Foot Orthoses for Pediatric Flexible Flatfoot

NewsBot · Dec 23, 2024

The effects of foot orthoses on radiological parameters and pain in children with flexible flat feet: a systematic review and meta-analysis
Chao Liu et al
Front. Pediatr., 02 August 2024

Objective: This study aimed to investigate the impact of foot orthoses on foot radiological parameters and pain in children diagnosed with flexible flatfoot.

Methods: A comprehensive search was conducted across several databases, including PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO, covering publications from the inception of each database up to 8 June 2024. The study focused on randomized controlled trials investigating the use of foot orthoses for treating flexible flat feet in children. Four researchers independently reviewed the identified literature, extracted relevant data, assessed the quality of the studies, and performed statistical analyses using RevMan 5.4 software.

Results: Six studies involving 297 participants were included. The methodological quality of the included literature ranged from moderate to high. Radiological parameters of the foot improved significantly in older children with flexible flat feet following foot orthotic intervention compared to controls, particularly in the lateral talar-first metatarsal angle [mean difference (MD) = −2.76, 95% confidence interval (95% CI) −4.30 to −1.21, p = 0.0005], lateral talo-heel angle (MD = −5.14, 95% CI −7.76 to −2.52, p = 0.0001) and calcaneal pitch angle (MD = 1.79, 95% CI 0.88–2.69, p = 0.0001). These differences were statistically significant. Additionally, foot orthoses significantly improved the ankle internal rotation angle and reduced foot pain in children with symptomatic flexible flatfoot (MD = −2.51, 95% CI −4.94 to −0.07, p = 0.04).

Conclusion: The use of foot orthoses positively impacts the improvement of radiological parameters of the foot and reduces pain in older children with flexible flat feet. However, in younger children with flexible flat feet, the improvement from foot orthoses was not significant, likely due to challenges in radiological measurements caused by the underdevelopment of the ossification centers in the foot. Further studies are needed. Consequently, the results of this meta-analysis support the implementation of an early intervention strategy using foot orthoses for the management of symptomatic flat feet in older children.
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NewsBot · Aug 13, 2025

OrthoticS for TReatment of symptomatic flat feet In CHildren (OSTRICH): a randomised controlled trial
Sarah Cockayne et al
Health Technol Assess. 2025 Aug 6:1-49.

Background: Children and young people with symptomatic pes planus (flat feet) often seek treatment from healthcare professionals. There are various treatment options, but there is a lack of high-quality evidence about which is most effective.

Objectives: To assess the clinical and cost-effectiveness of prefabricated orthoses, plus exercise and advice, compared with exercise and advice alone on physical function, measured using the physical domain of the Oxford Ankle Foot Questionnaire for Children, among children with symptomatic pes planus.

Design and methods: A pragmatic, multicentre, two-armed individually randomised controlled trial with an internal pilot, economic evaluation and qualitative study.

Setting and participants: Children and young people aged 6-14 years with symptomatic flat feet were recruited from hospital or community healthcare facilities in England and Wales. Participants were randomised 1 : 1 using a secure web-based randomisation system and followed up for up to 12 months.

Interventions: We planned to provide all participants with advice and exercises, with the intervention group also receiving a prefabricated orthosis. Due to the nature of the study treatments, blinding of participants or the research team was not possible.

Main outcome measures: The primary outcome was the physical domain subscale of the Oxford Ankle Foot Questionnaire for Children over the 12-month follow-up. Secondary outcomes included the physical domain subscale at 3, 6 and 12 months, and the 'School and Play' and 'Emotional' domains of the Oxford Ankle Foot Questionnaire, pain scores, healthcare resource use, EQ-5D-Y and Child Health Utility 9D at all time points. The qualitative study drew on health literacy and health belief perspectives and examined fidelity and explored the experiences of being in the trial for those receiving and delivering the study treatments.

