400 Section - Optimizing flatfoot management with insoles and exercise: a systemic review and meta-analysis

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

CS

Cho-E Sim, MD

Resident
Konyang University Hospital, Department of Rehabilitation Medicine
Seogu, Taejon-jikhalsi, Republic of Korea

Co-Author/Coautor(s)

MH

Mi Jin Hong, MD

Associated professor
Konyang University Hospital, Department of Rehabilitation Medicine
Seogu, Taejon-jikhalsi, Republic of Korea

Objectives : Flatfoot, characterized by a reduced medial longitudinal arch, can cause pain, instability, and functional impairment. Conservative treatments include exercise and foot orthoses, but their effectiveness varies due to differences in study designs, orthotic types, and outcomes. This study aimed to evaluate the comparative effectiveness of various foot orthoses and exercise interventions using a network meta-analysis (NMA).

Design: A systematic review and NMA were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with PROSPERO. Literature searches were performed in PubMed, Cochrane Library, and Embase up to November 30, 2024. Only randomized controlled trials (RCTs) were included. Eligible studies included flatfoot, comparing insoles, exercise, insole plus exercise, sensorimotor insoles, talus control foot orthoses (TCFO), and controls. Outcomes included pain, function, valgus angle, navicular drop, calcaneal pitch, foot posture index-6 (FPI), center of pressure (COP), and radiologic parameters. NMA was performed using the frequentist "netmeta" approach in R (version 4.3.1), with surface under the cumulative ranking curve (SUCRA) values ranking effectiveness. Risk of bias was assessed with the Cochrane Risk of Bias 2.0 tool.

Results: Nine RCTs were included. Insoles plus exercise showed the greatest pain reduction, followed by insoles alone. Functional improvements were observed but not statistically significant. Insole plus exercise showed the highest improvement in valgus angle and ranked highest in SUCRA. Navicular drop, calcaneal pitch, and FPI showed improvement trends. COP significantly improved with insoles. No publication bias was detected, and consistency tests supported NMA validity.

Conclusion: Insoles, especially combined with exercise, effectively reduce pain and correct valgus in flatfoot patients. Clinical use of insoles alone or with short foot exercises is supported. Future research should standardize outcomes, assess long-term effects, and explore patient subgroups to optimize treatment recommendations.