Foot orthoses for treating paediatric flat feet.

Area of Science:

• Orthopedics and Sports Medicine
• Pediatric Podiatry
• Evidence-Based Medicine

Background:

• Paediatric flat feet affect approximately 15% of children, with a minority experiencing pain or gait limitations.
• Current treatment strategies and consensus on using foot orthoses (FOs) for paediatric flat feet are lacking.
• This review assesses the efficacy and safety of FOs in managing paediatric flat feet.

Purpose of the Study:

• To evaluate the benefits and harms of foot orthoses (FOs) for treating paediatric flat feet.
• To compare customized FOs (CFOs) versus prefabricated FOs (PFOs) and FOs versus shoes.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) identified through comprehensive database searches (CENTRAL, MEDLINE, Embase).
• Included 16 trials with 1058 children (11 months to 19 years) with flexible flat feet (asymptomatic, JIA, symptomatic, DCD).
• Outcomes assessed: pain, function, quality of life, treatment success, and adverse events. Data heterogeneity precluded pooling.

Main Results:

• For asymptomatic flat feet, low to very low-quality evidence indicated little to no significant difference in pain or adverse events when comparing CFOs or PFOs to shoes, or CFOs to PFOs.
• For symptomatic (JIA) flat feet, very low to low-quality evidence suggested potential improvements in pain and function with CFOs compared to shoes, with some positive trends in quality of life.
• Evidence comparing PFOs to shoes for JIA showed little to no difference in pain or function. Comparisons between CFOs and PFOs for JIA also yielded minimal differences in outcomes.

Conclusions:

• The evidence regarding the effectiveness of CFOs and PFOs versus shoes, and CFOs versus PFOs for paediatric flat feet, is of low to very low certainty, making clinical recommendations uncertain.
• While FOs may offer some benefits for pain and function in children with JIA, the distinction between costly CFOs and less expensive PFOs is minimal.
• Research should shift focus from asymptomatic flat feet in healthy children to specific paediatric foot conditions with clear pathology, such as JIA, cerebral palsy, and others.