Every few years, there is a case report in the literature of foot pain being either the presenting feature of cancer or occuring in those with known cancer somewhere else in the body (due to a metastasis). Recently, there have been two ..... providing a timely reminder of our importance in arriving at a correct diagnosis:
From: International Urology & Nephrology. 2004;36(3):329-30.
Renal cell carcinoma presenting as solitary foot metastasis. [quote]Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.
From: Onkologie. 2005 Mar;28(3):141-3
Isolated talus metastasis from breast carcinoma: a case report and review of the literature. [quote]Background: Acrometastases are very rare and have been identified in only a few cases on the foot. At the onset, they might be misdiagnosed as arthritis. Case Report: A 59-year-old woman with isolated metastasis to the talus, originating from breast carcinoma was treated by radiotherapy, letrazole, and intravenous bisphosphonates. Results: The review of the literature revealed that this is the first case of an isolated metastasis to the bone of talus from a breast carcinoma, while there are a few cases originating from other organs. The differential diagnosis of acrometastases may be difficult. Conclusion: Pain in the foot or hand of a patient with a known history of malignancy should be considered as potential metastasis.
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Friday, March 25, 2005
Cancer Metatasis to the Foot
Every few years, there is a case report in the literature of foot pain being either the presenting feature of cancer or occuring in those with known cancer somewhere else in the body (due to a metastasis). Recently, there have been two ..... providing a timely reminder of our importance in arriving at a correct diagnosis:
From: International Urology & Nephrology. 2004;36(3):329-30.
Renal cell carcinoma presenting as solitary foot metastasis. [quote]Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.
From: Onkologie. 2005 Mar;28(3):141-3
Isolated talus metastasis from breast carcinoma: a case report and review of the literature. [quote]Background: Acrometastases are very rare and have been identified in only a few cases on the foot. At the onset, they might be misdiagnosed as arthritis. Case Report: A 59-year-old woman with isolated metastasis to the talus, originating from breast carcinoma was treated by radiotherapy, letrazole, and intravenous bisphosphonates. Results: The review of the literature revealed that this is the first case of an isolated metastasis to the bone of talus from a breast carcinoma, while there are a few cases originating from other organs. The differential diagnosis of acrometastases may be difficult. Conclusion: Pain in the foot or hand of a patient with a known history of malignancy should be considered as potential metastasis.
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From: International Urology & Nephrology. 2004;36(3):329-30.
Renal cell carcinoma presenting as solitary foot metastasis. [quote]Skeletal metastases from genitourinary tract are common, but metastatic tumors involving the hand and foot are rare. We herein present a case of 55-year-old man who presented with painful swelling of right foot and no urological complaints. Investigations revealed left renal mass and fine needle aspiration cytology from the swelling revealed findings consistent with metastatic clear cell carcinoma.
From: Onkologie. 2005 Mar;28(3):141-3
Isolated talus metastasis from breast carcinoma: a case report and review of the literature. [quote]Background: Acrometastases are very rare and have been identified in only a few cases on the foot. At the onset, they might be misdiagnosed as arthritis. Case Report: A 59-year-old woman with isolated metastasis to the talus, originating from breast carcinoma was treated by radiotherapy, letrazole, and intravenous bisphosphonates. Results: The review of the literature revealed that this is the first case of an isolated metastasis to the bone of talus from a breast carcinoma, while there are a few cases originating from other organs. The differential diagnosis of acrometastases may be difficult. Conclusion: Pain in the foot or hand of a patient with a known history of malignancy should be considered as potential metastasis.
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Monday, March 14, 2005
Qualitative research on diabetic foot ulcers
Medscape have a full text article on this (free registration required to access)
A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.
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A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.
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Qualitative research on diabetic foot ulcers
Medscape have a full text article on this (free registration required to access)
A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.
