Effects of Orthotic Interventions on Pain, Balance, and Plantar Pressure in Flexible Flatfoot: A Systematic Review.

Objective

To systematically review the evidence for orthotic interventions on pain, balance, and plantar pressure distribution in individuals with flexible flatfoot.

Methods

Randomized and nonrandomized controlled trials of orthotic interventions for flexible flatfoot were included. Primary outcomes were pain, balance, and plantar pressure. MEDLINE via PubMed, EMBASE via Elsevier, and the Cochrane Library were searched from inception to October 16, 2025. All effect sizes were independently recomputed, and pooling required two or more compatible datasets.

Results

Eight studies with 382 participants were included: six randomized controlled trials, one nonrandomized controlled trial, and one within-subject repeated-measures study. No domain met the pooling condition, so all previously reported summary estimates and heterogeneity statistics are withdrawn. Pain against a comparator without arch support rested on Yurt et al. (n = 67): g = -1.02 [95% CI: -1.54, -0.49] on the trial's designated primary outcome, a 100 mm visual analog scale, but g = -0.28 on its Foot Function Index total. In Elsayed et al. (n = 40) both arms wore the same orthosis, so g = -0.97 [-1.62, -0.33] estimates added exercise, not the device. Balance rested on Yalfani et al. (n = 30): g = -0.86 [-1.59, -0.13]. In Khodaei et al. (n = 19), plantar load was redistributed rather than reduced, moving from the heel and lesser metatarsals (g = -1.93 to -1.09) to the medial midfoot (+1.76). Taspinar et al. were withdrawn as arithmetically irreproducible.

Conclusions

Every domain rests on a single small study, so no general efficacy claim is supportable. The most defensible finding is mechanical: load shifts from the heel and lesser metatarsals to the medial midfoot, as a medial arch support is designed to do. The pain estimate is not robust to instrument choice within its own trial. GRADE certainty is very low for every outcome; certainty for plantar pressure began at low because the contributing study did not randomize allocation. The two nonrandomized studies were additionally appraised with ROBINS-I, at critical and serious risk, respectively. Adequately powered randomized trials with a defined comparator and a pre-specified primary outcome are required.

Keywords

biomechanics, foot orthoses, pain management, pes planus, postural balance