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To test this, we explored whether foot orthoses can modify patterns of bone marrow lesions (BMLs) in people with midfoot pain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Forty\u2010two people were recruited with midfoot pain, and magnetic resonance imaging\u2013confirmed midfoot BMLs. Participants were randomized (2:1 ratio) to receive either pre\u2010formed orthoses (n = 27) or control cushioning insoles (n = 15). Outcomes included foot pain (visual analog scale [VAS]), pain and functional impairment subscales of the Manchester Foot Pain and Disability Index, and BML volume measured at baseline and 12 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total 108 bones in the midfoot were identified with BMLs (mean 2.5 bones, SD 1.6). In the orthoses group, pain significantly reduced at 6 weeks (mean VAS = \u221214.8 mm, confidence interval [CI] \u221222.3 to \u22127.3) and 12 weeks (mean VAS = \u22127.1 mm, CI \u221215.0 to \u22120.9) compared to the control group at 6 weeks (mean VAS = \u22127.4 mm, CI \u221219.9 to 5.2) and 12 weeks (mean VAS = 2.8 mm, CI \u22129.1 to 14.7). In the orthoses group, functional impairment and pain impairment were significantly reduced at 6 weeks and to a lesser extent at 12 weeks. In the control group, only the functional impairment reduced significantly at 6 weeks. At 12 weeks, BML volume reduced more in the orthoses group (\u22121544.4 mm\n                      <jats:sup>3<\/jats:sup>\n                      , CI \u22123660.4 to 571.6), compared to the control group (\u2212315.8 mm\n                      <jats:sup>3<\/jats:sup>\n                      , CI \u22121528.2 to 896.7).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The foot orthoses group showed a greater reduction in foot pain and a greater reduction in the volume of BMLs compared with the control group.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/acr25648-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.25648","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T08:31:28Z","timestamp":1757925088000},"page":"547-556","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Foot Orthoses on Midfoot Pain and the Volume of Bone Marrow Lesions in the Midfoot: A Randomized Mechanism of Action Study"],"prefix":"10.1002","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9913-2569","authenticated-orcid":false,"given":"Jill","family":"Halstead","sequence":"first","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds  Leeds United Kingdom"},{"name":"Leeds Community Healthcare NHS Trust  Leeds United 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