An expository analysis of biomechanical and subjective impacts induced by shoe inserts in asymptomatic subjects: A systematic review on functionality and mechanisms of action

This systematic review explores the biomechanical and subjective effects of shoe inserts, including foot orthotics (FOs) and insoles, in asymptomatic subjects. Aimed at understanding their implications, the review poses two key research questions: (i) the influence of shoe inserts on lower extremity biomechanics and subjective perception and (ii) the effects of different design characteristics on these aspects. Following Preferred Reporting of Systematic Reviews and Meta-Analysis guidelines, a meticulous search of Scopus and PubMed from August 2022 to March 2023 yielded 34 articles, with 26 focusing on biomechanical effects and eight on comfort effects. The studies, conducted during static and dynamic activities, such as standing, walking, jogging, running, jumping, and cycling, reveal significant reductions in rearfoot eversion, knee joint forces, and lower extremity muscle forces through postings and wedging in FOs. Changes in stiffness impact rearfoot kinematics, plantar pressure distribution, and ankle–foot power distribution. Conversely, surface texture and arch variations demonstrate limited significance. FOs and shoe inserts, characterized by geometric, material, location, size, and fabrication features, effectively regulate forces and moments on the lower extremity. This control promotes uniform plantar pressure distribution and enhances comfort during various activities. These insights benefit manufacturers, clinicians, and stakeholders, providing a deeper understanding of the positive benefits of FOs and shoe inserts. However, further well-designed studies on clinical populations are necessary to validate these findings and establish their clinical efficacy, as the current focus remains on healthy subjects.