Effectiveness of Postural Insoles Adapted in Slippers for People With Persistent Heel Pain
Condition: Heel Pain Syndrome; Metatarsalgia
MeSH terms: Metatarsalgia
Study type: Interventional

Summary: 
      Introduction: Persistent heel pain from plantar fasciitis and calcaneal spurs, as well as
      metatarsalgia, are very common and prevalent complaints in the Brazilian population. One of
      the recommended treatments for these conditions in the literature is the use of insoles.
      However, the use of this feature requires the individual to wear closed shoes and this is an
      obstacle to treatment in cities with hot weather. Thinking about an alternative treatment,
      the customized slippers with the corrective elements of the insoles can be an alternative to
      increase the adhesion to this type of treatment. Objective: To evaluate the effectiveness of
      the insoles adapted in slippers in the improvement of the pain and the function in
      individuals with persistent pains in the backfoot of the city of Santa Cruz, RN. Methodology:
      This is a double-blind, randomized, controlled clinical study in which 66 patients diagnosed
      with persistent back pain and metatarsalgias will be divided into two groups. The
      intervention group will receive a customized slipper with foot pieces and synthetic leather
      cover, and the control group will receive a slipper without customization, only with a
      synthetic leather cover as used by the intervention group. The evaluator and the patient will
      be considered blind. Evaluations will be performed at baseline (T0), after 12 weeks of
      wearing the slippers (T12) and a reassessment at week 16 (T16) for pain monitoring. The
      evaluation instruments used will be the EVA (visual pain scale) and the algometer in the
      painful region of the foot; FFI - Foot Function Index questionnaire and FAAM questionnaire -
      Foot and Ankle Ability Measure for functional evaluation, and finally the 6 - minute walking
      test for walking performance. Statistical analysis: Data will be analyzed by t-test,
      Mann-Whitney test, repeated-measures ANOVA and intention-to-treat analysis.
    

Detailed description: 
      The evaluations for the prescription of the insoles will be made at the Physiotherapy School
      Clinic of FACISA / UFRN and a podoscope will be used to evaluate the foot typology and other
      morphological aspects, a pen to print the feet and make a mold for making the insoles.
      insoles, and different prosthetic parts molded previously.

      The volunteers will be invited to participate in the research and, upon accepting, will be
      informed of the research procedures, sign the informed consent form and only then will be
      evaluated by the blind evaluator of the study. It will also be informed that it can be drawn
      for any of the two groups (intervention group or control group). Allocation in groups will be
      done randomly, by lot.

      All volunteers, regardless of groups, will be evaluated individually, in a comfortable room,
      barefoot and wearing shorts or shorts.

      Evaluations will occur at the baseline (T0), after 12 weeks of use of the slippers (T12) and
      at the follow up 4 weeks after the end of the intervention (T16).

      The following evaluation tools will be used:

        -  Pain by Visual Analog Scale and algometer;

        -  The function of the foot by the FFI (Foot Function Index) questionnaire;

        -  Foot and ankle functionality by FAAM (Foot and Ankle Ability Measure);

        -  Functional ability by the 6-minute walk test;

        -  After this step, the volunteers will be evaluated on the podoscope using the foot pieces
           for the postural evaluation (fig 3). In the protocol, the volunteer's posture will be
           evaluated using the foot pieces to verify their influence on static balance and postural
           asymmetries. The volunteers will be evaluated in the frontal and sagittal planes.

        -  Finally, the volunteers will carry out the plantations (fig 4) that will be sent to make
           the slippers.

      6.2 Calculation of the sample The investigators will select 66 patients from the list of
      patients at the Physiotherapy School Clinic of the FACISA / UFRN, with diagnosis of calcaneal
      spurs, fasciitis and / or metatarsalgia, according to clinical evaluation criteria. The
      project will also be broadcast by local radio and media.

      The sample size was calculated based on the EVA variable, considering a power of 90%, a
      significance of 5% and a loss rate of 10%. Based on the study by Chuter, Searle and Spink
      (2016), where with similar methods they found a difference of 1.3 points, considering the
      standard deviation of this variable being equal to 1.8. Based on these data, a sample of 66
      subjects with 33 in each group was necessary to detect a clinically important difference. The
      calculation was based on comparisons of two samples by Gpower 3.1 software. The randomization
      will be through a computer program, and from this result, the chips will be placed in opaque
      and sealed envelopes to maintain allocation secrecy.

      6.3 Inclusion criteria Patients of both sexes with a diagnosis of persistent back pain and /
      or pain in the head region of the metatarsals for more than 3 months, aged 18-60 years,
      accustomed to wearing slippers that are not performing other types of physical therapy and
      sign the ICF.

      6.4 Exclusion Criteria Patients with foot wounds, previous foot and ankle surgeries,
      rheumatic diseases and / or skin diseases and those reporting that they can not wear
      slippers.

      6.5 Interventions Intervention Group (GI) - the intervention group volunteers will receive a
      pair of custom slippers with perforated synthetic leather cover. They will be advised to wear
      the slipper for 4 hours in the first week and up to 8 hours after that period. Should any
      part disturb you, the participant should return immediately to the appropriate adjustments to
      be made in the slipper.

      Control group (CG) - control group volunteers will receive custom slippers with the same
      coverage as those used by GI. The difference will be that these slippers will not have the
      elements podais, will be a slipper with smooth surface.
    

Intervention name(s): custom slippers with perforated synthetic leather cover.
Intervention type(s): Other
Intervention description(s): the intervention group volunteers will receive a pair of custom slippers with perforated synthetic leather cover.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A randomized controlled trial
Masking: Double (Participant, Investigator)
Primary purpose: Treatment