Effects of short-term foot orthoses application on walking kinematics and kinetics in adults with pronated feet: A systematic review with meta-analysis

Abstract Foot orthoses (FO) are frequently used medical devices to correct lower limbs malalignment in the form of excessive foot pronation. This systematic review with meta-analysis aimed to investigate the effects of short-term FO application on walking kinematics and kinetics in adults aged ≥18 years with excessive foot pronation. Five electronic databases (MEDLINE, Scopus, PubMed, EMBASE, and Cochrane Central Register of Controlled Trials [CENTRAL]) were systematically searched from inception to January 2024. According to the PICOS approach, the eligibility criteria were: (P) healthy participants with pronated feet, (I) short-term FO interventions (one session), (C) other walking conditions (e.g., barefoot, only shoe, fake foot orthosis), (O) lower limbs kinematics (e.g., rearfoot eversion) and kinetics (e.g., knee joint moments) during walking, and (S) case-control studies, cross-sectional studies, randomized control trials, cohort studies, and case series designs. The modified version of the Downs and Black checklist was used to assess the methodological quality. Between-group standardized mean differences (SMDs) with 95% confidence intervals (CI) were computed using a random-effects model to elucidate the effects of short-term FO compared to controls. Statistical significance was set at p<0.05. The heterogeneity between studies was assessed using the I2 index. Twenty-two studies were identified and meta-analyzed. Overall, the methodological quality of the included studies was moderate, with 15 studies achieving high-quality and the remaining seven moderate quality. For kinematics, the meta-analysis showed significant effects of short-term FO application during walking on peak rearfoot eversion (nine studies: moderate SMDs=0.66, 95% CI 0.34 to 0.99), peak ankle dorsiflexion (five studies: small SMDs=-0.33, 95% CI -0.54 to -0.12), and eversion (seven studies: moderate SMDs=0.58, 95% CI 0.27 to 0.90). Concerning kinetics, the meta-analysis indicated significant effects of short-term FO application on the peak ankle eversion moment (five studies: small SMDs=0.38, 95% CI 0.17 to 0.59) and the peak knee adduction (six studies: small SMDs=-0.30, 95% CI -0.50 to -0.10). Study heterogeneity ranged from I² = 0-87%. Our meta-analysis showed significant effects of short-term FO application on the rearfoot eversion angle during walking in adults aged ≥18 years. Accordingly, the wearing of FOs can be recommended for adults with foot malalignment. However, between study heterogeneity was high for selected outcome parameters (e.g., peak ankle eversion). Therefore, more high-quality research is needed to elucidate the effects of short-term FO application on walking kinematics and kinetics as well as lower limbs muscular activation. Registration number: The protocol for this systematic review with meta-analysis was registered with PROSPERO on November, 17th 2023 (Project: https://www.crd.york.ac.uk/prospero/#myprospero, ID: CRD42023480039).