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Evidence summaries

Prevention and Treatment of Lower Limb Stress Fractures in Young Adults

Shock absorbing inserts in footwear may reduce the incidence of stress fractures in military personnel. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 16 studies, mostly performed among military personnel or recruits. Ten prevention trials tested the effects of various foot inserts and other footwear modifications. "Shock-absorbing" boot inserts (4 trials) were associated with fewer stress injuries of the bone compared to controls. Acceptability of the boot inserts in terms of practicality and comfort was a key issue in several trials. Two cluster-randomised prevention trials found no significant effect of leg muscle stretching during warm up before exercise. The use of pneumatic braces in the rehabilitation of tibial stress fractures showed a significant reduction in the time to recommencing full activity (weighted mean difference -33.39 days, 95% CI -44.18 to -22.59 days), but the results were highly heterogeneous (I2 = 90%).

Comment: The quality of evidence is downgraded by limitations in study quality (inadequate or unclear allocation concealment, inadequate intention-to-treat adherence) and by imprecise results (limited study size for each comparison).

    References

    • Rome K, Handoll HHG, Ashford R. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. 2005;(2):CD000450 [PubMed]

Primary/Secondary Keywords