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Updated: Oct 5, 2025

Predictive Measurement for Windlass Change in Length and Selected Treatment Outcomes in Chronic Plantar Fasciitis
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Foot orthoses for treating paediatric flat feet.

Angela M Evans1, Keith Rome2, Matthew Carroll3

  • 1Discipline of Podiatry, School  of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia.

The Cochrane Database of Systematic Reviews
|January 26, 2022
PubMed
Summary

Foot orthoses (FOs) show uncertain benefits for paediatric flat feet, with low-quality evidence suggesting little difference compared to shoes or between custom and prefabricated options. Research should focus on symptomatic conditions rather than asymptomatic flat feet.

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Area of Science:

  • Podiatry
  • Pediatric Orthopedics
  • 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.

Purpose of the Study:

  • To evaluate the benefits and harms of using foot orthoses (FOs) for treating paediatric flat feet.

Main Methods:

  • A systematic review of randomized controlled trials (RCTs) was conducted, searching major databases up to September 2021.
  • Included trials involved children aged 11 months to 19 years with flexible flat feet, comparing FOs with sham interventions, shoes, or other types of FOs.
  • Outcomes assessed included pain, function, quality of life, treatment success, and adverse events, with data presented separately for asymptomatic and symptomatic (Juvenile Idiopathic Arthritis) flat feet.

Main Results:

  • Low to very low-certainty evidence indicates uncertain effects of custom (CFOs) and prefabricated (PFOs) foot orthoses compared to shoes or each other for asymptomatic flat feet regarding pain and adverse events.
  • For symptomatic (JIA) flat feet, very low-quality evidence suggests little difference in pain, but potential improvements in function and quality of life with CFOs versus shoes.
  • Evidence comparing CFOs and PFOs for symptomatic flat feet showed little difference in pain, function, or quality of life.

Conclusions:

  • The effectiveness of foot orthoses for paediatric flat feet remains uncertain due to low-quality evidence and significant bias in existing trials.
  • For asymptomatic flat feet in healthy children, there is no supporting evidence for the use of costly custom orthoses.
  • Future research should prioritize children with symptomatic foot conditions and clear pathology, rather than asymptomatic flat feet in healthy children.