Effects of foot orthoses application during walking on lower limb joint angles and moments in adults with flat Feet: A systematic review with Meta-Analysis

• Published in: Journal of biomechanics Vol. 176; p. 112345
• Main Authors: Jafarnezhadgero, AmirAli, Esmaeili, Ali, Hamed Mousavi, Seyed, Granacher, Urs
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01.11.2024; Elsevier Limited
• Subjects: Adult; Adults; Ankle; Ankle Joint - physiology; Ankle Joint - physiopathology; Biomechanical Phenomena; Calcaneus; Clinical trials; Feet; Flatfoot - physiopathology; Flatfoot - therapy; Foot - physiology; Foot Orthoses; Gait; Height; Heterogeneity; Humans; Insoles; Joints (anatomy); Kinematics; Kinetics; Knee Joint - physiology; Knee Joint - physiopathology; Lower Extremity - physiology; Lower Extremity - physiopathology; Medical Subject Headings-MeSH; Meta-analysis; Orthoses; Posture; Pressure distribution; Pronation; Radiography; Range of Motion, Articular - physiology; Systematic review; Walking; Walking - physiology; FF; Std; MLA; Gait; CI; CENTRAL; NNHT; RCSP; FO; Pronation; SMDs; SD; Kinematics; Kinetics; Insoles; FPI
• ISSN: 0021-9290; 1873-2380; 1873-2380
• DOI: 10.1016/j.jbiomech.2024.112345

•This study aimed to investigate the effects of foot orthoses application on lower limb mechanics in adults with flat-feet.•We observed greater effects of foot orthoses application on walking mechanics in the studies that used the foot posture index.•We recommend to uniformly use the foot posture index as a foot posture measure in future studies. This systematic review with meta-analysis aimed to investigate the effects of foot orthoses (FO) application on lower limb joint angles and moments in adults with flexible flat-feet during walking. The following five databases were systematically searched from inception until March 2024: Scopus, PubMed, EMBASE, PEDro, and Cochrane Central Register of Controlled Trials (CENTRAL). Between-group standardized mean differences (SMDs) with 95% confidence intervals were computed using a random-effects model. Study heterogeneity was assessed using the I2-index. Twenty-four studies were identified and meta-analyzed. Studies were then categorized according to the applied flat-feet assessment method: (1) foot posture index (FPI-6) or clinical observation; (2) foot print arch index or radiography; (3) arch height index (including navicular drop, the arch height index, navicular height normalized to foot length [NNHT]); (4) forefoot varus method; (5) rearfoot eversion or resting calcaneal stance position (RCSP). The meta-analysis showed significant effects of FO application during walking on peak rearfoot eversion (ten studies: moderate SMDs), peak ankle dorsiflexion (five studies: small SMDs), and eversion (seven studies: moderate SMDs). This meta-analysis indicated significant effects of FO application on peak ankle eversion moment (five studies: small SMDs) and peak knee adduction moment (six studies: small SMDs). We observed greater effects of FO application on walking mechanics in the studies that used the FPI-6 method for the assessment of foot posture. Since previous research showed particularly high test–retest reliability measures for the FPI-6 method, we recommend to uniformly use this type of foot posture measure in future studies.