NEW YORK (Reuters Health) – Custom-fit insoles may help ease foot pain caused by high arches, rheumatoid arthritis and certain other conditions, a research review suggests.

Australian researchers found that in 11 clinical trials, custom-designed orthotic devices for the shoes helped ease certain forms of foot pain. One study, for instance, showed that within 3 months, the shoe inserts improved pain in adults with abnormally high arches.

Another study, of 209 adults younger than 60, found that custom orthoses eased pain from bunions — though they did not appear to be as effective as surgery in the long run.

Custom orthoses are shoe inserts that are prescribed by a doctor and designed based on an impression taken of the patient’s feet. They are widely used, but few well-designed clinical trials have been done to confirm that the devices work.

The bottom line is that for a few forms of foot pain, custom orthoses are better than no treatment at all, said Fiona Hawke of the University of Newcastle, the lead researcher of the review.

“It is, however, difficult to confidently recommend custom-made foot orthoses over other interventions, as very little research has been performed,” she told Reuters Health.

Hawke and her colleagues report their findings in the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Besides showing promise for painful high arches and bunions, the researchers found that custom orthoses may ease foot pain from juvenile idiopathic arthritis — a form of arthritis that affects children. In these cases, though, it was not clear that custom orthotics were any more effective than “off-the-shelf” shoe inserts.

A few studies have also examined custom orthotic devices for foot pain caused by rheumatoid arthritis. They have generally shown that the devices may diminish pain in the back of the foot, at least in the short term.

When it comes to plantar fasciitis, a common cause of heel pain, custom orthoses have shown limited benefits. They did, however, seem to ease patients’ pain when combined with splints worn at night to keep the sole of the foot in a lengthened position.

The evidence is strongest for using the shoe inserts to treat pain caused by high arches, according to Hawke. She noted, though, that “strong” in this case means that the evidence came from a high-quality study — and not that people with high arches will necessarily get substantial pain relief.

It’s also not known, Hawke added, how custom-made orthoses measure up with off-the-shelf versions.

SOURCE: Cochrane Library, online July 16, 2008.

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