***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: Objectives : Evaluate effects of a new off-the-shelf insert on frontal plane foot biomechanics and compare effectiveness of the new and an existing off-the-shelf insert and a motion-control shoe in neutralizing frontal plane foot biomechanics . Design : Descriptive . Setting : Biomechanics laboratory . Participants : Fifteen uninjured subjects with a flexible flatfoot secondary to forefoot varus . Assessment of Risk Factors : Three-dimensional kinematic and kinetic data were collected as subjects walked and jogged at their self-selected speed while wearing a motion-control running shoe , the shoe with a new off-the-shelf insert , and the shoe with an existing off-the-shelf insert . Main Outcome Measures : Frontal plane kinematics and rearfoot kinetics were evaluated during stance . Statistical analysis was performed using a repeated measures analysis of variance and Student-Newman-Keuls post hoc tests ( α ≤ 0.05 ) . Results : The new insert and motion-control shoe placed the forefoot in a less-everted position than the existing off-the-shelf insert during walking . There were no differences in forefoot kinematics during jogging , nor were there differences in rearfoot motion during walking or jogging . The rearfoot eversion moment was significantly lower with the new off-the-shelf insert compared with the motion-control shoe and the existing insert during walking and jogging . Conclusions : A new off-the-shelf device is available that promotes more neutral frontal plane biomechanics , thus providing a theoretical rationale for using this device for injury prevention and treatment . The comparative biomechanical effectiveness of a motion-control shoe and the orthotic inserts may assist health care professionals in selecting a device to correct the flatfoot structure CONTEXT Foot-orthosis ( FO ) intervention to prevent and treat numerous lower extremity injuries is widely accepted clinical ly . However , the results of quantitative gait analyses have been equivocal . The foot models used , participants receiving intervention , and orthoses used might contribute to the variability . OBJECTIVE To investigate the effect of a custom-molded FO intervention on multisegment medial foot kinematics during walking in participants with low-mobile foot posture . DESIGN Crossover study . SETTING University biomechanics and ergonomics laboratory . PATIENTS OR OTHER PARTICIPANTS Sixteen participants with low-mobile foot posture ( 7 men , 9 women ) were assigned r and omly to 1 of 2 FO groups . INTERVENTION(S ) After a 2-week period to break in the FOs , individuals participated in a gait analysis that consisted of 5 successful walking trials ( 1.3 to 1.4 m/s ) during no-FO and FO conditions . MAIN OUTCOME MEASURE(S ) Three-dimensional displacements during 4 subphases of stance ( loading response , midstance , terminal stance , preswing ) were computed for each multisegment foot model articulation . RESULTS Repeated- measures analyses of variance ( ANOVAs ) revealed that rearfoot complex dorsiflexion displacement during midstance was greater in the FO than the no-FO condition ( F(1,14 ) = 5.24 , P = .04 , partial η(2 ) = 0.27 ) . Terminal stance repeated- measures ANOVA results revealed insert-by-insert condition interactions for the first metatarsophalangeal joint complex ( F(1,14 ) = 7.87 , P = .01 , partial η(2 ) = 0.36 ) . However , additional follow-up analysis did not reveal differences between the no-FO and FO conditions for the balanced traditional orthosis ( F(1,14 ) = 4.32 , P = .08 , partial η(2 ) = 0.38 ) or full-contact orthosis ( F(1,14 ) = 4.10 , P = .08 , partial η(2 ) = 0.37 ) . CONCLUSIONS Greater rearfoot complex dorsiflexion during midstance associated with FO intervention may represent improved foot kinematics in people with low-mobile foot postures . Furthermore , FO intervention might partially correct dysfunctional kinematic patterns associated with low-mobile foot postures Study design : r and omized , double-blinded , clinical trial . Background : Low back pain is one of the commonest disorders affecting the back . The literature reflects how over time excessive pronation of the foot has become to be recognized as linked to chronic low back pain , and how the problem can evolve for the better with the use of compensating foot orthoses . Objectives : The main objective of this study is to answer the question of whether the use of a certain type of custom-made foot orthosis alleviates low back pain . Material and methods : In a sample of 51 participants with excessive subtalar pronation and chronic low back pain ( 43 women and 8 men ) , the effect of custom-made foot orthoses  in low back pain was studied . The study design was a r and omized , double-blinded , clinical trial with two groups : experimental , treated with the custom-made foot orthoses , and control , treated with a placebo .  Low back pain was evaluated by a visual analog scale for pain and Oswestry ’s Disability Index Question naire for lower back pain at two moments — on the day of inclusion in the study and after 4 weeks of treatment . Results : The evolution of the low back pain showed significant differences in the experimental group , showing a significant reduction of pain and disability ( p < 0.001 , visual analog scale ; p < 0.001 , Oswestry ’s Index ) . Conclusions : In the sample studied , the use of custom-made foot orthoses to control foot pronation had a short-term effect in reduction of perceived low back pain . Clinical relevance If subtalar joint hyperpronation plays a fundamental role in the pathomechanics of lower limb , and this can facilitate the development of low back pain , then controlling the abnormal mobility of subtalar joint by means of foot orthoses should improve this symptom . This article could help solve this controversy Background Foot orthoses are widely used in the management of flexible pes planus , yet the evidence to support this intervention has not been clearly defined . This systematic review aim ed to critically appraise the evidence for the use of foot orthoses for flexible pes planus in adults . Methods Electronic data bases ( Medline , CINAHL , Cochrane , Web of science , SportD iscus , Embase ) were systematic ally search ed in June 2013 for r and omised controlled , controlled clinical and repeated measure trials where participants had identified flexible pes planus using a vali date d and reliable measure of pes