Results: COVID-19 severely delayed trial set-up and recruitment and the study closed before meeting its recruitment target. Of 549 participants assessed for eligibility, 134 were randomised (intervention n = 70, control n = 64). The mean age of participants was 10.6 years (range 6.3-14.8) and 55.2% were male. No adverse events were reported. The planned statistical and health economic analyses could not be fully conducted due to the limited data. The qualitative study identified pain, posture and gait as the most common concerns by participants with pain relief as the primary motivator for seeking health care. Participants generally reported little understanding of their condition with barriers including misattribution (e.g. growing pains). Misinformation was common emphasising a need for accessible accurate education materials and structured follow-up care. There was a common belief that orthoses were superior to exercises leading to high levels of adherence, satisfaction and outcomes with orthoses compared with poor adherence, and low perceived efficacy with exercises linked to challenges incorporating these into daily routines.

Limitations: We could not deliver the study objectives as planned. Due to the limited data available, we were unable to undertake the planned analysis.

Conclusions: The COVID-19 pandemic significantly impacted trial set-up and recruitment. Extending the study was not feasible due to cost and time constraints.

Future work: The evidence for the clinical and cost-effectiveness of orthotics for the treatment of symptomatic flat feet in children remains inconclusive and an area for further research.
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NewsBot · Dec 2, 2025

Research trends and future directions in foot orthosis for flatfoot: A bibliometric approach to innovation and ergonomic design
Lina Dianati Fathimahhayati et al
Assist Technol. 2025 Dec 2:1-18.

Flatfoot is a common condition characterized by a low foot arch, causing pain and discomfort. Foot orthoses are commonly used to alleviate these symptoms. This study conducts a bibliometric analysis of 465 documents from the Scopus database using VOSviewer and Biblioshiny tools to identify research trends and future directions in foot orthosis for flatfoot treatment. The research is grouped into five main clusters: orthopedic and surgical procedures, patient demographics, biomechanics and physical assessments, advanced technologies in orthosis development, and clinical research. Key keywords include flatfoot, foot orthosis, female, adult, and biomechanics. The United States leads the publication output with 392 articles, followed by China, Italy, Iran, and South Korea. Future research should focus on new materials for orthoses, optimizing designs for better foot biomechanics, and incorporating advanced technologies such as 3D printing and computer simulations to enhance production. The study also calls for more research on patient-specific treatments, considering gender and demographic differences. Furthermore, controlled clinical trials are essential for evaluating long-term effectiveness and patient outcomes. Addressing these research gaps will improve foot orthosis design, manufacturing, and clinical application, enhancing treatment efficacy and patient outcomes.
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NewsBot · Mar 18, 2026

Biomechanical effects of foot orthoses in children with flexible flat foot; a systematic review
Mahsa Zangi et al
Source

Background
Flexible flatfoot, characterized by a collapsed medial longitudinal arch during weight-bearing, was a common pediatric condition associated with pain, balance deficits, and an increased risk of musculoskeletal complications. Foot orthoses were frequently prescribed, but their biomechanical effects in children had not been fully established. This systematic review aimed to synthesize evidence on the biomechanical effects of foot orthoses in children with flexible flatfoot.
Methods
Following the PRISMA 2020 guidelines, four databases (PubMed, Scopus, Web of Science, and ProQuest) were searched from inception to July 2025. Eligible studies included randomized controlled trials, cohort studies, quasi-experimental studies, and cross-sectional studies that evaluated biomechanical outcomes of orthotic interventions. Due to heterogeneity, a narrative synthesis was conducted. Risk of bias was assessed using the Modified Downs and Black checklist.
Results
Twenty-two studies (n = 844; mean age: 8.9 years; 52% male) were included. Orthoses reduced midfoot plantar pressure (up to −48.5 kPa), ankle inversion moments (−0.3 Nm/kg), and center of pressure displacement (−5 mm), while improving step length (+5 cm), balance, muscle activity, and radiographic indices (e.g., talonavicular coverage angle improved by 5°). Predictors of better outcomes included low navicular height (<1 cm), high arch index (>0.26), and higher pain scores (>3).
Conclusion
Foot orthoses offered measurable biomechanical benefits in pediatric flexible flatfoot. Clinical use should be individualized and guided by objective assessment. Further high-quality RCTs with standardized outcome measures and longer follow-up are warranted.
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NewsBot · Mar 27, 2026

Biomechanical effects of foot orthoses in children with flexible flat foot; a systematic review
Mahsa Zangi et al
J Rehabil Assist Technol Eng. 2026 Mar 13:13:20556683261429364

Background: Flexible flatfoot, characterized by a collapsed medial longitudinal arch during weight-bearing, was a common pediatric condition associated with pain, balance deficits, and an increased risk of musculoskeletal complications. Foot orthoses were frequently prescribed, but their biomechanical effects in children had not been fully established. This systematic review aimed to synthesize evidence on the biomechanical effects of foot orthoses in children with flexible flatfoot.

