TOPLINE:

Patients with midfoot pain and MRI-detected bone marrow lesions who wore firm foot orthoses achieved greater reductions in pain and bone marrow lesion volume over 12 weeks than those who wore cushioning sham insoles.

METHODOLOGY:

• Researchers conducted a study to examine whether foot orthoses can reduce midfoot pain and the volume of MRI-detected bone marrow lesions in patients with these conditions.
• They included 42 patients (mean age, 53 years; 71% women ) who had midfoot pain lasting more than 3 months and at least one MRI-confirmed bone marrow lesion; the participants were randomly assigned to receive either firm foot orthoses (orthoses group; n = 27) or cushioning sham insoles (control group; n = 15).
• The primary outcomes were the severity of foot pain in the last 24 hours measured using a visual analog scale at baseline, 6 weeks, and 12 weeks and the MRI-measured bone marrow lesion volume at baseline and 12 weeks.
• The secondary outcomes were foot pain-related disability measured using the pain and functional impairment subscales of the Manchester Foot Pain and Disability Index and self-reported global improvement at 6 and 12 weeks.

TAKEAWAY:

• The orthoses group showed significantly greater midfoot pain reduction than the control group at 6 weeks (mean difference [MD], -14.8 mm vs -7.4 mm) and 12 weeks (MD, -18.5 mm vs -7.8 mm).
• After 12 weeks, the reduction in bone marrow lesion volume was greater in the orthoses group than in the control group (MD, -1544.4 mm³ vs -315.8 mm³).
• At 6 weeks, both foot pain impairment and functional impairment were reduced in the orthoses group, whereas in the control group only functional impairment was significantly reduced.
• At 12 weeks, the proportion of patients with self-reported improvement was higher in the orthoses group than in the control group (86% vs 40%).

IN PRACTICE:

“This novel exploratory study suggests that wearing orthoses for 12 weeks can reduce midfoot pain and BML [bone marrow lesion] size, compared to the control sham group. The orthoses intervention also reduced short-term pain and impairment, more than the control insole,” the authors wrote.

SOURCE:

This study was led by Jill Halstead, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England. It was published online on September 15, 2025, in Arthritis Care & Research.

LIMITATIONS:

The small sample size was a major limitation of this study. The unequal 2:1 randomization favoring the intervention group restricted direct group comparisons. The Manchester Foot Pain and Disability Index showed limited responsiveness, as both groups had similar reductions despite differences in patient-reported improvement.

DISCLOSURES:

This study was funded by a grant from Versus Arthritis. The authors had no financial disclosures.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.