planus and the intervention was a rigid or semi-rigid orthoses with the comparison being a no-orthoses ( shoes alone or flat non-posted insert ) condition . Outcomes of interest were foot pain , rearfoot kinematics , foot kinetics and physical function . Results Of the 2,211 articles identified by the search es , 13 studies met the inclusion criteria ; two were r and omised controlled trials , one was a controlled trial and 10 were repeated measure studies . Across the included studies , 59 relevant outcome measures were reported with 17 calculated as statistically significant large or medium effects observed with use of foot orthoses compared to the no orthoses condition ( SMD range 1.13 to -4.11 ) . Conclusions No high level evidence supported the use of foot orthoses for flexible pes planus . There is good to moderate level evidence that foot orthoses improve physical function ( medial-lateral sway in st and ing ( level II ) and energy cost during walking ( level III ) ) . There is low level evidence ( level IV ) that foot orthoses  improve pain , reduce rearfoot eversion , alter loading and impact forces ; and reduce rearfoot inversion and eversion moments in flexible pes planus . Well- design ed r and omised controlled trials that include appropriate sample sizes , clinical cohorts and involve a measure of symptom change are required to determine the efficacy of foot orthoses to manage adult flexible pes planus Despite the widespread use of customised foot orthoses ( FOs ) for the pronated foot type there is a lack of reliable information on the dose-response effect on lower limb mechanics . This study investigated these effects in subjects with normal and pronated foot types .  Customised FOs were administered to 12 participants with symptomatic pronated foot type and 12 age and gender matched controls . A computer-aided design ( CAD ) software was used to design nine FOs per participant with dose incrementally changed by varying only the rearfoot post angle . This was done in 2 ° increments from 6 ° lateral to 10 ° medial posting . A 3D printing method was used to manufacture the FOs . Quantification of the dose-response effect was performed using three-dimensional gait analyses for selected rearfoot and knee kinematics and kinetics . Under these experimental conditions , significant and linear effects of posting were seen for the peak ( p<0.001 ) and mean ( p<0.001 ) rearfoot eversions , peak ( p=0.003 ) and mean ( p<0.001 ) ankle eversion moments and peak ( p=0.017 ) and mean ( p=0.005 ) knee adduction moment variables . Group effects were observed for the peak ( p=0.007 ) and mean ( p=0.007 ) forefoot abduction and for the peak ( p=0.007 ) knee adduction moment . A significant interaction between posting and group was seen for internal tibial rotation ( p=0.004 ) . These data indicate that a dose-response effect , with a linear trend for both the rearfoot and knee , exists for customised FOs used to treat pronated foot type OBJECTIVE To quantify the effects of posting and custom-molding of foot orthotics on lower extremity kinematics and kinetics during running . DESIGN Repeated measures . Background . Several kinematic and kinetic factors have been suggested to increase a runner 's risk for injuries . It has been speculated that foot orthotics can be used to reduce injury related complaints or even prevent running injuries by affecting these factors . METHODS Twenty one volunteers participated in this study . Kinematic and kinetic variables obtained during overground running for medial posting , custom-molding , and the combination of medial posting and custom-molding of foot orthotics were compared to a control condition . Repeated measures ANOVA and student t-tests were used to detect significant differences ( alpha=0.05 ) . RESULTS Posting of foot orthotics reduced maximum foot eversion and ankle inversion moment and increased vertical loading rate and maximum knee external rotation moment ( P<0.05 ) . Molding and posting and molding reduced vertical loading rate and ankle inversion moment and increased maximum foot inversion and maximum knee external rotation moment ( P<0.05 ) . CONCLUSIONS The effects of posting and molding of foot orthotics are extremely different and when combining posting and molding , the effects of molding appear to be dominant . It yet remains to be determined whether posting or molding is more beneficial with respect to overuse running injuries . RELEVANCE The potential of foot orthotics for reducing pain and injuries is convincing . The current study provides valuable information about the role of specific structural components of foot orthotics and contributes to the knowledge about the mechanism underlying the effect of foot orthotics in running OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE To compare walking stance phase rearfoot and forefoot motion , ankle joint moments and extrinsic foot muscle EMG profiles between normal and pes planus feet . DESIGN A cross-sectional comparative study . BACKGROUND Musculoskeletal conditions are often attributed to pes planus , in which motion is assumed to be excessive and the muscle control inadequate . However , many of the speculated differences in mechanics and control between the normal and the pes planus foot have not been quantified . METHODS Kinematic and kinetic data were obtained from video recordings of skin surface markers and a force plate , and EMG was recorded with surface electrodes . Analysis of variance was carried out to compare the group profiles . RESULTS In the pes planus group : the forefoot was less adducted ( P < .05 ) at toe-off , and total transverse plane range of motion , at 8 degrees versus 10 degrees , was less ( P < .01 ) ; the peak plantarflexor ank 
    Output:
    
Findings : Meta‐ analysis revealed less rearfoot eversion with the use of foot orthoses  including medial forefoot or both forefoot and rearfoot posting .
However , no significant effect  of foot orthoses with arch support and neutral rearfoot posting to control excessive foot pronation were found .
In terms of kinetics , none of the foot orthoses showed effects .
Interpretation : Using medial posting is the most effective foot orthotic feature to reduce the peak rearfoot eversion and to control excessive foot pronation .
Nevertheless , heterogeneity between study protocol s contributes to the low evidence s of foot orthoses effects on kinematics and kinetics during walking in people with pes planovalgus