Whitford 2007.

Study characteristics
Methods	Randomised clinical three‐arm parallel trial
Participants	672 children responded to advertisements Recruited 178 with flexible flat feet Age: 7 to 11 years Gender: male 53.4%, female 46.6% Inclusion: bilateral flexible flat feet, as indicated by RCSP > 5° everted, Navicular drop 10 mm or greater Exclusion: unilateral flexible excessive foot pronation, history of lower limb surgery, any serious medical pathology, such as cancer, known neuromuscular motor co‐ordination condition, prior or recent foot orthoses use, intellectual or learning difficulty, or any chromosomal abnormality Location: Adelaide, South Australia Setting: outpatients Baseline characteristics: lower laxity score in CFO group 17.0 versus PFO 26.2, and shoes 30.6
Interventions	Gp 1: CFOs Gp 2: PFOs Gp 3: no orthoses (control)
Outcomes	Assessment at baseline, 3 months, 12 months Outcome included in the trial 1. motor proficiency 2. pain ‐ proportion with pain in subgroup that had pain (post hoc analysis) 3. exercise efficiency 4. self‐perception profile Outcome included in this review is proportion without pain at 12 months
Source of funding	not stated (NHMRC)
Notes	Most children did not have pain at baseline, pain analysed as subgroup Secondary outcomes measured included ligamentous laxity, tight calf muscles, and body mass index
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomization was undertaken using computer generated lists of equally sized groups’.
Allocation concealment (selection bias)	Unclear risk	Insufficient information to permit judgement of low risk or high risk.
Blinding of participants and personnel (performance bias) All outcomes	High risk	‘… participants, and parents were not blinded.’ ‘Prescribing podiatrists… were not blinded’.
Blinding of outcome assessment (detection bias) ‐ self‐reported outcomes (e.g., pain, function)	High risk	Motor proficiency, pain, Self Perception Profile ‐ outcomes are subjective or influenced by participants, and participants were not blinded
Blinding of outcome assessment (detection bias) ‐ objective outcomes	Low risk	exercise efficiency ‐ ‘As in‐shoe orthoses are concealed within the child’s shoes when worn, raters of outcome measures were blinded to the orthotic status of the child.’
Incomplete outcome data (attrition bias) All outcomes	Low risk	Attrition rate and reasons similar between groups
Selective reporting (reporting bias)	Unclear risk	No reference to study protocol. The measurement of pain was done using VAS as a continuous measure, but reported only as a dichotomous outcome.
Other bias	Unclear risk	Funding source not stated