Foot orthoses for flexible flatfeet in children and adults: a systematic review and meta-analysis of patient-reported outcomes

Abstract

Background This systematic review and meta-analysis examined the effectiveness of orthoses for flexible flatfeet in terms of patient-reported outcomes in children and adults. Methods EMBASE, Medline (OvidSP), Web-of-Science, Scopus, CINAHL, Cochrane Central Register of Controlled Clinical Trials, i.e., Cochrane Central and Pubmed were searched to identify relevant studies since their inception up to February 2021. We included randomized controlled trials (RCT) and prospective studies in which patient reported outcomes at baseline and follow-up in an orthoses group were compared with a no orthoses or sham sole group. Methodological quality of the studies was assessed using the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Risk Of Bias In Non-Randomized Studies of Interventions (ROBINS-I). A meta-analysis was performed where there were multiple studies with the same outcome measures, which was the case for the Visual Analogue Scale (VAS) for pain in adults. Results In total nine studies were included: four RCT in children (N = 353) and four RCT and one prospective study in adults (N = 268) were included. There was considerable heterogeneity between studies. A meta-analysis demonstrated that pain reduction between baseline and follow-up was significantly larger in the orthoses (N = 167) than in the control groups in adults (N = 157; − 4.76, 95% CI [− 9.46, − 0.06], p0.05). Conclusion Due to heterogeneity in study designs, we cannot conclude that foot orthoses are useful for flexible flatfoot in children and adults. However, based on the meta-analysis orthoses might be useful in decreasing pain in adults. The authors did not receive support from any organization for the submitted work.

Pediatric Flatfoot: Is There a Need for Surgical Referral?

“…No article to date has provided evidence to justify the treatment of flexible, asymptomatic flatfeet; therefore, caution should be exercised when deciding to treat this condition. Plantar orthosis, sometimes combined with foot exercises, is debatable as an efficient mechanism to improve the plantar arch [38][39][40][41][42][43][44]; however, this can relieve medial arch pain associated with flatfoot [40,41].…”

“…A flowchart based on literature review and the authors' opinion summarizing the recommended management of pediatric flatfoot can be found in Figure 2 [12][13][14][15][16][17][18][19][24][25][26][38][39][40][41]44].…”

The role of different physiotherapy methods in tibialis posterior muscle insufficiency – a literature review

“…In a metaanalysis, Leonoor NT Oerlemans et al showed that due to the heterogeneity of study designs, it is not possible to conclude that foot orthoses are useful for the treatment of flexible flat feet in children and adults. However, after analyzing the data, it can be deduced that orthoses are useful in reducing pain in adults [16]. Minettchen Herchenröder et al performed a literature review to synthesize the evidence on foot orthoses in adults with flat feet.…”

Pediatric and Adolescent Flatfoot: A Questionnaire Based Middle East and North Africa Study

“…10 Foot orthoses remain the most common form of management, despite the fact that their effectiveness is questionable. 5,11 This article's primary aim was to study pediatric flatfoot and its epidemiology in the Middle East and North Africa (MENA) region, to investigate the reasons that make parents seek medical attention, the prevalence of using foot orthoses, and if there was a reported improvement after using them.…”