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Am Fam Physician. 2023;107(3):232-233

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

Does treatment with customized or prefabricated foot orthoses improve pain, function, or quality-of-life scores in children with flat feet (pes planus)?

Evidence-Based Answer

Customized or prefabricated foot orthoses do not result in significant improvements in pain, function, or parent and child quality-of-life scores. Importantly, quality-of-life scores were not reported in patients who were asymptomatic. There is a need for further targeted studies to identify the clinical utility of foot orthoses in children with flat feet that are associated with underlying conditions; however, asymptomatic flat feet in children should not be routinely treated.1 (Strength of Recommendation: C, consensus, disease-oriented evidence, usual practice, expert opinion, or case series.)

Practice Pointers

Flatfoot is a common condition estimated to affect 44% to 70% of children three to six years of age.1 Historically, foot orthoses have been suggested as treatment to promote postural stability and efficient gait function. However, recent data suggest that the use of foot orthoses in childhood flatfoot may not be necessary.2,3 Flat feet develop as a child ages and usually self-correct without the need for intervention.4 This Cochrane review evaluated whether customized or prefabricated foot orthoses provided benefits to children with flat feet in patient-reported pain levels, functional status, or parent and child quality-of-life scores.

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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