***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The aim of the study was to investigate the role played by anatomical ( lower limb length discrepancy ) and biomechanical ( alterations in the dynamics of movement ) factors in the pathophysiology of myofascial pain syndrome ( MPS ) of the peroneus longus . DESIGN Patients affected with MPS of the peroneus longus of one side were su bmi tted to either correction of their lower limb discrepancy by heel lift ( 6 patients ) or normalization of altered biomechanical parameters during movement , as measured via ground-foot reaction analysis ( g-f ) by dynamic insoles ( 6 patients ) for 60 days . At days 7 , 15 , 30 , and 60 , the effect of treatment was verified on painful symptoms [ VAS scale , presence of the active trigger point ( TrP ) in the muscle ] and on g-f parameters [ peaks of vertical force ( F1 and F3 of Fz ) and of lateral shear force ( Fx ) ] . RESULTS Treatment with heel lift produced a moderate , significant reduction of the spontaneous pain and of the abnormal Fx peak in the affected leg after 7 to 14 days with no further improvement afterward . Treatment with dynamic insoles caused a marked , significant reduction of the pain at 7 days , with complete resolution of the painful symptoms at 30 days and concomitant disappearance of the active TrP in the muscle . It also produced a significant and progressive reduction of the abnormal Fx peak in the affected leg starting at the 7th day and continuing until the 60th day . CONCLUSION Both anatomical and biomechanical alterations of the dynamics of movement play a role in the painful symptoms of MPS of the peroneus longus , but the biomechanical factor is by far the more prominent BACKGROUND Shock-absorbing and biomechanic shoe orthoses are frequently used in the prevention and treatment of back and lower extremity problems . One review concludes that the former is clinical ly effective in relation to prevention , whereas the latter has been tested in only 1 r and omized clinical trial , concluding that stress fractures could be prevented . OBJECTIVES To investigate if biomechanic shoe orthoses can prevent problems in the back and lower extremities and if reducing the number of days off-duty because of back or lower extremity problems is possible . DESIGN Prospect i ve , r and omized , controlled intervention trial . STUDY SUBJECTS One female and 145 male military conscripts ( aged 18 to 24 years ) , representing 25 % of all new conscripts in a Danish regiment . METHOD Health data were collected by question naires at initiation of the study and 3 months later . Custom-made biomechanic shoe orthoses to be worn in military boots were provided to all in the study group during the 3-month intervention period . No intervention was provided for the control group . Differences between the 2 groups were tested with the chi-square test , and statistical significance was accepted at P < .05 . Risk ratio ( RR ) , risk difference ( ARR ) , numbers needed to prevent ( NNP ) , and cost per successfully prevented case were calculated . OUTCOME VARIABLES Outcome variables included self-reported back and /or lower extremity problems ; specific problems in the back or knees or shin splints , Achilles tendonitis , sprained ankle , or other problems in the lower extremity ; number of subjects with at least 1 day off-duty because of back or lower extremity problems and total number of days off-duty within the first 3 months of military service because of back or lower extremity problems . RESULTS Results were significantly better in an actual-use analysis in the intervention group for total number of subjects with back or lower extremity problems ( RR 0.7 , ARR 19 % , NNP 5 , cost 98 US dollars ) ; number of subjects with shin splints ( RR 0.2 , ARR 19 % , NNP 5 , cost 101 US dollars ) ; number of off-duty days because of back or lower extremity problems ( RR 0.6 , ARR < 1 % , NNP 200 , cost 3750 US dollars ) . In an intention-to-treat analysis , a significant difference was found for only number of subjects with shin splints ( RR 0.3 , ARR 18 % , NNP 6 cost 105 US dollars ) , whereas a worst-case analysis revealed no significant differences between the study groups . CONCLUSIONS This study shows that it may be possible to prevent certain musculoskeletal problems in the back or lower extremities among military conscripts by using custom-made biomechanic shoe orthoses . However , because care-seeking for lower extremity problems is rare , using this method of prevention in military conscripts would be too costly . We also noted that the choice of statistical approach determined the outcome Twenty-three adult patients with Morton 's neuroma of one foot were r and omized to receive in-shoe orthoses made from a hard , compressed , felt material that would either pronate or supinate both feet . The response of the neuroma pain was measured using subjective visual analogue scales , an objective examination , and the MACTAR patient-specific measure of maximal function . The development of any other lower limb symptoms was also recorded . The pain associated with Morton 's neuroma was not significantly altered by changing the position of the foot with the compressed felt orthosis . Forcibly pronating the foot did not produce a significant incidence of lower limb symptoms in the short term Properly conducted r and omised trials can aid clinical decision-making by providing unbiased estimates of the average size of treatment effects . This paper , the first of two , discusses how readers of clinical trials can extract simple estimates of treatment effect size from trial reports when trial outcomes are measured on a continuous scale . When making decisions about therapy for individual patients , these estimates can be modified on the basis of patient characteristics . Modified estimates of treatment effect size can be used to determine if the effect of treatment is likely to be large enough to be " clinical ly worthwhile " . This approach optimises clinical decision-making by combining unbiased estimates of the size of treatment effect from clinical trials with clinical intuition and patient preferences Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists BACKGROUND AND PURPOSE The effectiveness of soft foot orthotics in the treatment of patients who have patellofemoral pain syndrome was investigated . SUBJECTS Subjects were 20 adolescent female patients , aged 13 to 17 years ( mean = 14.8 , SD = 1.2 ) , who were diagnosed with patellofemoral pain syndrome and who exhibited excessive forefoot varus or calcaneal valgus . METHODS Subjects were r and omly assigned to one of two groups : a control group ( n = 10 ) , which took part in an exercise program , or a treatment group ( n = 10 ) , which used soft foot orthotics in addition to participating in the exercise program . The exercise program consisted of quadriceps femoris and hamstring muscle strengthening and stretching exercises . A visual analogue scale was used to assess the level of pain of the subjects over an 8-week period . RESULTS Both the treatment and control groups demonstrated a significant decrease in the level of pain , but the improvement of the treatment group was significantly greater than that of the control group . CONCLUSION AND DISCUSSION The results suggest that in addition to an exercise program , the use of soft foot orthotics is an effective means of treatment for the patient with patellofemoral pain syndrome This study evaluated the clinical effectiveness and cost-effectiveness of two different types of foot orthoses used to treat plantar heel pain . Forty-eight patients were r and omly assigned to receive either a functional or an accommodative orthosis .  