Corrective Shoes and Inserts as Treatment for Flexible Flatfoot in Infants and Children

We performed a prospective study to determine whether flexible flatfoot in children can be influenced by treatment. One hundred and twenty-nine children who had been referred by pediatricians, and for whom the radiographic findings met the criteria for flatfoot, were randomly assigned to one of four groups: Group I, controls; Group II, treatment with corrective orthopaedic shoes; Group III, treatment with a Helfet heel-cup; or Group IV, treatment with a custom-molded plastic insert. All of the patients in Groups II, III, and Iv had a minimum of three years of treatment, and ninety-eight patients whose compliance with the protocol was documented completed the study. Analysis of ra- diographs before treatment and at the most recent fol- low-up demonstrated a significant improvement in all groups (p 0.4). We concluded that wearing corrective shoes or in- serts for three years does not influence the course of flexible flatfoot in children. shoes were responsible for any improvement that they may have noted. Despite concerted attention to the subject, no scientific study has established whether corrective shoes or inserts in shoes affect the course of flexible flat feet. Previous studies either have been retrospective or, when described as pro- spective, have not included randomization of patients to treatment and control groups or the use of matched con- trols23. In 1977 , we conducted a prospective study to determine whether treatment with corrective shoes and inserts changes the course of flexible flatfoot in children. We enrolled forty patients, but we were forced to abandon the trial because the parents of the patients, who had been selected from a clinical population, had a poor understanding of the study, and the compliance with treatment was unsatisfactory. We were also criticized by the Prescription Footwear Associa- tion because the shoes were not fitted by certified pedorth- ists. In 1978, we redesigned the study, incorporating the expertise of the Prescription Footwear Association for fitting the shoes. To minimize problems with compliance, we re- cruited only children who had typical flat feet and who were referred by private pediatricians.