1. Study characteristics of the 16 included trials.
| Study Country | Follow‐up time | Baseline sample size | Age (SD) | Final sample size (% of baseline) | Intervention | Outcome measures | |
| Flexible asymptomatic flat feet in healthy children (9 studies) | |||||||
| Wenger 1989 USA | 3 years | 131 | 1 to 6 years | 98 (75%) | Shoe: N = 28
Heel cup: N = 27 UCBL: N = 22 Control: N = 21 |
X‐ray Clinical photos | |
| Gould 1989 USA | 5 years | 125 | 11 to 14 months | 52 (42%) | SL shoe: N = 25 SL shoe/ cookie: N = 10 Ortho shoes: N = 7 Ortho/mla: N = 10 | X‐ray Pedotopography Clinical assess ment | |
| Whitford 2007 Australia | 1 year | 178 | 7 to 11 years | 160 (90%) | CFO: N = 59 FO: N = 59 Control: N = 60 | Pain SPPC Motor skills VO² max | |
| Asgaonkar 2012 India | 1 year | 80 | 5 to 15 years | 60 (75%) | Valgus insole: N = 30 Control: N = 30 | Pain (VAS) Physical cost (HR) Gait (step parameters) | |
| Kanatli 2016 Turkey | 2 to 5 years | 45 | 17 to 72 months (average 39.5 months) | 45 (100%) | Orthotic shoes: N = 21 Control: N = 24 | X‐ray Laxity AI | |
| Ahn 2017 Korea | 1 year | 40 | 10.14 years (4.99) | 40 (100%) | TCFO: N = 20 RFO: N = 20 | X‐ray RCSP | |
| Khamooshi 2017 Iran | 8 weeks | 60 | 9 to 13 years | 60 (100%) | Foot exercises: N = 20
Foot/core exercises: N = 20 Control: N = 20 |
Pedoscope Staheli AI ND Tiptoe/mla | |
| Jafarnezhadgero 2018 Iran | 4 months | 30 | 8 to 12 years | 30 | CFO: N = 15 Sham insole: N = 15 |
Gait kinematic Kinetic parameters | |
| Solanki 2020 India | 4 weeks | 44 | approximately 13 to 14 years | 44 | Conventional exercises + Faradic foot bath + rigid taping: N = 22 Conventional exercises + Faradic foot bath + sham tape: N = 22 | SEBT VJH IAT |
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| Abd‐Elmonem 2021 Egypt | 4 months | 72 | 7 to 12 years | 66 | Corrective exercises + NMES: N = 36 Corrective exercises + sham NM ES: N = 36 | Staheli AI ND x‐ray |
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| Children with juvenile idiopathic arthritis and foot pain (2 studies) | |||||||
| Powell 2005 USA | 3 months | 48 | 5 to 19 years | 40 (83%) | CFO: N = 15 Neoprene inserts: N = 12 Sports shoe: N = 13 | Pain (VAS) PedsQL Timed walk FFI |
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| Coda 2014 UK | 0, 3, 6 months | 60 | 10 to 11 years (3.5) | 60 (100%) | CPFO: N = 31 PFO: N = 29 | VAS PedsQL | |
| Flexible flat feet in children with foot pain (1 study) | |||||||
| Hsieh 2018 Taiwan | 12 weeks | 52 | 6 to 7 years | 50 | PFO: N = 24 Control: N = 26 | Physical activity Function (PODCI) Psychometric (PODCI, HRQoL) |
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| Flexible flat feet in children with foot pain (immediate effects only; 1 study) | |||||||
| Bok 2016 South Korea | immediate | 21 | 8 to 13 years (average 9.9 years) | 21 (100%) | 0° inverted CFO/15° inverted CFO/30° inverted CFO: N = not specified Shoes only (usual): N = not specified |
Pedar ‐ peak pressure, max. force, contact area | |
| Flexible flat feet in children without foot pain (immediate effects only: 1 study) | |||||||
| Aboutorabi 2013 Iran | immediate | 50 (30 flat feet: 20 controls) | 7.76 years (1.4) | 50 (100%) | Shoes + CFO/ Medical shoes/Barefoot: N = 30 Control (no flat feet): N = 20 | Gait ‐ Step – length, width, symmetry Velocity CoP | |
| Flexible flat feet in children with developmental co‐ordination disorder (1 study) | |||||||
| Morrison 2013 UK | 7 weeks | 22 | 6 to 11 years | 14 (64%) | CFO: N = 9 Control: N = 5 | 6‐minute walk Gait rite | |
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Abbreviations: ADRs: adverse reactions; AI: arch index; CFO: customised/bespoke foot orthoses; CoP: centre of pressure; FF: flat feet; FO: foot orthoses; HR: heart rate; HRQoL: health‐related quality of life IAT: Illinois Agility test; JIA: juvenile idiopathic arthritis; ND: navicular drop; NMES: neuromuscular electrical stimulation NS: not significant; PedsQL: Pediatric quality of life inventory; PFO: prefabricated foot orthoses; PODCI: Paediatric outcome data collection instrument RCSP: resting calcaneal stance position; RFO: rigid FO; SEBT: start excursion balance test; SL: straight last (shoe); SPPC: self perception profile; TCFO: talus control FO; UCBL: University of California Biomechanics Laboratory heel cup orthosis; VAS: visual analogue score; VJH: vertical jump height. |
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Prefabricated foot orthoses definition
A prefabricated foot orthosis is an in‐shoe medical device that is not made from an individual scan, cast, or mould of the foot. This generic device is intended to alter the magnitudes and temporal patterns of the reaction acting on the plantar aspect of the foot and normalise foot and lower extremity function; decreasing abnormal loading forces on the structural components of the foot and lower extremity during weight‐bearing and related activity.
Customised prefabricated foot orthoses definition
A modified version of a basic generic device, which is initially mass produced, and then specifically modified for the foot and gait requirements of an individual child. The modifications are usually added by the treating clinician, and may include: additional arch fill, varus or valgus wedges, and topcovers.
Custom foot orthoses definition
A bespoke foot orthosis is an individually customised in‐shoe medical device that is made from an individual scan, cast, or mould of the foot. The design is prescribed by a qualified healthcare professional to alter the magnitudes and temporal patterns of the reaction forces acting on the plantar aspect of the foot, in order to allow more normal foot and lower extremity function, and to decrease pathologic loading forces on the structural components of the foot and lower extremity during weight‐bearing and related activity.