Prescribed footwear and orthoses are not prophylactic in preventing lower extremity injuries in military tactical athletes. A systematic review with meta-analysis.

This article was published in BMJ Mil Health in 2024  (DOI: https://doi.org/10.1136/bmjmilitary-2021-001955).

Note: This article was not submitted to ExultX Spotlight by the authors. However, due to its relevance, we have decided to share it with our community. This text is a commentary on the original article, attempting to highlight the key points. For a more thorough and complete understanding of the content, we strongly recommend everyone to read the original article.

All rights to the findings belong to the authors of the article. Responsibility for the commentary lies with ExultX.

Musculoskeletal injuries (MSKIs) are a major issue in the military, affecting readiness, performance, and costing billions annually. These injuries, often caused by repetitive, high-impact activities like marching and running, have led to the use of interventions such as foot orthoses, shock-absorbing insoles, and other prescribed footwear. While these may improve foot mechanics, their effectiveness in preventing injuries, particularly in military personnel who face unique physical demands and a “mission-first” culture, remains unclear. This review investigates whether prescribed footwear and orthoses reduce lower limb injury risks in military tactical athletes.

1. Description of the Methodology

The study design was a systematic review with meta-analysis. Databases including MEDLINE, Embase, Web of Science, and others were searched for randomised controlled trials (RCTs) comparing prescribed footwear or orthoses with placebo or no treatment. Eligible studies focused on military tactical athletes and reported injury numbers, population sizes, and study durations. Systematic reviews, retrospective studies, or non-randomised trials were excluded. Data analysis included the calculation of relative risk (RR), cumulative incidence, and heterogeneity of outcomes. Subgroup analyses assessed different types of interventions such as orthoses, insoles, and footwear. The risk of bias was assessed using the Cochrane Collaboration tool. A sensitivity analysis and funnel plot were conducted to evaluate reporting bias.

2. Key Takeaways

No Consistent Benefits: The meta-analysis did not demonstrate significant protective effects of prescribed footwear or orthoses on lower extremity MSKIs in military personnel.

Heterogeneity in Findings: Subgroup analyses and individual studies occasionally showed minor effects, but results were inconsistent and lacked generalisability.

High Bias Risk: Many studies exhibited methodological limitations, including inadequate blinding, unclear randomisation, and attrition biases.

Current Recommendations: Prescribed footwear and orthoses do not seem to have a preventative effect on lower quarter MSKIs in military personnel. Most of the studies included in the review that prescribed these interventions did not account for the individual characteristics or specific needs of the military members. As a result, the broad application of these non-specific interventions in these studies cannot be recommended for use.

3. Day-to-Day Applications

Clinical Practice: It is advisable for clinicians to exercise caution when considering the prescription of generic orthoses or footwear for injury prevention in military personnel. A more tailored approach, involving individual assessments and attention to specific needs, may be more beneficial.

Policy Development:  Military organisations may wish to reassess policies that promote the widespread prescription of universal footwear or orthoses, and instead consider investing in more targeted prevention strategies.

Research Needs: Future studies should adopt robust methodologies to explore injury prevention strategies tailored to military-specific demands.

Learn more about the article here.