Foot orthoses for treating paediatric flat feet

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.