title: Changes in gait economy between full-contact custom-made foot orthoses and prefabricated inserts in patients with musculoskeletal pain: a randomized clinical trial.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Foot-Knee-Back Clinic, Ancaster, Ontario, Canada. leslietrotter@cogeco.ca
authors.forename: Leslie C
authors.initials: LC
authors.lastname: Trotter
authors.forename: Michael Raymond
authors.initials: MR
authors.lastname: Pierrynowski
mesh_terms: D000328:Adult; D004734:Energy Metabolism; D004867:Equipment Design; D005260:Female; D005528:Foot; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D009989:Orthotic Devices; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D059408:Pain Management; D016896:Treatment Outcome; D055815:Young Adult