Methods: Following the PRISMA 2020 guidelines, four databases (PubMed, Scopus, Web of Science, and ProQuest) were searched from inception to July 2025. Eligible studies included randomized controlled trials, cohort studies, quasi-experimental studies, and cross-sectional studies that evaluated biomechanical outcomes of orthotic interventions. Due to heterogeneity, a narrative synthesis was conducted. Risk of bias was assessed using the Modified Downs and Black checklist.

Results: Twenty-two studies (n = 844; mean age: 8.9 years; 52% male) were included. Orthoses reduced midfoot plantar pressure (up to -48.5 kPa), ankle inversion moments (-0.3 Nm/kg), and center of pressure displacement (-5 mm), while improving step length (+5 cm), balance, muscle activity, and radiographic indices (e.g., talonavicular coverage angle improved by 5°). Predictors of better outcomes included low navicular height (<1 cm), high arch index (>0.26), and higher pain scores (>3).

Conclusion: Foot orthoses offered measurable biomechanical benefits in pediatric flexible flatfoot. Clinical use should be individualized and guided by objective assessment. Further high-quality RCTs with standardized outcome measures and longer follow-up are warranted.
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NewsBot · Mar 30, 2026

Do customized arch-support insoles improve physical functional performance and psychological well-being in asymptomatic healthy children? A randomized controlled study
Ying-Chen Kuo et al
J Pediatr Orthop B. 2026 Feb 11.

This study aimed to evaluate the short-term effects of customized arch-support insoles on physical functional performance, physical function, and psychological well-being in asymptomatic, healthy children. In this randomized controlled trial, 45 healthy, asymptomatic children were assigned to a treatment group (customized arch-support insoles) or a control group (no insoles) for 12 weeks. Physical functional performance was assessed by walking speed, stair ascent and descent time, chair rise time, and the Timed Up and Go test. Physical function and psychological well-being were measured using the Pediatric Outcome Data Collection Instrument-Parent and the Child Health Questionnaire-Parent Form 28 (CHQ-PF28). Adverse events related to insole use were monitored. All 45 participants (25 boys and 20 girls; mean age: 5.6 ± 2.5 years) completed the study, and no adverse events were reported. Baseline characteristics were comparable between groups. At 12 weeks, significant between-group differences favored the treatment group for stair ascent (mean difference: 2.01; P = 0.007) and stair descent (mean difference: 2.23; P = 0.007). The treatment group also showed greater improvement in the Pediatric Outcome Data Collection Instrument-Sports and Physical Function subscale (mean difference: 4.5; P = 0.031). No significant between-group differences were observed for the Child Health Questionnaire-Parent Form 28 well-being scores. Customized arch-support insoles were associated with improvements limited to stair-climbing performance, with no measurable effects on overall physical function or psychological well-being over 12 weeks. Although no adverse effects were observed, the additional time and financial costs do not support routine use of customized arch-support insoles in healthy, asymptomatic children.
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NewsBot · Apr 4, 2026

Immediate and Four-Week Effects of Sensorimotor
(SMFO) and Biomechanical (BMFO) Foot Orthoses
on Rearfoot Angle in Children with Pes Planovaglus.
A Randomized Controlled Trial
Stephan Becker et al
Source

