Pediatric symptomatic flexible flatfoot could be relieved by wearing insoles for 2 years

Flexible flatfoot or physiological flatfoot is the most common variant of flatfoot, where the medial longitudinal arch can be seen upon dorsiflexion of the big toe or tiptoeing but disappears upon standing with weight-bearing. Symptomatic flexible flatfoot is one of the various types which need treatment. Wearing insoles is considered one of the conservative therapies, but its effects are still uncertain. Jin Li et al conducted a study to provide evidence for the efficacy of insoles treatment among school-aged children with symptomatic flexible flatfoot. The study has been published in Indian Journal of Orthopaedics.

The inclusion criteria were: (a) children aged 6 years or more, (b) treated with insoles, and (c) having a follow-up of at least 24 months. Exclusion criteria were: (a) children with pathological flatfoot, (b) having inadequate medical or physiotherapy records, and (c) follow-up period.

All children were diagnosed based on physical examination and measurement of the arch index. The children and their caregivers were informed that the children needed to receive insole treatment for at least 8 h per day. Their guardians were responsible for monitoring and recording the wearing time every day. Patient's age, body mass index, pain positions, pain frequency, valgus angle, arch index and visual analogue scale (VAS) score were collected before and after insole treatment. After obtaining the feet model with plaster and modifying its shape, the insoles were customized and prepared with polyurethane components. After six to nine months, insoles were changed according to the feet growth.

The key findings of the study were:

• A total of 32 (18 boys and 14 girls) children were included in this study.

• Among the participants, 25 children (15 boys and 10 girls) had normal BMI, while seven children (3 boys and 4 girls) were overweight. Most overweight children had pain in the plantar arch, and only one of them had pain in the plantar heel.

• The results showed that wearing insoles for 2 years caused a significant improvement in pain frequency, valgus angle, arch index and VAS score.

The authors concluded that – "This study indicated that pediatric symptomatic flexible flatfoot could be relieved by wearing insoles for 2 years. Insole treatment might be a workable option for pediatric symptomatic flexible flatfoot in children older than 6 years old."

Further reading:

Effect of Insoles Treatment on School Age Children with Symptomatic Flexible Flatfoot: A 2 Year Follow Up Study

Jin Li, Zimo Yang et al

Indian Journal of Orthopaedics (2022) 56:1985–1991

https://doi.org/10.1007/s43465-022-00698-1