Learning to love big brother.

A pologies to George Orwell but the Evidence Based gurus have replaced the Thought Police. The Ministry of Love has been taken over by the Cochrane Collaboration. Perhaps it is just as well! The latest piece of research to cross my desk creates some food for thought. One area of sports medicine that has slipped under the radar is podiatry, where practitioners prescribe orthoses on the basis that they reduce or treat lower limb injury. Having been the recipient of some fairly expensive hard orthoses for shin splints, it has crossed my mind on more than one occasion that the therapeutic benefit may be directly related to the cost of the item. When I heard that you can now get lightweight carbon-fibre orthoses I felt cheated. Surely such space age technology belongs in my shoes. A randomised controlled trial of the effectiveness of two different types of orthoses in preventing injuries among Royal Air Force (RAF) recruits in the UK was recently published. As one may guess from this roundabout introduction, there was no difference in injury rates between the shock absorbing and non-shock absorbing orthoses. The authors should be congratulated in successfully presenting a large trial answering a clinically important question. Other trials of foot orthoses for a variety of lower limb conditions have been published previously; however, these have either been relatively underpowered or equivocal in their outcome. Is this finding generalisable? Certainly this study was limited to shock absorbing orthoses rather than biomechanical correction and the laudatory aim of a primary injury prevention rather than an interventional trial in subjects with a prior lower limb injury. As such, it certainly provides powerful evidence against the routine prescription of shock absorbing capability in subjects exposed to repetitive heavy physical activity. One can only wonder whether this could be applicable to the population at large where athletic shoe manufacturers utilise the shock absorption capability of their products as a major selling point.