Do orthotics work as an injury prevention strategy for the military?

Background: The effectiveness of orthotics as an injury prevention strategy for the military has not been well established. Objectives: To estimate the effectiveness of an orthotic intervention in preventing specific injuries among military personnel. Methods: A systematic review of English and translated articles from: CINAHL, Cochrane, Medline, PubMed, Scopus, and Web of Science as well as reference lists of relevant articles and a hand search was completed. The criteria for inclusion were: randomized controlled trials (RCTs) investigating the use of orthotics as an injury prevention strategy for military personnel, which used a prospective design and followed participants for a minimum of 3 months, where comparison involved a parallel control group. Results: Seven trials were identified which met the inclusion criteria. Results were pooled into specific injuries. Based on a meta-analysis of specific injuries, orthotic use was found to have no effect for 8 out of 10 overuse injuries of the lower limb and back. Of the remaining injuries (femoral stress fractures and tibial stress fractures) orthotic use had a significant injury reduction effect. However, the overall quality was poor, with five out of seven studies being of low quality. Conclusions: The findings of this systematic review indicate that no strong conclusions can be made on the use of orthotics as a preventive measure for overuse injury in the military. Orthotic provision was only found to be effective as a prevention strategy for 2 out of 10 overuse injuries identified as commonly occurring within the military. Unfortunately, the practicality of their supply is still unknown due to the absence of intention to treat analyses. This, along with other findings, should be addressed in future research.