{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:56:43Z","timestamp":1790830603925,"version":"4.1.0"},"reference-count":42,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Foot and Ankle Research"],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically review the evidence for orthotic interventions on pain, balance, and plantar pressure distribution in individuals with flexible flatfoot.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Randomized and nonrandomized controlled trials of orthotic interventions for flexible flatfoot were included. Primary outcomes were pain, balance, and plantar pressure. MEDLINE via PubMed, EMBASE via Elsevier, and the Cochrane Library were searched from inception to October 16, 2025. All effect sizes were independently recomputed, and pooling required two or more compatible datasets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eight studies with 382 participants were included: six randomized controlled trials, one nonrandomized controlled trial, and one within\u2010subject repeated\u2010measures study. No domain met the pooling condition, so all previously reported summary estimates and heterogeneity statistics are withdrawn. Pain against a comparator without arch support rested on Yurt et\u00a0al. (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a067):\n                      <jats:italic>g<\/jats:italic>\n                      \u00a0=\u00a0\u22121.02 [95% CI: \u22121.54, \u22120.49] on the trial's designated primary outcome, a 100\u00a0mm visual analog scale, but\n                      <jats:italic>g<\/jats:italic>\n                      \u00a0=\u00a0\u22120.28 on its Foot Function Index total. In Elsayed et\u00a0al. (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a040) both arms wore the same orthosis, so\n                      <jats:italic>g<\/jats:italic>\n                      \u00a0=\u00a0\u22120.97 [\u22121.62, \u22120.33] estimates added exercise, not the device. Balance rested on Yalfani et\u00a0al. (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a030):\n                      <jats:italic>g<\/jats:italic>\n                      \u00a0=\u00a0\u22120.86 [\u22121.59, \u22120.13]. In Khodaei et\u00a0al. (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a019), plantar load was redistributed rather than reduced, moving from the heel and lesser metatarsals (\n                      <jats:italic>g<\/jats:italic>\n                      \u00a0=\u00a0\u22121.93 to \u22121.09) to the medial midfoot (+1.76). Taspinar et\u00a0al. were withdrawn as arithmetically irreproducible.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Every domain rests on a single small study, so no general efficacy claim is supportable. The most defensible finding is mechanical: load shifts from the heel and lesser metatarsals to the medial midfoot, as a medial arch support is designed to do. The pain estimate is not robust to instrument choice within its own trial. GRADE certainty is very low for every outcome; certainty for plantar pressure began at low because the contributing study did not randomize allocation. The two nonrandomized studies were additionally appraised with ROBINS\u2010I, at critical and serious risk, respectively. Adequately powered randomized trials with a defined comparator and a pre\u2010specified primary outcome are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jfa2.70218","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:19:34Z","timestamp":1790828374000},"source":"Crossref","is-referenced-by-count":0,"title":["Effects of Orthotic Interventions on Pain, Balance, and Plantar Pressure in Flexible Flatfoot: A Systematic Review"],"prefix":"10.1002","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0858-121X","authenticated-orcid":false,"given":"Taeseok","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Physical Therapy Kunjang University College  Gunsan\u2010Si South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0584-7054","authenticated-orcid":false,"given":"Sangbin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy Namseoul University  Cheonan\u2010Si South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1324-6723","authenticated-orcid":false,"given":"Wansuk","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy Kyungwoon University  Gumi\u2010Si South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0763-8245","authenticated-orcid":false,"given":"Seoyoon","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy Kyungbok University  Namyangju\u2010Si South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.2019190046"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.2106\/jbjs.rvw.16.00116"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2023.05.007"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3113\/fai.2008.0910"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2010.09.024"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2015.03.004"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/107110070602700102"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1757\u20101146\u20107\u201023"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010022\u201006044\u20108"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0237382"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jfas.2004.12.001"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/107110079701800104"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01241398\u2010200105000\u201000022"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.msksp.2025.103359"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gaitpost.2014.12.012"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2023.102042"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.5604\/01.3001.0053.9346"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.12659\/msm.916975"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.23736\/s1973\u20109087.23.07846\u20102"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.23736\/s1973\u20109087.18.05108\u20100"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2024.102127"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.3233\/bmr\u2010150399"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.foot.2017.07.002"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.2307\/1164588"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919"},{"key":"e_1_2_13_29_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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