Articles
| Open Access |
DOI: Therapeutic update of pediatric flatfoot: a systematic review with meta-analysis
Bianca Gabriella de Oliveira , Salvador, BA, Brasil Gihad Reda Khalil , Médico residente em Ortopedia e Traumatologia do Hospital Municipal Padre Germano Lauck, Foz do Iguaçu, PR Hussien Ali Mustapha , Médico residente em Ortopedia e Traumatologia da Fundação Municipal de Foz do Iguaçu, Foz do Iguaçu, PR André Luís Matos Caetano , Médico residente em Ortopedia e Traumatologia do Hospital Municipal Padre Germano Lauck, Foz do Iguaçu, PR Vanderson Reis de Sousa Brito , Médico pelo Centro universitário Tiradentes, Maceió, AL Marcella Rodrigues Costa Simões , Universidade Federal de Minas Gerais, Belo Horizonte, MG, BrasilAbstract
Objectives: The aim of this systematic review is to evaluate the effectiveness of the use of orthoses in the treatment of pediatric flatfoot.
Methodology: A systematic review was carried out in the online databases Cochrane Library, EMBASE, CINAHL, Medline and PubMed, using the following terms: flatfoot AND pediatric AND Orthotic
Devices. There were no limitations on gender, date or language. All results up to
February 1, 2024 were included.
Results: 213 patients under the age of 18 were included in this study. The use of medial arch support insoles proved to be effective in the treatment of flat feet in children, with an improvement in ankle internal rotation angles and knee internal and external rotation.
Conclusion: The use of orthoses has shown good results and is a reproducible and reliable approach, especially in pre- school patients who have been using them for more than 12 months, with improvements in gait, alignment and coordination of the lower limbs.
Keywords
Flatfoot, Pediatrics, Orthopedic procedures
References
Dars S, Uden H, Banwell HA, Kumar S. The effectiveness of non-surgical intervention (Foot Orthoses) for paediatric flexible pes planus: A systematic review: Update. PLoS One. 2018;13(2):e0193060. Published 2018 Feb 16. doi:10.1371/journal.pone.0193060
Stolzman S, Irby MB, Callahan AB, Skelton JA. Pes planus and paediatric obesity: a systematic review of the literature. Clin Obes. 2015;5(2):52-59. doi:10.1111/cob.12091
Rome K, Ashford RL, Evans A. Non-surgical interventions for paediatric pes planus. Cochrane Database Syst Rev. 2010;(7):CD006311. Published 2010 Jul 7. doi:10.1002/14651858.CD006311.pub2
BanwellHA,ParisME,MackintoshS,WilliamsCM.Paediatricflexibleflatfoot: how are we measuring it and are we getting it right? A systematic review. J Foot Ankle Res. 2018;11:21. Published 2018 May 30. doi:10.1186/s13047-018- 0264-3
Smith C, Zaidi R, Bhamra J, Bridgens A, Wek C, Kokkinakis M. Subtalar arthroereisis for the treatment of the symptomatic paediatric flexible pes planus: a systematic review. EFORT Open Rev. 2021;6(2):118-129. Published 2021 Feb 1. doi:10.1302/2058-5241.6.200076
PageMJ,McKenzieJE,BossuytPM,etal.AdeclaraçãoPRISMA2020:diretriz atualizada para relatar revisões sistemáticas [The PRISMA 2020 statement: an updated guideline for reporting systematic reviewsDeclaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas]. Rev Panam Salud Publica. 2022;46:e112. Published 2022 Dec 30. doi:10.26633/RPSP.2022.112
LiebauKH,SchmittAP,FröhlichS,BünzenC,MittelmeierW,SchulzeC. Comparison of the Influence of Supportive and Sensorimotor Insoles on Flat Feet in Children - a Double-Blind, Prospective, Randomized, Controlled Trial. Ortop Traumatol Rehabil. 2023 Aug 31;25(4):195-206. doi: 10.5604/01.3001.0053.9346. PMID: 37947144.
JafarnezhadgeroA,Madadi-ShadM,Alavi-MehrSM,GranacherU.Thelong- term use of foot orthoses affects walking kinematics and kinetics of children with flexible flat feet: A randomized controlled trial. PLoS One. 2018 Oct 9;13(10):e0205187. doi: 10.1371/journal.pone.0205187. PMID: 30300405; PMCID: PMC6177172.
SinhaS,SongHR,KimHJ,ParkMS,YoonYC,SongSH.Medialarch orthosis for paediatric flatfoot. J Orthop Surg (Hong Kong). 2013 Apr;21(1):37- 43. doi: 10.1177/230949901302100111. PMID: 23629985.