General ( EuroQol ) and specific ( Foot Health Status Question naire ) health-status measures were used . Data were also collected using economic question naires relating to National Health Service costs for podiatry , other health-service costs , and patient costs . Data were measured at baseline and at 4- and 8-week intervals . Thirty-five patients completed the study . The results demonstrated a significant decrease in foot pain and a significant increase in foot function with the functional foot orthoses over the 8-week trial . The accommodative foot orthoses demonstrated a significant reduction in foot pain only at 4 weeks . The cost-effectiveness analysis demonstrated that functional orthoses , although initially more expensive , result in a better quality of life . Use of functional orthoses result ed in an increased cost of pound 17.99 ( 32.74 dollars ) per patient , leading to an incremental cost per quality -adjusted life year of pound 1,650 ( 3,003 dollars ) for functional orthoses Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospect i ve r and omized trial to compare several nonoperative treatments for proximal plantar fasciitis ( heel pain syndrome ) . Included were 236 patients ( 160 women and 76 men ) who were 16 years of age or older . Most reported duration of symptoms of 6 months or less . Patients with systemic disease , significant musculoskeletal complaints , sciatica , or local nerve entrapment were excluded . We r and omized patients prospect ively into five different treatment groups . All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner . One group was treated with stretching only . The other four groups stretched and used one of four different shoe inserts , including a silicone heel pad , a felt pad , a rubber heel cup , or a custom-made polypropylene orthotic device . Patients were reevaluated after 8 weeks of treatment . The percentages improved in each group were : ( 1 ) silicone insert , 95 % ; ( 2 ) rubber insert , 88 % ; ( 3 ) felt insert , 81 % ; (4)stretching only , 72 % ; and ( 5 ) custom orthosis , 68 % . Combining all the patients who used a prefabricated insert , we found that their improvement rates were higher than those assigned to stretching only ( P = 0.022 ) and those who stretched and used a custom orthosis ( P = 0.0074 ) . We conclude that , when used in conjunction with a stretching program , a prefabricated shoe insert is more likely to produce improvement in symp-toms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device In a prospect i ve study of stress fractures the hypothesis that a shock-absorbing orthotic device worn within military boots could lessen the incidence of stress fractures was tested . The incidence of metatarsal , tibial , and femoral stress fractures was lower in the orthotic group , but only the latter difference was statistically significant . The time of onset and the location of stress fractures between orthotic and nonorthotic users did not differ . These findings suggest that the incidence of femoral stress fractures , which are the most dangerous type of stress fracture because of their high risk of developing into displaced fractures , can be reduced by an orthotic device In a prospect i ve study of stress fractures the hypothesis that training with custom made biomechanical shoe orthoses could lessen the incidence of stress fractures in infantry recruits was tested . Recruits were assigned r and omly to groups and given soft biomechanical orthoses or semirigid biomechanical orthoses and compared with a control group that did not train in biomechanical orthoses .  All recruits wore infantry boots with soles design ed like those of basketball shoes . Recruits were examined biweekly during 14 weeks of basic training . The incidence of stress fractures was 15.7 % for the recruits with the semirigid biomechanical orthoses , 10.7 % for the recruits with the soft biomechanical orthoses , and 27 % for the control group . The soft biomechanical orthoses were tolerated better by the recruits than were the semirigid devices . Among trainees at high risk for stress fractures , prophylactic use of custom made biomechanical orthoses may be warranted A r and omized , prospect i ve study was conducted to compare the effectiveness of three individual mechanical modalities in the treatment of plantar fasciitis . Two hundred fifty-five subjects were r and omly assigned to one of three treatment groups : custom-made orthoses , over-the-counter arch supports , or tension night splints . Subjects were treated for 3 months , with follow-up visits at 2 , 6 , and 12 weeks . No statistically significant difference was noted among treatment groups with respect to final outcomes based on first-step pain or pain felt during the day . However , there was a statistically significant difference among the three groups with respect to early patient withdrawal from the study due to continued severe pain , noncompliance , or inability to tolerate the device . Patient compliance was greatest with the use of custom-made orthoses The purpose of this prospect i ve study was to determine whether an association exists between foot structure and the development of musculoskeletal overuse injuries . The study group was a well-defined cohort of 449 trainees at the Naval Special Warfare Training Center in Coronado , California . Before beginning training , measurements were made of ankle motion , subtalar motion , and the static ( st and ing ) and dynamic ( walking ) characteristics of the foot arch . The subjects were tracked prospect ively for injuries throughout training . We identified risk factors that predispose people to 
    Output:
    
There is evidence from the meta- analysis to support the use of foot orthoses in the prevention of the first incidence of lower-limb overuse conditions .
There is evidence from pooled data that there is no difference between the use of custom and prefabricated foot orthoses , inferring that practitioners may use either in the prevention and treatment of lower-limb overuse injuries .