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Costa ARA, de Almeida Silva HJ, Mendes AAMT, et al. Effects of insoles adapted in flip-flop sandals in people with plantar fasciopathy: a randomized, double-blind clinical, controlled study. Clin Rehabil. 2019 Dec 6:269215519893104. doi: 10.1177/0269215519893104. (Original study)
Abstract

OBJECTIVE: To evaluate the effects of insoles adapted into flip-flop sandals on pain and function in individuals with plantar fasciopathy (PF).

DESIGN: Randomized, double-blind controlled study.

SETTING: Physiotherapy clinic of the Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil.

SUBJECTS: Sixty-six patients of both genders with PF were randomized into two groups: sandal insole group (SI; n = 34), which received a pair of custom flip-flop sandals with insoles covered with smooth synthetic leather; and plain sandal group (PS; n = 32), which received an identical pair of flip-flop sandals, but without the insoles.

INTERVENTIONS: Patients were instructed to wear the flip-flops for 12 weeks for at least 4 hours/day.

MAIN MEASURES: Pain (visual analogue scale-VAS) in the morning and at the end of the day were considered primary outcomes. Function (Foot Function Index-FFI and Foot and Ankle Ability Measure-FAAM) and functional capacity (6-minute walk test-6MWT) were considered secondary outcomes. The outcomes were evaluated at baseline and immediately after the intervention by a blind assessor.

RESULTS: Between-group differences were observed in terms of morning pain (mean difference (MD) = -1.82 cm; 95% confidence interval (CI) = -3.3 to -0.3; P = 0.016) and function (MD = -0.10; 95% CI = -0.19 to -0.01; P = 0.023) after the interventions with the SI group showing superior improvements in comparison to the PS group.

CONCLUSION: The use of insoles adapted in flip-flop sandals for 12 weeks was effective at improving pain and function in individuals with PF.

LEVEL OF EVIDENCE: 1b.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
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  Foot Pain   Plantar Fasciitis
Comments from MORE raters

Physician rater

Although this is interesting passive physiotherapy, looking carefully into the results, I am not sure that the difference between the groups is clinical significant.

Physician rater

As a general internist, I believe a new and non-invasive therapy for plantar fasciitis is welcome. Many patients wear flip-flops in many countries besides Brazil, where this study was conducted. Since this was a small study, additional assessment would be needed before adopting this approach in daily practice.
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