Back to home page
A Qualitative Approach to Understanding the Experience of Ulceration and Healing in the Diabetic Foot: Patient and Podiatrist Perspective
Abstract The management of a diabetic foot ulcer requires the patient to change his or her behavior. Despite little evidence, it is suggested that psychological factors are influential in the healing of diabetic foot ulcers. It is, therefore, important to determine how patients with diabetic foot ulcers and the podiatrists who treat them perceive and understand foot ulceration, as this may influence patients' behaviors. To address this gap in knowledge, 2 qualitative studies were undertaken. In the first study, interviews were conducted with 13 patients with diabetic foot ulcers recruited from outpatient podiatry clinics. A second study was conducted with podiatrists working in the outpatient clinics from which the patients were recruited. In both studies, the interview schedules consisted of a series of open-ended questions concerned with examining beliefs about ulcers, causes and treatment of ulcers, and adherence to treatment recommendations. All interviews were tape recorded, transcribed, and coded for emerging themes using the "constant comparison" approach to qualitative data analysis. The experience of having ulcers had a considerable impact on patients' lifestyles. Both ulcer and treatment affected the patient's mobility, independence, and social life. These experiences often lead to anger, fear, depression, helplessness, boredom, and loss of self-esteem. Podiatrists also perceived that foot ulcers had a negative impact on patients' lives and their emotional well-being and were aware of factors that may influence adherence to treatment. It is suggested that understanding and addressing the psychosocial aspects of foot ulceration may lead to better adherence and may improve clinical outcomes.
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Sunday, February 27, 2005
New research should have impact on clinical practice
The latest Diabetes Care has two important papers:
Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers
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Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers
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New research should have impact on clinical practice
The latest Diabetes Care has two important papers:
Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers
Back to home page
Evaluation of Removable and Irremovable Cast Walkers in the Healing of Diabetic Foot Wounds A randomized controlled trial
David G. Armstrong, Lawrence A. Lavery, Stephanie Wu, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to evaluate the effectiveness of a removable cast walker (RCW) and an "instant" total contact cast (iTCC) in healing neuropathic diabetic foot ulcerations.
RESEARCH DESIGN AND METHODS—We randomly assigned 50 patients with University of Texas grade 1A diabetic foot ulcerations into one of two off-loading treatment groups: an RCW or the same RCW wrapped with a cohesive bandage (iTCC) so patients could not easily remove the device. Subjects were evaluated weekly for 12 weeks or until wound healing.
RESULTS—An intent-to-treat analysis showed that a higher proportion of patients had ulcers that were healed at 12 weeks in the iTCC group than in the RCW group (82.6 vs. 51.9%, P = 0.02, odds ratio 1.8 [95% CI 1.1–2.9]). Of the patients with ulcers that healed, those treated with an iTCC healed significantly sooner (41.6 ± 18.7 vs. 58.0 ± 15.2 days, P = 0.02). CONCLUSIONS—Modification of a standard RCW to increase patient adherence to pressure off-loading may increase both the proportion of ulcers that heal and the rate of healing of diabetic neuropathic wounds.
A Randomized Trial of Two Irremovable Off-Loading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers
Ira A. Katz, Anthony Harlan, Bresta Miranda-Palma, Luz Prieto-Sanchez, David G. Armstrong, John H. Bowker, Mark S. Mizel, Andrew J.M. Boulton
OBJECTIVE—The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treatment of diabetic neuropathic plantar foot ulcers.
RESEARCH DESIGN AND METHODS—In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were randomly assigned to one of two groups: a RCW rendered irremovable by wrapping it with a single layer of fiberglass casting material (i.e., an iTCC) or a standard TCC. Primary outcome measures were the proportion of patients with ulcers that healed at 12 weeks, healing rates, complication rates, cast placement/removal times, and costs.
RESULTS—The proportions of patients with ulcers that healed within 12 weeks in the iTCC and TCC groups were 80 and 74%, respectively (94 and 93%, respectively, when patients who were lost to follow-up were excluded). Survival analysis (healing rates) was statistically equivalent in the two groups, as were complication rates, but with a trend toward benefit in the iTCC group. The iTCC took significantly less time to place and remove than the TCC with 39% and 36% reductions, respectively. There was also an overall lower cost associated with the use of the iTCC compared with the TCC.
CONCLUSIONS—The iTCC may be equally efficacious, faster to place, easier to use, and less expensive than the TCC in the treatment of diabetic plantar neuropathic foot ulcers
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Sunday, February 06, 2005
RCT on Foot orthoses and low back pain
A Controlled Randomized Study of the Effect of Training With Orthoses on the Incidence of Weight Bearing Induced Back Pain Among Infantry Recruits. Spine. 2005 Feb 1;30(3):272-275.Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A.
Quote:
STUDY DESIGN.: Randomized 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 randomized 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 randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed 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.
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Quote:
STUDY DESIGN.: Randomized 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 randomized 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 randomly assigned to received either custom soft, semirigid biomechanical, or simple shoe inserts without supportive or shock absorbing qualities. Recruits were reviewed 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.
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