Background/Objectives: Pes planovalgus is one of the most common misalignments in children. In
this study the established biomechanical foot orthoses (BMFO) are being compared with a more
recent treatment: sensorimotor foot orthoses (SMFO). SMFO are a more recent treatment and aim to
correct malalignment by specifically modulating muscle activity rather than relying solely on passive
mechanical support, as is the case with BMFO. Methods: Thirty-two children and adolescents aged
six to six-teen participated in this study. After randomized group allocation, the rearfoot angle was
analyzed by two-dimensional gait analysis in the SMFO-group (n=18) and the BMFO group (n=14)
under three conditions: without foot orthoses (baseline), with foot orthoses (immediate) and after
four weeks of use. Results: (1) SMFO and BMFO significantly improved the rearfoot angle
immediately after application, (2) the achieved correction was maintained over four weeks in both
groups, and (3) despite baseline differences, the superior rate of improvement in the SMFO-group
resulted in comparable rearfoot alignment between SMFO and BMFO at the four-week follow-up.
Conclusions: Based on the results, it can be concluded that SMFO and BMFO are comparable
methods for treating pes planovalgus in children and adolescents.
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NewsBot · May 8, 2026

Biomechanical evaluation of orthotic insole design features for pediatric flexible flatfoot using finite element analysis
Xinming Wu et al
Comput Methods Biomech Biomed Engin. 2026 May 8:1-11.

This study proposes a finite element (FE) framework to quantitatively evaluate customized insole designs for pediatric flexible flatfoot. Validated subject-specific FE models from nine pediatric cases were analyzed under static weight-bearing to assess the effects of arch support height, arch support area, and medial heel wedge height on plantar loading. Results revealed that arch support height and medial heel wedge height dominantly influence load transfer, with arch height facilitating midfoot loading and the heel wedge correcting hindfoot mechanics, whereas arch support area has limited impact. This quantitative approach demonstrates the potential of FE analysis to guide patient-specific orthotic prescriptions.
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NewsBot · May 12, 2026

Pain and functional outcomes of orthotic insoles plus rehabilitation in adolescent flatfoot: A 6-month retrospective cohort study
Kuo Li et al
Prosthet Orthot Int. 2026 May 12.

Background: Developmental flatfoot in children and adolescents often causes pain and reduced function. The real-world effectiveness of combining orthotic insoles with rehabilitation remains unclear.

Methods: We retrospectively analyzed 100 patients (aged 6-18) with developmental flatfoot treated between March and December 2024. Fifty received orthotic insoles plus rehabilitation; 50 received rehabilitation alone. Outcomes Visual Analog Scale (VAS) pain scores, Foot and Ankle Ability Measure function scores, plantar pressure (measured in kPa), and navicular drop (ND, mm) assessed at 12 and 24 weeks. Statistical analyses were conducted using SPSS version 26.0. Mann-Whitney U tests and chi-square tests were applied for between-group comparisons, whereas Friedman tests were used to assess changes over time. A p-value <0.05 was considered statistically significant.

Results: At 12 weeks, 84% in the intervention group had ≥2-point VAS reduction vs. 58% in controls (p = 0.006). Foot and Ankle Ability Measure scores improved more (+12.0 vs. +7.0; p = 0.009), with greater plantar pressure and navicular drop improvements. Benefits persisted at 24 weeks and were more pronounced in children aged 6-12. No serious adverse events occurred.

Conclusion: Orthotic insoles combined with rehabilitation improve pain, function, and alignment in adolescent flatfoot, especially in younger patients.
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NewsBot · Jun 8, 2026 at 3:10 AM

Treatment of pediatric flatfoot: a systematic review-based consensus and guidelines by CPAM-LRC
Sharula et al
Front Pediatr. 2026 May 8:14:1825355.

