Introduction
Methods
Inclusion and exclusion criteria
Information sources
First author, year published | Country of conduction | Design, type of analysis | Overall risk of bias c | N (% male) | Mean age in years ± SD (inclusion age range per study) | Included patients (% flexible) | Measurement method for including pes planus | Brand or type of orthoses versus control group (N) | Outcome measurement a | FU | Conclusion of authors a | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Children | Asgaonkar 2012 [28] | India | RCT, PP | High | 60 (50%) | I: 9.4 ± 2.7 (NA) C: 9.3 ± 2.4 | Flatfoot (100%) | Staheli arch index Instep footprint | I: Valgus pad, rubber (30) C: No orthoses (30) | Pain (VAS) | 1Y | Significantly less pain established in orthoses group compared to control group (p < .05) |
Hsieh 2018 [29] | Taiwan | RCT, ITT | Low | 52 (54%) | I: 6.9 ± 0.6 (3–10) C: 6.2 ± 0.4 | Symptomatic flatfoot (100%) | Beighton > 4 NDT ≥6 mm FPI-6 > 6 X-ray angles | I: Thermoplastic insoles with medial arch support High-density EVA (26) C: No orthoses (26) | Physical function Questionnaires: PODCI and HRQoL | 3 M | Significant improvement in pain/comfort and physical health (p < .05) in intervention group compared to control group | |
Sinha 2013 [30] | India | RCT, PP | High | 81 (59%) | I: 8.3 ± 4.3 (3-17b) C: 8.3 ± 4.4 (3-16b) | Symptomatic flatfoot (100%) | Pain Fatigue Gait disturbances | I: Medial arch orthoses (55) C: No orthoses (26) | AOFAS score | >2Y | Significant improvement in AOFAS scores between intervention and control group, benefitting the intervention group (p < .05) | |
Whitford 2007 [31] | Australia | RCT, PP | Low | 160 (53%) | I: 9.5 ± 1.5 (7–11) I: 9.8 ± 1.3 C: 9.5 ± 1.4 | Excess pronation (100%) | RCSP > 4 NDT | I: Custom orthoses (52) I: Ready-made orthoses (54) C: No orthoses (54) | Pain yes/no Self Perception Profile for Children | 1Y | No significant differences between groups in self-perception and pain | |
Adults | Andreasen 2013 [32] | Denmark | RCT, PP | High | 70 (19%) | 43.0 ± 3.0 (18–70) | Flatfoot and chronic pain conditions in the foot (100%) | Calcaneal valgus > 6° Overload-related pain under knee | I: Medial arch and calcaneus support, EVA (20) I: Exercise program (19) I: Orthoses + exercise program (17) C: Folder with exercises (14) | Pain during walking, running, resting (VAS) | 1Y | No significant differences in pain between orthoses groups compared to non-orthoses groups |
Esterman 2005 [33] | Australia | RCT, ITT, PP | High | 47 (94%) | 21.6 ± 3.9 (NA) | Air Force recruits with flatfeet (100%) | Arch index = footprint B/(A + B + C) | I: Flexible/semi-rigid orthoses, AOL, with rearfoot varus wedge (25) C: No orthoses (22) | Pain yes/no General foot health, injury Quality of life Physical health | 8 W | No significant differences between study groups for pain, injury, foot health, and quality of life | |
Shih 2011 [34] | Taiwan | RCT, PP | High | 24 (75%) | I: 31.3 ± 8.3 (NA) C: 34.4 ± 9.8 | Flatfoot in runners with pain over anterior knee or foot region during running (100%) | Navicular Drop Test Non-weightbearing rearfoot varus > 5° or weightbearing calcaneal valgus > 5° | I: Wedged foot orthoses, EVA (12) C: Sham orthoses (12) | Pain (VAS) after 60-minute treadmill test | 2 W | Significantly less pain in the immediate and short-term effects on incidence of pain between groups (p < .05) | |
Taspinar 2017 [35] | Turkey | PS, PP | Some concerns | 60 (25%) | 50.5 ± 9.0 (15–65) | Bilateral flatfoot, identical type (97%) | Navicular Drop Test X-ray: CP < 20 | I: Medial arch support (20) I: Thomas heel, external support (20) C: Exercise program (20) | Foot pain index Foot function index SF36-PCS | 3 M | All groups improved on pain, foot function index, and quality of life (p < .05); no significant difference between groups | |
Yurt 2019 [36] | Turkey | RCT, ITT | Low | 67 (42%) | I: 21.7 ± 2.9 (18–45) I: 23.1 ± 5.5 C: 21.1 ± 2.0 | Foot pain for at least 1 month due to flatfoot (100%) | MFPI ≥6 Tibiocalcaneal angle > 5° | I: CAD-CAM orthoses and exercise (22) I: Conventional orthoses and exercise (22) C: Sham orthoses and exercise (23) | Pain (VAS) Foot function index SF-36 Satisfaction | 8 W | Pain intensity and physical health significantly improved in CAD-CAM and conventional orthoses compared to sham group (p < .05) |