***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 Rheumatoid arthritis ( RA ) frequently causes  foot pain and swelling that affect ambulation . Pharmaceutical management of pain and disability is st and ard in clinical practice . The use of functional posted foot orthoses , as an adjunct to pharmaceutical treatment , is a promising treatment for managing  foot pain and disability in RA . Its effectiveness , however , has not been rigorously evaluated . We performed a double-blind clinical trial using foot orthoses vs. placebo orthoses in the management of the rheumatoid arthritic foot , while subjects continued customary treatment . On the basis of findings of no effect on disability and pain measures , this study indicates no benefit of functional posted foot orthoses over placebos 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 CONTEXT Hallux valgus is a common foot deformation in adults , but evidence for effectiveness of surgical and conservative treatments for this condition is limited . OBJECTIVE To compare the effectiveness of surgical and orthotic treatment with no treatment in patients with hallux valgus . DESIGN AND SETTING R and omized controlled trial conducted in 4 general community hospitals in Finl and in 1997 - 1998 , with a follow-up period of 12 months . PARTICIPANTS Two hundred nine consecutive patients ( mean age , 48 years ; 93 % women ) with a painful bunion and a hallux valgus angle 35 degrees or less . INTERVENTIONS Patients were r and omly assigned to surgery ( distal chevron osteotomy ; n = 71 ) , orthosis ( n = 69 ) , or a 1-year waiting list ( control group , n = 69 ) . MAIN OUTCOME MEASURES Pain intensity during walking on a visual analog scale ( 0 - 100 ) , patient assessment of global improvement , number of painful days , cosmetic disturbance , footwear problems , functional status , and treatment satisfaction , compared among treatment groups . RESULTS Follow-up rates at 6 and 12 months were 99 % and 98 % , respectively . At 6 months , pain intensity decreased more in the surgical group than in the control group ( adjusted mean differences , -20 [ 95 % confidence interval ( CI ) , -28 to -12 ] ) and more in orthosis than in the control groups ( adjusted mean difference , -14 [ 95 % CI , -22 to -6 . At 1 year , pain intensity decreased more in the surgical than in the control groups ( adjusted mean difference , -19 [ 95 % CI , -28 to -10 ] ) and more than in the surgical and orthosis groups ( adjusted mean difference , -14 [ 95 % CI , -22 to -5 ] ) . At 1 year , 83 % , 46 % , and 24 % in the surgery , orthosis , and control groups , respectively , thought they had improved compared with baseline ( number needed to treat ) , 1.7 between surgical and control groups ) . Number of painful days , cosmetic disturbance , and footwear problems were least and functional status and satisfaction with treatment were best in the surgical group . CONCLUSIONS Surgical osteotomy is an effective treatment for painful hallux valgus . Orthoses provide short-term symptomatic relief AIM The purpose of the study was to evaluate the prevalence of  foot pain and foot deformities in adolescents . It was aim ed to obtain information on the association between foot pain and foot deformities . METHOD A total of 2 368 adolescents ( age 14.5 + /- 0.7 years ) were evaluated . The frequency of foot pain was probed by using a self-reporting question naire . The foot deformities were evaluated during clinical examinations by school doctors . RESULTS The prevalence of foot pain was 14.0 % and the prevalence of foot deformities was 13.7 % . The prevalence of pain was significantly higher in adolescents with foot deformity ( 17.8 % ) than in persons without deformity ( 13.4 % ) , p < 0.05 . The prevalence of a flexible flat foot was 6.2 % and the prevalence of a rigid flat foot was 0.5 % . Other deformities registered were splay foot ( 2.3 % ) and flexible splay-flat foot ( 2.0 ) . The prevalence of hallux-valgus deformity was 3.5 % . A total of 3.5 % patients were suffering from a plantar hyperkeratosis . This was significantly correlated to a high pain prevalence ( the hyperkeratosis was significantly associated with a high prevalence of pain ) . Significant factors which were significantly associated with foot pain were foot deformity ( 1.4 fold ) and hyperkeratosis ( 75 fold ) . Foot pain was 1.4 fold higher in children with foot deformity and 75 fold higher in feet with hyperkeratosis . CONCLUSION The prevalence of foot pain and foot deformity in adolescent is high . Mild deformities ( flexible flat foot and splay foot ) are physiological variations without any association to foot pain . Pathological conditions that are associated with foot pain are the rigid flat foot , the hallux valgus and the cavus deformity . Plantar hyperkeratosis is an indicator of foot pathology Background : The literature suggests mechanical interventions such as foot orthoses and night splints are effective in reducing pain from plantar fasciitis . There is , however , a lack of controlled trials . We studied the effects of foot orthoses and night splints , alone or combined , in a prospect i ve , r and omized trial with 1-year followup . Methods : Forty-three patients ( 34 women and nine men with a mean age of 46 years ) with plantar fasciitis were r and omized to receive foot orthoses ( n = 13 ) , foot orthoses and night splints ( n = 15 ) , or night splints alone ( n = 15 ) . Data were available for 34 ( 79 % ) patients after treatment ( 12 weeks ) , and for 38 ( 88 % ) at 1-year followup . Pain , functional limitations , and quality of life were evaluated with the Foot and Ankle Outcome Score . Results : All groups improved significantly in all outcomes evaluated across all times ( p < 0.04 ) . At 12 weeks , pain reduction of 30 % to 50 % compared to baseline were seen ( p < 0.03 ) . At 52 weeks , pain reduction of 62 % was seen in the two groups using foot orthoses compared to 48 % in the night splint only group ( p < 0.01 ) . Better compliance and fewer side effects were reported for orthosis use . At 12 months , 19 of 23 patients reported still using foot orthoses compared to 1 of 28 still using the night splint . Conclusions : Foot orthoses and anterior night splints were effective both short-term and long-term in treating pain from plantar fasciitis . Parallel improvements in function , foot-related quality of life , and a better compliance suggest that a foot orthosis is the best choice for initial treatment plantar fasciitis OBJECTIVE . To compare the clinical efficacy of custom foot orthotics , prefabricated " off-the-shelf " shoe inserts , and supportive athletic shoes worn alone , on reducing pain and improving function for children with juvenile idiopathic arthritis ( JIA ) . METHODS Children with JIA and foot pain ( n = 40 ) were r and omized to one of 3 groups receiving : ( 1 ) custom-made semirigid foot orthotics with shock absorbing posts ( n = 15 ) , ( 2 ) off-the-shelf flat neoprene shoe inserts ( n = 12 ) , or ( 3 ) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone ( n = 13 ) . Foot pain and functional limitations were measured using the Pediatric Pain Question naire-visual analog scale ( VAS ) , Timed Walking , Foot Function Index ( FFI ) , and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory ( PedsQL ) . Measures were administered by personnel blinded to group status at baseline ( before wearing the assigned intervention ) and at 3 months ' followup . RESULTS Children in the orthotics group showed significantly greater improvements in overall pain ( p = 0.009 ) , speed of ambulation ( p = 0.013 ) , activity limitations ( p = 0.002 ) , foot pain ( p = 0.019 ) , and level of disability ( p = 0.024 ) when compared with the other 2 groups . Both children and parents in the orthotics group reported clinical ly meaningful improvement in child health-related quality of life , although the group by time interaction did not show statistical significance . Except for a reduction in pain for supportive athletic 
    Output:
    
Custom-made foot orthoses were effective for painful pes cavus ( NNTB:5 ) , rearfoot pain in rheumatoid arthritis ( NNTB:4 ) , foot pain in JIA ( NNTB:3 ) and painful hallux valgus ( NNTB:6 ) ; however , surgery was even more effective for hallux valgus and non-custom foot orthoses appeared just as effective for JIA but the analysis may have lacked sufficient power to detect a difference in effect .
It is unclear if custom-made foot orthoses were effective for plantar fasciitis or metatarsophalangeal joint pain in rheumatoid arthritis .
There is limited evidence on which to base clinical decisions regarding the prescription of custom-made foot orthoses for the treatment of  foot pain .
Currently , there is gold level evidence for painful pes cavus and silver level evidence for foot pain in JIA , rheumatoid arthritis , plantar fasciitis and hallux valgus