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Shoe Insoles and Shoe Lifts 
Panel findings and recommendations: 
 -   Shoe insoles may be effective for patients with low back problems who stand for prolonged periods of time.  Given the low cost and low potential for harms, shoe insoles are a treatment option.  (Strength of Evidence = C.) 
 -   Shoe lifts are not recommended for treatment of low back problems when lower limb length difference is <2 cm.  (Strength of Evidence = D.)  
  Shoe insoles (or inserts) are devices placed inside shoes that may vary from over-the-counter foam or rubber inserts to custom-made orthotics.  The therapeutic objective of shoe inserts is the reduction of back pain. 
  Shoe lifts (or raises) are additions made to the heel or sole of a shoe to increase its height.  The therapeutic objective of shoe lifts is to compensate for lower limb length inequality and thereby reduce back pain.  
Shoe Insoles and Shoe Lifts 
Literature Reviewed     Evidence on Efficacy   Potential Harms and Costs      Summary of Findings  Author's Example 
Shoe Insoles and Shoe Lifts 
  Literature Reviewed.  Of seven articles reviewed for this topic, only one was an RCT that met criteria for review.165  Other articles contained information used by the panel, but did not meet article selection criteria.166, 167, 168 
  Evidence on Efficacy.    Basford and Smith 165 used a randomized crossover design to evaluate the use of shoe insoles compared with no insoles in adults with mild back pain who spent at least 75 percent of each workday standing.  Of 39 subjects studied, 44 percent reported reduced back pain when using the insoles, 3 percent reported increased back pain, and 51 percent reported no difference.  Of the subjects who reported no improvement, many stated that their shoes were too tight to allow insoles to be added comfortably.  
  There were no controlled trials that evaluated shoe lifts in patients with either acute or chronic low back problems.  The extent to which leg length inequality might be associated with low back problems has not been established.  Lower limb length differences of up to 2 cm are frequently seen in subjects with no history of low back problems.167, 168  One study evaluated aircraft industry workers and found no correlation between a 2-cm limb length inequality and either previous back problems or later reports of back complaints.166 
  Potential Harms and Costs.  Shoe insoles and shoe lifts are low-risk treatments; their cost varies from low (for ready-made items) to moderate (for custom-made orthotics). 
  Summary of Findings.  Limited evidence (one crossover study) indicates that shoe insoles may reduce back pain in some individuals with mild back complaints.  There is no evidence they provide any long-term benefit.  The extent to which leg length inequality might be associated with low back problems has not been established, although differences of less than 2 cm are unlikely to be problematic. Prospective Trials studying primary prevention of back problems, did not support the use of shoe inserts (RCTs by Larsen et al.`02b and Milgrom et al.`05). 
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