Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial

Arch Phys Med Rehabil. 2017 Sep;98(9):1752-1762. doi: 10.1016/j.apmr.2017.03.028. Epub 2017 Apr 30.


Objectives: To investigate the efficacy of shoe orthotics with and without chiropractic treatment for chronic low back pain compared with no treatment.

Design: Randomized controlled trial.

Setting: Integrative medicine teaching clinic at a university.

Participants: Adult subjects (N=225) with symptomatic low back pain of ≥3 months were recruited from a volunteer sample.

Interventions: Subjects were randomized into 1 of 3 treatment groups (shoe orthotic, plus, and waitlist groups). The shoe orthotic group received custom-made shoe orthotics. The plus group received custom-made orthotics plus chiropractic manipulation, hot or cold packs, and manual soft tissue massage. The waitlist group received no care.

Main outcome measures: The primary outcome measures were change in perceived back pain (numerical pain rating scale) and functional health status (Oswestry Disability Index) after 6 weeks of study participation. Outcomes were also assessed after 12 weeks and then after an additional 3, 6, and 12 months.

Results: After 6 weeks, all 3 groups demonstrated significant within-group improvement in average back pain, but only the shoe orthotic and plus groups had significant within-group improvement in function. When compared with the waitlist group, the shoe orthotic group demonstrated significantly greater improvements in pain (P<.0001) and function (P=.0068). The addition of chiropractic to orthotics treatment demonstrated significantly greater improvements in function (P=.0278) when compared with orthotics alone, but no significant difference in pain (P=.3431). Group differences at 12 weeks and later were not significant.

Conclusions: Six weeks of prescription shoe orthotics significantly improved back pain and dysfunction compared with no treatment. The addition of chiropractic care led to higher improvements in function.

Trial registration: NCT02089750.

Keywords: Chiropractic; Low back pain; Orthotic devices; Rehabilitation; Shoes.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chronic Pain / physiopathology
  • Chronic Pain / therapy*
  • Combined Modality Therapy
  • Female
  • Foot Orthoses*
  • Humans
  • Low Back Pain / physiopathology
  • Low Back Pain / therapy*
  • Male
  • Manipulation, Chiropractic / methods*
  • Middle Aged
  • Treatment Outcome

Associated data