–knee kinematics and centre-of-pressure progression characteristics of the human trunk during stand-to-sit (STSI) transfer in people with different foot types. This study investigates the lower arch foot influence on lumbar–pelvic–knee kinematics and centre-of-pressure progression trunk characteristics during STSI transfer.

Methods
Thirty-nine participants were assessed using the R-scan footscan system to define three different foot types (flat feet, normal feet, and asymmetric feet). Two electro goniometers and one inclinometer were used to record lumbar, pelvic and knee joint kinematic data during STSI transfer. A Tekscan mat system laced under the gluteal area was used to measure the trunk centre-of-pressure progression. The centre-of-pressure progression path, standard path deviation, velocity and acceleration were calculated.

Results
The flat foot group tended to use a more frontal plane range of motion and velocity in the pelvis than the normal group. The asymmetric foot group exhibited smaller sagittal plane lumbar motion and velocity, with a more frontal plane motion and velocity than normal participants. When arch support was used, the centre-of-pressure path standard deviation in the medial–lateral and anterior–posterior directions exhibited a significant decrease in all groups. There were no significant differences in kinematics, total centre-of-pressure path and centre-of-pressure progression acceleration between those with and without foot arch support.

Conclusion
Participants with flat or asymmetric feet might have difficulty distributing the load forces evenly through both lower limbs and must use a different lumbar–pelvic strategy to compensate. Whether these adaptive kinematic strategies in the low arch group induce the development of injury requires further long-term investigation.
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Brian A. Rothbart · Nov 11, 2019

NewsBot said: ↑

From LER:
Gaps remain in literature on insoles and back pain
Click to expand...

Low back pain is a symptom, not a primary etiology. First determine the cause of the LBP. If it is due to poor foot function, determine the foot structure you are dealing with (PMS, PCFD, etc). This will determine which orthotic is indicated and augment the effectiveness of orthotic therapy.

Dispensing the wrong type of orthotic can increase the patient's symptoms.

NewsBot · Sep 23, 2020

Effects of Orthotic Insoles on Gait Kinematics and Low Back Pain in Subjects with Mild Leg Length Discrepancy
Charlotte Menez, Jérémy Coquart, Damien Dodelin, Claire Tourny, Maxime Lhermette
J Am Podiatr Med Assoc. 2020 Sep 15

Background: Mild leg length discrepancy (LLD) increases the biomechanical asymmetry during gait, which leads to low back pain (LBP). Orthotic insoles (OI) with a directly integrated heel lift were used to reduce this asymmetry and thus the associated LBP. The aim of this study was to analyze the biomechanical adaptations of the locomotor apparatus during gait and the subjective pain ratings before and after the establishment of OI use.

Methods: Eight subjects with mild LLD ({less than or equal to} 2.0 cm) underwent 3-dimensional biomechanical analysis while walking, before and after 3 weeks of OI use. LBP was assessed separately before both measurement sessions using a visual analogue scale.

Results: The analysis of the kinematic parameters highlighted individual adaptations. The symmetry index (SI) of Robinson indicated that OI had no significant effect on the kinematic gait parameters and an unpredictable effect across subjects. OI use significantly and systematically (in all subjects) reduced LBP (P < 0.05), which was correlated with changes in ankle kinematics (P = 0.02, r = 0.80).

Conclusions: The effects of OI on gait symmetry are unpredictable and specific to each subject's individual manner of biomechanical compensation. The reduction in LBP seems associated with the improved ankle kinematics during gait.
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NewsBot · Jul 4, 2021

Custom-Made Foot Orthoses as Non-Specific Chronic Low Back Pain and Pronated Foot Treatment
Aurora Castro-Méndez et al
Int J Environ Res Public Health. 2021 Jun 25;18(13):6816.

Excessive foot pronation has been reported as being related to chronic low back pain symptoms and risk factors in sports-specific pathologies. Compensating custom-made foot orthotics treatment has not been entirely explored as an effective therapy for chronic low back pain (CLBP). This study aims to observe the effects of custom-made foot orthoses, in subjects with foot pronation suffering from CLBP. A total of 101 patients with nonspecific CLBP and a pronated foot posture index (FPI) were studied. They were randomized in two groups: an experimental one (n = 53) used custom-made foot orthotics, and the control group (n = 48) were treated with non-biomechanical effect orthoses. The CLBP was measured using the Oswestry Disability Index (ODI) Questionnaire and a visual analogue scale (VAS), both for lower back pain. The symptoms were evaluated twice, at first when the subject was included in the study, and later, after 4 weeks of treatment. The analysis of outcomes showed a significant decrease in CLBP in the custom-made foot orthoses participants group (p < 0.001 ODI; p < 0.001 VAS). These findings suggest that controlling excessive foot pronation by using custom-made foot orthoses may significantly contribute to improving CLBP.
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NewsBot · May 2, 2022

Combined Chiropractic and Podiatric Treatment for Chronic Low Back Pain Concomitant With a Unilateral Pronated Foot: Protocol for a Multicenter Pilot Randomized Controlled Trial
Carlos Gevers-Montoro et al
J Chiropr Med. 2021 Dec;20(4):177-182.

Objective: The purpose of this article is to describe a protocol to examine the feasibility of combining podiatric orthotic treatment with multimodal chiropractic treatment to treat chronic low back pain (CLBP) in those with a functional short leg on the same side as a unilateral pronated foot.