Hsieh RL, Peng HL, Lee WC. Short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children: A randomized controlled trial. Medicine (Baltimore). 2018;97(20):e10655. doi:10.1097/MD.0000000000010655
Halabchi, F.; Mazaheri, R.; Mirshahi, M.; Abbasian, L. Pediatric flexible flatfoot; clinical aspects and algorithmic approach. Iran. J. Pediatr. 2013, 23, 247.
KAYMAZ. Pediatric Pes Planus (flatfoot). Fam. Pract. Palliat. Care 2022, 7, 118–123.
Shin, B.-J.; Lee, K.M.; Chung, C.Y.; Sung, K.H.; Chun, D.; Hong, C.H.; Kim, J.B.; Kwon, S.-W.; Kim, W.J.; Song, M.G. Analysis of factors influencing improvement of idiopathic flatfoot. Medicine 2021, 100, e26894.
Marchena, A.; Cortés, M.; Noguerón, G.G. Revisión bibliográfica de los tratamientos del pie plano flexible. Análisis retrospectivo(1977–2011). Rev. Int. Cienc. Podol. 2013, 7, 9–22.
Taylor, T.L. Idiopathic flexible flatfoot in the adolescent. Clin. Podiatr. Med. Surg. 1989, 6, 537–553.
Harris, E.J.; Vanore, J.V.; Thomas, J.L.; Kravitz, S.R.; Mendelson, S.A.; Mendicino, R.W.; Silvani, S.H.; Gassen, S.C. Diagnosis and treatment of pediatric flatfoot. J. Foot Ankle Surg. 2004, 43, 341–373.
Evans, A.M. The flat-footed child—To treat or not to treat: What is the clinician to do? J. Am. Podiatr. Med. Assoc. 2008, 98, 386–393.
Dare, D.M.; Dodwell, E.R. Pediatric flatfoot: Cause, epidemiology, assessment, and treatment. Curr. Opin. Pediatr. 2014, 26,93–100.
Bresnahan, P.J.; Juanto, M.A. Pediatric Flatfeet—A Disease Entity That Demands Greater Attention and Treatment. Front. Pediatr.2020, 8, 19.
MacKenzie, A.J.; Rome, K.; Evans, A.M. The efficacy of nonsurgical interventions for pediatric flexible flat foot: A critical review.J. Pediatr. Orthop. 2012, 32, 830–834.
Mulligan, E.P.; Cook, P.G. Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function. Man. Ther. 2013, 18, 425–430.
Arachchige, S.N.K.K.; Chander, H.; Knight, A. Flatfeet: Biomechanical implications, assessment and management. Foot 2019, 38,81–85.
Blitz, N.M.; Stabile, R.J.; Giorgini, R.J.; DiDomenico, L.A. Flexible pediatric and adolescent pes planovalgus: Conservative and surgical treatment options. Clin. Podiatr. Med. Surg. 2010, 27, 59–77.
Herdea, A.; Neculai, A.-G.; Ulici, A. The Role of Arthroereisis in Improving Sports Performance, Foot Aesthetics and Quality of Life in Children and Adolescents with Flexible Flatfoot. Children 2022, 9, 973.
Molina-García C, Banwell G, Rodríguez-Blanque R, Sánchez-García JC, Reinoso-Cobo A, Cortés-Martín J, Ramos-Petersen L. Efficacy of Plantar Orthoses in Paediatric Flexible Flatfoot: A Five-Year Systematic Review. Children (Basel). 2023 Feb 13;10(2):371.
Zhang, M.; Nie, M.; Qi, X.; Ke, S.; Li, J.; Shui, Y.; Zhang, Z.; Wang, M.; Cheng, C.-K. A Strong Correlation Between the Severity of Flatfoot and Symptoms of Knee Osteoarthritis in 95 Patients. Front. Surg. 2022, 9, 936720.
Youn, K.-J.; Ahn, S.Y.; Kim, B.-O.; Park, I.S.; Bok, S.-K. Long-term effect of rigid foot orthosis in children older than six years with flexible flat foot. Ann. Rehabil. Med. 2019, 43, 224–229.
Lee, E.C.; Kim, M.O.; Kim, H.S.; Hong, S.E. Changes in resting calcaneal stance position angle following insole fitting in children with flexible flatfoot. Ann. Rehabil. Med. 2017, 41, 257–265.
Jafarnezhadgero, A.; Shad, M.M.; Ferber, R. The effect of foot orthoses on joint moment asymmetry in male children with flexible flat feet. J. Bodyw. Mov. Ther. 2018, 22, 83–89.
Ho, M.; Kong, P.W.; Chong, L.J.-Y.; Lam, W.-K. Foot orthoses alter lower limb biomechanics but not jump performance in basketball players with and without flat feet. J. Foot Ankle Res. 2019, 12, 24.
