***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 
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    Input: This r and omised feasibility study aim ed to examine the clinical and biomechanical effects of functional foot orthoses ( FFOs ) in the treatment of midfoot osteoarthritis ( OA ) and the feasibility of conducting a full r and omised controlled trial . Participants with painful , radiographically confirmed midfoot OA were recruited and r and omised to receive either FFOs or a sham control orthosis . Feasibility measures included recruitment and attrition rates , practicality of blinding and adherence rates . Clinical outcome measures were : change from baseline to 12 weeks for severity of pain ( numerical rating scale ) , foot function ( Manchester Foot Pain and Disability Index ) and patient global impression of change scale . To investigate the biomechanical effect of foot orthoses , in-shoe foot kinematics and plantar pressures were evaluated at 12 weeks . Of the 119 participants screened , 37 were r and omised and 33 completed the study ( FFO = 18 , sham = 15 ) . Compliance with foot orthoses and blinding of the intervention was achieved in three quarters of the group . Both groups reported improvements in pain , function and global impression of change ; the FFO group reporting greater improvements compared to the sham group . The biomechanical outcomes indicated the FFO group inverted the hindfoot and increased midfoot maximum plantar force compared to the sham group . The present findings suggest FFOs worn over 12 weeks may provide detectable clinical and biomechanical benefits compared to sham orthoses . This feasibility study provides useful clinical , biomechanical and statistical information for the design and implementation of a definitive r and omised controlled trial to evaluate the effectiveness of FFOs in treating painful midfoot OA Background Musculoskeletal injuries during initial military training are a significant medical problem facing military organisations globally . In order to develop an injury management programme , this study aims to quantify the incidence and rehabilitation times for injury specific diagnoses . Methods This was a prospect i ve follow-up study of musculoskeletal injuries in 6608 British Army recruits during a 26-week initial military training programme over a 2-year period .  Incidence and rehabilitation times for injury specific diagnoses were recorded and analysed . Results During the study period the overall incidence of musculoskeletal injuries was 48.6 % , and the most common diagnosis was iliotibial b and syndrome ( 6.2 % ) . A significant proportion of the injuries occurred during the first 11 weeks of the programme . The longest rehabilitation times were for stress fractures of the femur , calcaneus and tibia ( 116 ± 17 days , 92 ± 12 days , and 85 ± 11 days , respectively ) . The combination of high incidence and lengthy rehabilitation indicates that medial tibial stress syndrome had the greatest impact on training , accounting for almost 20 % of all days spent in rehabilitation . Conclusion When setting prevention priorities consideration should be given to both the incidence of specific injury diagnoses and their associated time to recovery 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 Orthotic insoles are suggested to prevent  low back pain . This r and omized controlled study assessed if customised orthotic insoles prevent low back pain .  Healthy military conscripts ( n = 228 ; mean age 19 years , range 18–29 ) were r and omly assigned to use either customised orthotic insoles ( treatment group , n = 73 ) or nothing ( control group , n = 147 ) . The main outcome measure was low back pain requiring a physician visit and result ing in minimum 1 day suspension from military duty . Twenty-four ( 33 % ) treated subjects and 42 ( 27 % ) control subjects were suspended from duty due to low back pain ( p = 0.37 ; risk difference 4.3 % ; 95 % CI : −8.7 to 17.3 % ) . Mean suspension duration was 2 days ( range 1–7 ) in both groups . Four ( 5 % ) treated subjects and eight ( 5 % ) control subjects were released from duty due to persistent low back pain ( p = 0.92 ; risk difference 0 % ; 95 % CI : −6 to 6 % ) . Use of orthotic insoles is therefore not recommended to prevent physical stress-related low back pain Study Design . R and omized controlled trial . Objectives . To determine if the use of custom shoe orthoses can lessen the incidence of weight bearing-induced back pain .  Summary of Background Data . The scientific basis for the use of orthoses to prevent back pain is based principally on studies that show that shoe orthoses can attenuate the shock wave generated at heel strike . The repetitive impulsive loading that occurs because of this shock wave can cause wear of the mechanical structures of the back . Previous r and omized studies showed mixed results in preventing back pain , were not blinded , and used orthoses for only short periods of time . Methods . A total of 404 eligible new infantry recruits without a history of prior back pain were r and omly assigned to received either custom soft , semirigid biomechanical , or simple shoe inserts without supportive or shock absorbing qualities . Recruits were review ed biweekly by an orthopaedist for back signs and symptoms during the course of 14 weeks of basic training Results . The overall incidence of back pain was 14 % . By intention-to treat and per- protocol analyses , there was no statistically significant difference between the incidence of either subjective or objective back pain among the 3 treatment groups . Significantly more recruits who received soft custom orthoses finished training in their assigned orthoses ( 67.5 % ) than those who received semirigid biomechanical orthoses ( 45.5 % ) or simple shoe inserts ( 48.6 % ) , P = 0.001 . Conclusions . The results of this study do not support the use of orthoses , either custom soft or semirigid biomechanical , as prophylactic treatment for weight bearing-induced back pain .  