The Impact of Foot Orthoses and Exercises on Pain and Navicular Drop for Adult Flatfoot: A Network Meta-Analysis

Ngoc-Tuyet-Trinh Hoang, Shuya Chen, Li-Wei Chou, Ngoc-Tuyet-Trinh Hoang, Shuya Chen, Li-Wei Chou

Abstract

Background: Adult flatfoot leads to injury and decreased quality of life. The most widely applied noninvasive approaches are wearing foot orthoses or exercising. Both interventions raise controversy about reducing pain and neutralizing foot posture. This study investigated the impact of foot orthoses and exercise on pain and navicular drop (present for foot posture).

Methods: Four databases were used: MEDLINE, PubMed, Web of Science, and Cochrane, from the earliest records to November 2020. Randomized controlled studies focused on adult flatfoot that evaluated the effect of exercise and foot orthoses on pain and navicular drop were extracted. We used data analysis to estimate the relative effect of heterogeneity using I2 and publication bias using funnel plots.

Results: Ten studies were identified through to November 2020. Active interventions (AIs) were exercise and exercise combined with foot orthoses; passive interventions (PIs) were foot orthoses and added stretching. Both AIs and PIs decreased pain significantly (SMD -0.94, 95% CI -1.35, -0.54 and SMD -1.4, 95% CI -1.87, -0.92). The AIs reduced pain level better than PIs. Controversially, no treatment was found to affect navicular drop.

Conclusion: Both exercise and foot orthoses can reduce pain but not realign foot posture. Exercise alone or combined with foot orthoses showed a better effect on adult flatfoot than only wearing foot orthoses. Active intervention was shown to have better efficacy in reducing pain than passive intervention.

Keywords: adult flatfoot; exercises; foot orthoses; insoles; navicular drop; orthoses; pain.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Net graphs of included studies. AI, active intervention; PI, passive intervention. (a) Net graph of pain; line thickness indicates number of studies with AI vs. PI (n = 5), AI vs. control (n = 3), and PI vs. control (n = 4). (b) Net graph of navicular drop; line thickness indicates number of studies with AI vs. PI (n = 3), AI vs. control (n = 5), and PI vs. control (n = 1).
Figure 3
Figure 3
Forest plot of (a) pain and (b) navicular drop.
Figure 4
Figure 4
The forest plot between mixing foot orthoses with exercises and foot orthoses in pain.
Figure 5
Figure 5
Funnel plot of publication bias of (a) pain and (b) navicular drop.

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