Methods: This is a protocol for a multicenter feasibility 2-arm parallel randomized controlled trial. One hundred and thirty-two adults with CLBP and a functional short leg on the same side as a unilateral pronated foot are to be recruited in Melbourne, Australia, and Madrid and Seville, Spain. Forty-four participants at each site are to be randomized to multimodal chiropractic treatment including spinal manipulation or to multimodal chiropractic treatment also involving spinal manipulation, together with podiatric custom-made orthoses. Chiropractic visits are to comprise 12 treatments over 4 weeks. Outcome measures will be recruitment, compliance, costs, CLBP-related disability, and perceived low back pain.

Results: Feasibility results will be reported in text format and the clinical data reported using descriptive statistics focusing on any clinically significant results.

Conclusion: This protocol describes a feasibility study for assessing the combination of podiatric orthotic treatment with multimodal chiropractic treatment to treat CLBP in those with a functional short leg on the same side as a unilateral pronated foot.
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NewsBot · Mar 30, 2023

A randomised controlled trial investigating the effect of foot orthoses for the treatment of chronic nonspecific low back pain
Sean Sadler et al
Musculoskeletal Care. 2023 Mar 23

Objectives: The primary aim was to investigate the effect of prefabricated foot orthoses on pain and function in people with chronic nonspecific low back pain (LBP). Secondary aims were to report on the recruitment rate, adherence to and safety of these interventions, and the relationship between physical activity and pain and function.

Design: A two-arm parallel group (intervention vs. control) randomised (1:1) controlled trial.

Subjects: Forty-one participants with chronic nonspecific LBP.

Intervention: Twenty participants were randomised to the intervention group (prefabricated foot orthotic and The Back Book) and 21 to the control group (The Back Book). The primary outcomes for this study were change in pain and function from baseline to 12 weeks.

Results: No statistically significant difference in pain was found between the intervention and control group (adjusted mean difference -0.84, 95% CI: -2.09 to 0.41, p = 0.18) at the 12-week follow-up. No statistically significant difference in function was found between the intervention and control group (adjusted mean difference -1.47, 95% CI: -5.51 to 2.57, p = 0.47) at the 12-week follow-up.

Conclusion: This study found no evidence of a significant beneficial effect of prefabricated foot orthoses for chronic nonspecific LBP. This study demonstrated that the rate of recruitment, intervention adherence and safety, and participant retention is acceptable and supportive of conducting a larger randomised controlled trial.
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NewsBot · May 4, 2023

Effects of Insoles on Gait Kinematics and Low Back Pain in Patients with Leg Length Inequality: A Systematic Review
Charlotte Menez et al
J Am Podiatr Med Assoc. 2023 Mar-Apr;113(2):21-004. doi: 10.7547/21-004.

The aim of this systematic review was to examine the effects of foot orthoses on gait kinematics and low back pain (LBP) in individuals with leg length inequality (LLI). This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and has been undertaken in the PubMed-NCBI, EBSCO Host, Cochrane Library, and ScienceDirect databases. Inclusion criteria were the analysis of kinematic parameters during walking or LBP before and after foot orthosis use in patients with LLI. Ultimately, five studies were retained. We extracted the following information: study identity, patients, type of foot orthosis, duration of orthopedic treatment, protocols, methods, and data to assess gait kinematics and LBP. The results showed that insoles seem to reduce pelvic drop and active compensations of the spine when LLI is moderate/severe. However, insoles do not always seem to be efficient in improving gait kinematics in patients with low LLI. All of the studies noted a significant reduction of LBP with use of insoles. Consequently, although these studies revealed no consensus on whether and how insoles affect gait kinematics, the orthoses seemed helpful in relieving LBP.
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NewsBot · Apr 24, 2024 at 2:56 AM

Effects of physical interventions on pain and disability in chronic low back pain with pronated feet: a systematic review and meta-analysis
Md Farhan Alam et al
Physiotherapy Theory and Practice: 03 Mar 2024

Background
A link between pronated feet (PF) and chronic low back pain (CLBP) has been reported in the literature. However, physical interventions (PI) like physiotherapy and orthotics mainly target the lower back, neglecting the broader biomechanical impacts of PF that affect the feet, ankles, and overall posture. Currently, there is a lack of comprehensive meta-analyses or systematic reviews on this subject.

Objectives
This systematic review with a meta-analysis aimed to evaluate the effects of PI on pain and disability in patients having CLBP with PF.

Methods
From inception until October 15, 2023, Medline/PubMed, Web of Science, and Scopus databases were searched using the desired keywords for randomized control trials (RCTs). The quality of the RCTs was evaluated using the PEDro scale and risk of bias tool.

Results
Four studies involving 268 patients were identified, two compared custom-made foot orthoses to non-biomechanical foot insoles, while the other two used exercises. The meta-analysis included four studies for pain and three for disability. The results showed a significant change in pain [−2.43 (95% CI −2.73 to −2.13, p < .001)] and disability of −6.69 (95% CI −8.04 to −5.33, p < .001)].

Conclusions
This systematic review and meta-analysis of four RCTs elucidates that PI, specifically targeting PF, significantly alleviate pain and reduce disability in patients having CLBP with PF. These findings advocate for integrating foot-based PI within the treatment protocols for patients suffering from CLBP accompanied by PF.
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