Karimi, M.T.; Tahmasebi, R.B.; Satvati, B.; Fatoye, F. Influence of foot insole on the gait performance in subjects with flat foot disorder. J. Mech. Med. Biol. 2019, 19, 1950050.
Xu, R.; Wang, Z.; Ren, Z.; Ma, T.; Jia, Z.; Fang, S.; Jin, H. Comparative study of the effects of customized 3D printed insole and prefabricated insole on plantar pressure and comfort in patients with symptomatic flatfoot. Med. Sci. Monit. Int. Med. J. Exp. Clin. Res. 2019, 25, 3510.
Su, S.; Mo, Z.; Guo, J.; Fan, Y. The effect of arch height and material hardness of personalized insole on correction and tissues of flatfoot. J. Healthc. Eng. 2017, 2017,8614341.
Chen, K.-C.; Chen, Y.-C.; Yeh, C.-J.; Hsieh, C.-L.; Wang, C.-H. The effect of insoles on symptomatic flatfoot in preschool-aged children: A prospective 1- year follow-up study. Medicine 2019, 98, e17074.
Choi, J.Y.; Lee, D.J.; Kim, S.J.; Suh, J.S. Does the long-term use of medial arch support insole induce the radiographic structural changes for pediatric flexible flat foot?—A prospective comparative study. Foot Ankle Surg. 2020, 26, 449–456.
Hsieh, R.-L.; Peng, H.-L.; Lee, W.-C. Short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children: A randomized controlled trial. Medicine 2018, 97, e10655.
Choi, J.Y.; Hong, W.H.; Suh, J.S.; Han, J.H.; Lee, D.J.; Lee, Y.J. The long- term structural effect of orthoses for pediatric flexible flat foot: A systematic review. Foot Ankle Surg. 2020, 26, 181–188.
Urrea, V.P. Evaluación del tratamiento ortopodológico en el pie plano flexible en niños de tres a cinco años de edad. REDUCA (Enfermería Fisioter. Podol.) 2011, 270, 265–288.
Radwan, N.L.; Ibrahim, M.M.; Eid, M.A.; Aly, S.M. The long-term effect of foot insoles on kinetic gait parameters in female children with flexible flat foot. IMJ 2020, 485–494
Pfeiffer, M.; Kotz, R.; Ledl, T.; Hauser, G.; Sluga, M. Prevalence of flat foot in preschool-aged children. Pediatrics 2006, 118, 634–639.
Živkovic ́, D.; Karaleic ,́ S.; And ̄elkovic ́, I. Flat feet and obesity among children. Facta Univ. Ser. Phys. Educ. Sport 2018, 347–358.
Lee, E.C.; Kim, M.O.; Kim, H.S.; Hong, S.E. Changes in resting calcaneal stance position angle following insole fitting in children with flexible flatfoot. Ann. Rehabil. Med. 2017, 41, 257–265.
Napolitano, C.; Walsh, S.; Mahoney, L.; McCrea, J. Risk factors that may adversely modify the natural history of the pediatric pronated foot. Clin. Podiatr. Med. Surg. 2000, 17, 397–417.
Rodriguez, N.; Volpe, R.G. Clinical diagnosis and assessment of the pediatric pes planovalgus deformity. Clin. Podiatr. Med. Surg.2010, 27, 43–58.
Pérez, L.C.; Iglesias, M.E.L. Prevalencia de alteraciones musculoesqueléticas en el pie infantil: Estudio preliminar/Prevalence of musculoskeletal disorders in children’s foot: Preliminary study. Rev. Int. Cienc. Podol. 2015, 9, 1–16.
Evans, A.M.; Rome, K. A review of the evidence for non-surgical interventions for flexible pediatric flat feet. Eur. J. Phys. Rehabil.Med. 2011, 47, 1–21.
Xu, L.; Gu, H.; Zhang, Y.; Sun, T.; Yu, J. Risk Factors of Flatfoot in Children: A Systematic Review and Meta-Analysis. Int. J.Environ. Res. Public Health 2022, 19, 8247.
Chang, J.-H.; Wang, S.-H.; Kuo, C.-L.; Shen, H.C.; Hong, Y.-W.; Lin, L.-C. Prevalence of flexible flatfoot in Taiwanese school-aged children in relation to obesity, gender, and age. Eur. J. Pediatr. 2010, 169, 447–452.
Morrison, S.C.; Tait, M.; Bong, E.; Kane, K.J.; Nester, C. Symptomatic pes planus in children: A synthesis of allied health professional practices. J. Foot Ankle Res. 2020, 13, 5.
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Copyright (c) 2025 Bianca Gabriella de Oliveira, Gihad Reda Khalil, Hussien Ali Mustapha, André Luís Matos Caetano, Vanderson Reis de Sousa Brito, Marcella Rodrigues Costa Simões
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