Summary of findings 2. Prefabricated foot orthoses compared to shoes in children with asymptomatic flat feet.

Prefabricated foot orthosescompared to shoes in children with asymptomatic flat feet
Patient or population: children with asymptomatic flat feet Setting: outpatient hospital clinic Intervention: prefabricated foot orthoses (PFO) Comparison: shoes
Outcomes	Relative effect (95% CI)	Anticipated absolute effects* (95% CI)			Certainty of the evidence (GRADE)	What happens
		With shoes (N = 52)	With PFOs (N = 54)	Difference (absolute)
Pain (measured as proportion with pain) follow‐up: 12 months № of participants: 106 (1 RCT)	RR 0.94 (0.76 to 1.16)	78.8%	74.1% (59.9 to 91.5)	4.7% fewer (18.9% fewer to 12.6% more)	⊕⊕⊝⊝ Lowa,b	PFOs likely result in little to no difference in the proportion of children reporting pain, absolute reduction 4.7% (18.9% fewer to 12.6% more)
Function or disability	‐	‐	‐	‐	‐	not reported
Quality of life	‐	‐	‐	‐	‐	not reported
Treatment success	‐	‐	‐	‐	‐	not reported
Withdrawal due to adverse events follow‐up: 12 months № of participants: 338 (4 RCTs)	RR 0.99 (0.79 to 1.23)	72.3%	71.6% (57.1% to 88.9%)	0.7% fewer (15.2% fewer to 16.6% more)	⊕⊝⊝⊝ Very lowa,b,c	We are uncertain of the effects of PFOs on withdrawal due to adverse events. Absolute reduction 0.7% (15.2 fewer to 16.6 more)
Adverse events	‐	‐	‐	‐	‐	not reported
Serious adverse events	‐	‐	‐	‐	‐	not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

^aDowngraded for bias, (performance, attrition, other bias), participants, parents, and examiners not blinded; pain only assessed post hoc, as subgroup analysis; high attrition in some trials (notably Gould 1989) 
^bDowngraded for imprecision; wide 95% CI for intervention
^cDowngraded for indirectness; variably aged participant samples between studies