A Cochrane review included 3 studies with a total of 305 children. Due to clinical heterogeneity, data were not pooled. One study (40 children with juvenile arthritis with pes planus and foot pain) showed that use of custom-made orthoses compared with supportive shoes alone resulted in significantly greater reduction in pain intensity (MD -1.5 points on a 10-point visual analogue scale (VAS), 95% CI -2.8 to -0.2; number need to treat to benefit (NNTB) 3, 95% CI 2 to 23), and reduction in disability, measured using the disability subscale of the Foot Function Index on a 100 mm scale (MD -18.65 mm, 95% CI -34.42 to -2.68 mm). The second study of 7 to 11 year old children with bilateral flat feet and no pain at baseline (n = 178) found no difference in the number of participants with foot pain between custom-made orthoses, prefabricated orthoses and the control group who received no treatment. A third study of 1 to 5 year olds with bilateral flat feet (n=129) did not report pain at baseline but reported the subjective impression of pain reduction after wearing shoes. Only one trial reported on adverse effects; the authors reported no adverse effects with the use of foot orthoses and shoes.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment), by inconsistency (variability in results across studies), and by imprecise results (limited study size for each comparison).