Custom soft orthoses had a higher utilization rate than the semirigid biomechanical or simple shoe inserts . The pretraining physical fitness and sports participation of recruits were not related to the incidence of weight bearing-induced back pain Background Foot orthoses are frequently used for the prevention of lower limb overuse injuries but evidence for their effectiveness is limited . The primary aim of this study is to determine if prefabricated foot orthoses reduce the incidence of lower limb overuse injuries in naval recruits undertaking 11 weeks of basic training . Methods This study is a participant and assessor blinded , parallel-group , r and omised controlled trial . The trial will recruit participants undertaking 11 weeks of basic training at the Royal Australian Navy Recruit School , Cerberus , Victoria , Australia . Participants will be r and omised to a control group ( flat insole ) or an intervention group ( prefabricated foot orthosis ) . Over the 11 weeks of basic training , participants will document the presence and location of pain in weekly self-report diaries . The end-point for each participant will be the completion of 11 weeks of basic training . The primary outcome measure will be the combined incidence of four lower limb injuries ( medial tibial stress syndrome , patellofemoral pain , Achilles tendinopathy , and plantar fasciitis/plantar heel pain ) which are common among defence members . Secondary outcome measures include : ( i ) overall incidence of lower limb pain , ( ii ) severity of lower limb pain , ( iii ) time to injury , ( iv ) time to drop-out due to injury , ( v ) adverse events , ( vi ) number of lost training days , ( vii ) shoe comfort , and ( viii ) general health status . Data will be analysed using the intention-to-treat principle . Discussion This r and omised controlled trial will evaluate the effectiveness of prefabricated foot orthoses for the prevention of common lower limb overuse injuries in naval recruits . Trial registration Australian New Zeal and Clinical Trials Registry : ACTRN12615000024549 Background The effectiveness of foot orthoses has been evaluated in many clinical trials with sham foot orthoses used as the control intervention in at least 10 clinical trials . However , the mechanical effects and credibility of sham orthoses has been rarely quantified . This study aim ed to : ( i ) compare the effects on plantar pressures of three sham foot orthoses to a customised foot orthosis , and ( ii ) establish the perceived credibility and the expected benefit of each orthotic condition . Methods Thirty adults aged between 18 and 51 participated in this study . At 0 and 4 weeks , plantar pressure data were collected for the heel , midfoot and forefoot using the pedar ® -X in-shoe system for the following five r and omly assigned conditions : ( i ) shoe alone , ( ii ) customised foot orthosis , ( iii ) contoured polyethylene sham foot orthosis , ( iv ) contoured EVA sham foot orthosis , and ( v ) flat EVA sham foot orthosis . At the initial data collection session , each participant completed a Credibility/Expectancy Question naire ( CEQ ) to determine the credibility and expected benefit of each orthotic condition . Results Compared to the shoe alone at week 0 , the contoured polyethylene sham orthosis was the only condition to not significantly effect peak pressure at any region of the foot . In contrast , the contoured EVA sham orthosis , the flat EVA sham orthosis and the customised orthosis significantly reduced peak pressure at the heel . At the medial midfoot , all sham orthoses provided the same effect as the shoe alone , which corresponded to effects that were significantly different to the customised orthosis . There were no differences in peak pressure between conditions at the other mask regions , the lateral midfoot and forefoot . When the conditions were compared at week 4 , the differences between the conditions were generally similar to the findings observed at week 0 . With respect to credibility and expected benefit , all orthotic conditions were considered the same with the exception of the contoured polyethylene sham orthosis , which was perceived as being less credible and less likely to provide benefits . Conclusion The findings of this study indicate that all of the sham orthoses tested provided the same effect on plantar pressures at the midfoot and forefoot as a shoe alone . However , the contoured EVA sham orthosis and the flat EVA sham orthosis  significantly reduced peak pressure under the heel , which was similar to the customised orthosis . In contrast , the contoured polyethylene sham orthosis had no significant effect on plantar pressure and was comparable to the shoe alone at all regions of the foot . Hence , lower plantar pressures were found under the heel with some sham orthoses , but not with others . Importantly , participants perceived the polyethylene sham orthosis – the sham that had no effect on plantar pressure – to be the least credible orthosis and the least likely to provide benefits . This may be critical for the design of future clinical trials as it may introduce confounding effects that produce inaccurate results . These findings provide some evidence for the mechanical effects , treatment credibility and expected benefit of sham foot orthoses , which should be considered when they are used as a control intervention in a clinical trial Soccer referees participating in large soccer tournaments may develop overuse injuries . In this study the effect of shock absorbing heel inserts in the incidence of soreness was investigated . Forty-eight referees were r and omly selected to wear 
    Output:
    
Conclusions Foot orthoses were found to be effective for preventing overall injuries and stress fractures but not soft-tissue injuries , while shock-absorbing insoles were not found to be effective for preventing any injury .