Article Text

Download PDFPDF
Prescribed footwear and orthoses are not prophylactic in preventing lower extremity injuries in military tactical athletes: a systematic review with meta-analysis
  1. Scott L Paradise1,2,3,
  2. J R Beer3,4,
  3. C A Cruz5,
  4. K M Fechner3,
  5. A J MacGregor6,7 and
  6. J J Fraser6
  1. 1Department of Orthopaedics, United States Navy Medicine Readiness and Training Command Guam, Agana, GU, USA
  2. 2Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
  3. 3Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, USA
  4. 4Sports Medicine and Rehabilitation Therapy Clinic, United States Navy Medicine Readiness and Training Unit Parris Island, Parris Island, SC, USA
  5. 5Medical Home Port Clinic, United States Navy Medicine Readiness and Training Command Lemoore, Lemoore, CA, USA
  6. 6Directorate for Operational Readiness & Health, Naval Health Research Center, San Diego, CA, USA
  7. 7Axiom Resource Management, Inc, San Diego, CA, USA
  1. Correspondence to Dr Scott L Paradise, PSC 455 Box 208, Department of Orthopaedics, US Navy Medicine Readiness and Training Command Guam, FPO, AP, USA;{at}


Introduction Military members are exposed to high cumulative physical loads that frequently lead to injury. Prescribed footwear and orthoses have been used to prevent injury. The purpose of this systematic review with meta-analysis was to assess if prescribed prophylactic footwear or foot orthoses reduced the risk of lower extremity injury in military tactical athletes.

Methods MEDLINE, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, SportDiscus, and Defense Technical Information Center databases were searched for randomised controlled trials published at any time that compared foot orthoses or prescribed footwear (to include shock-absorbing insoles and socks) with a placebo intervention or a no-treatment control. Methodological quality was assessed and the number of injuries, population at risk and duration of the study epoch were extracted and relative risk (RR) calculated. An omnibus meta-analysis was performed assessing all prescribed footwear and orthoses intervention studies, with subgroup analyses conducted on studies with similar interventions (ie, basketball athletic shoes, athletic shoes (prescribed by foot type), foot orthoses, shock-absorbing insoles, socks, tropical combat boots).

Results Of 1673 studies identified, 22 were included. Three of eight studies that employed orthoses demonstrated significantly reduced overuse injuries compared with no-treatment controls (RR range: 0.34–0.68); one study showed neoprene insoles significantly decreased overuse injuries (RR: 0.75). There were no other significant effects in the individual studies and no protective effects observed in the omnibus meta-analysis or in the component subanalyses.

Conclusions Prescribed footwear and orthoses do not appear to have a prophylactic effect on lower quarter musculoskeletal injuries in military members and cannot be recommended at this time.

  • sports medicine
  • musculoskeletal disorders
  • foot & ankle

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Statistics from

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

View Full Text


  • Twitter @NavyPT

  • Contributors SLP, JRB, KMF and JJF conceived of the study idea. SLP, JRB, CAC and KMF performed the data extraction. SLP, JJF and AJM conceived of the statistical methodology. SLP, JJF and AJM performed the data analysis. All authors contributed to the drafting and editing of the manuscript. SLP is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The authors are military service members or employees of the US Government. This work was prepared as part of their official duties. Title 17, USC §105 provides that copyright protection under this title is not available for any work of the US Government. Title 17, USC §101 defines a US Government work as work prepared by a military service member or employee of the US Government as part of that person’s official duties. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense nor the US Government.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.