The purpose of this clinical practice guideline is to provide evidence-based recommendations for the treatment of pediatric flexible flatfoot, developed in accordance with the Appraisal of Guidelines for Research and Evaluation II framework and with evidence certainty assessed using the GRADE framework and the Oxford Centre for Evidence-Based Medicine levels of evidence system. A multidisciplinary guideline development group under the Limb Reconstruction Committee of the Orthopedics Branch of China International Exchange and Promotion Association for Medical and Health Care systematically searched and reviewed evidence from primary studies including randomized controlled trials, cohort studies, and comparative studies, supplemented by existing systematic reviews and expert society surveys, to evaluate the effectiveness of conservative and surgical interventions and to guide clinicians and families on the content of an optimal treatment pathway. The guideline targets children and teenagers with flexible flatfoot and addresses interventions available to orthopedic surgeons, podiatrists, rehabilitation physicians, and orthotists, including observation, rehabilitative exercises, foot orthoses, subtalar arthroereisis, calcaneal osteotomy, and criterion-based progression to surgery. Structured conservative management should be considered the mainstay of care for all symptomatic children, with a minimum 6-month trial before surgical referral. However, there is limited evidence on the optimal type, dose, and duration of conservative treatment, and what constitutes an adequate trial of nonoperative care remains undefined. Foot orthoses can be helpful for symptomatic relief when pain or functional limitation is present, and rehabilitative exercise programs may allow superior normalization rates compared to orthoses alone. Pain-free ambulation and return to unrestricted sport are key milestones for both conservative and surgical pathways. However, no validated progression or discharge criteria exist to guide the transition from one treatment phase to the next. While the certainty of evidence was low to very low for most components of the treatment pathway, all 15 recommendation statements were formulated through two rounds of Delphi consensus polling, with 13 achieving the predefined ≥75% agreement threshold. This guideline also highlights the need for standardized diagnostic definitions, multicenter registry data, and age-stratified surgical indications not systematically addressed in previously published literature.
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NewsBot · Jun 8, 2026 at 9:36 PM

Biomechanical effects of foot orthoses in children with flexible flat foot; a systematic review.
Zangi, Mahsa; Taheri, Mohammadyasin; Ahmadi, Obeydollah;
Journal of Rehabilitation & Assistive Technologies Engineering, 2026, v. 13, p. 1, doi. 10.1177/20556683261429364

Background: Flexible flatfoot, characterized by a collapsed medial longitudinal arch during weight-bearing, was a common pediatric condition associated with pain, balance deficits, and an increased risk of musculoskeletal complications. Foot orthoses were frequently prescribed, but their biomechanical effects in children had not been fully established. This systematic review aimed to synthesize evidence on the biomechanical effects of foot orthoses in children with flexible flatfoot. Methods: Following the PRISMA 2020 guidelines, four databases (PubMed, Scopus, Web of Science, and ProQuest) were searched from inception to July 2025. Eligible studies included randomized controlled trials, cohort studies, quasi-experimental studies, and cross-sectional studies that evaluated biomechanical outcomes of orthotic interventions. Due to heterogeneity, a narrative synthesis was conducted. Risk of bias was assessed using the Modified Downs and Black checklist. Results: Twenty-two studies (n = 844; mean age: 8.9 years; 52% male) were included. Orthoses reduced midfoot plantar pressure (up to −48.5 kPa), ankle inversion moments (−0.3 Nm/kg), and center of pressure displacement (−5 mm), while improving step length (+5 cm), balance, muscle activity, and radiographic indices (e.g., talonavicular coverage angle improved by 5°). Predictors of better outcomes included low navicular height (<1 cm), high arch index (>0.26), and higher pain scores (>3). Conclusion: Foot orthoses offered measurable biomechanical benefits in pediatric flexible flatfoot. Clinical use should be individualized and guided by objective assessment. Further high-quality RCTs with standardized outcome measures and longer follow-up are warranted.
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Foot Orthoses for Pediatric Flexible Flatfoot

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Pediatric flatfeet correction with foot orthoses

Exercise more effective than foot orthoses in pediatric flat foot

Foot orthoses and asymptomatic pediatric flatfoot

Foot orthoses with and without heel plugs

The Misuse of Foot Orthoses

Bridging the gap between custom foot orthoses research and clinical practice

Shoe modifications and foot orthoses in conservative treatment of lesser toe deformities

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Foot Orthoses for Pediatric Flexible Flatfoot

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Pediatric flatfeet correction with foot orthoses

Exercise more effective than foot orthoses in pediatric flat foot

Foot orthoses and asymptomatic pediatric flatfoot

Foot orthoses with and without heel plugs

The Misuse of Foot Orthoses

Bridging the gap between custom foot orthoses research and clinical practice

Shoe modifications and foot orthoses in conservative treatment of lesser toe deformities

Share This Page

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