The Long-Term Structural Effect of Orthoses for Pediatric Flexible Flat Foot: A Systematic Review

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Several conservative treatment methods, from intrinsic muscle exercises to orthoses, including insoles or specially designed shoes, have been introduced for pediatric flexible flat foot (PFFF). However, the structural effects of orthoses use remain unclear because the normal physiological maturation of the medial longitudinal arch cannot be ruled out. METHODS: A comprehensive literature search using five databases, namely MEDLINE, the Cochrane Library, Scopus, the Web of Science, and EMBASE, was performed for pertinent articles published before March 30, 2018. Studies with quantitative data on the effects of the long-term use of orthoses for PFFF were included. The search strategy was adapted as appropriate for all other databases searched considering the differences in indexing terms and search syntax for each database. RESULTS: All studies, including randomized controlled trials or prospective cohort studies, could not prove the estimated effects of orthoses on the medial longitudinal arch. However, they revealed that flexible flat feet in young children slowly improved with growth, regardless of the type of footwear used. However, three of four studies, which were case series, revealed that positive long-term effects could be achieved using orthoses. CONCLUSION: There is no strong evidence that the long-term use of orthoses improved the structural problem of PFFF.