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).
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