Interventions for the prevention and treatment of pes cavus

Joshua Burns; Karl B Landorf; Monique M Ryan; Jack Crosbie; Robert A Ouvrier

doi:10.1002/14651858.CD006154.pub2

Intervenciones para la prevención y el tratamiento del pie cavo

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Referencias

Referencias de los estudios incluidos en esta revisión

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estudios excluidos
otras referencias

Burns J, Crosbie J, Ouvrier R, Hunt A. Effective orthotic therapy for the painful cavus foot: a randomized controlled trial. Journal of the American Podiatric Medical Association 2006;96(3):205‐11.

Burns J, Scheinberg A, Ryan MM, Rose KJ, Ouvrier RA. Randomized trial of botulinum toxin to prevent pes cavus progression in pediatric CMT1A. Muscle & Nerve 2010;42(2):262‐7.

Hertel J, Sloss BR, Earl JE. Effect of foot orthotics on quadriceps and gluteus medius electromyographic activity during selected exercises. Archives of Physical Medicine and Rehabilitation 2005;86(1):26‐30.

Wegener C, Burns J, Penkala S. Effect of neutral‐cushioned running shoes on plantar pressure loading and comfort in athletes with cavus feet: a crossover randomized controlled trial. American Journal of Sports Medicine 2008;36(11):2139‐46.

Referencias de los estudios excluidos de esta revisión

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estudios incluidos
otras referencias

Bellomo F, Carannante G, Negretto R. Treatment of external pes cavus with long‐acting muscular stimulants. Minerva Ortopedica 1982;33(11):1107‐9.

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Bus SA, Ulbrecht JS, Cavanagh PR. Pressure relief and load redistribution by custom‐made insoles in diabetic patients with neuropathy and foot deformity. Clinical Biomechanics 2004;19(6):629‐38.

Butler RJ. Interaction of arch type and footwear on running mechanics. Interaction of arch type and footwear on running mechanics PhD Thesis. Delaware: University of Delaware, 2005.

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Butler RJ, Davis IS, Hamill J. Interaction of arch type and footwear on running mechanics. American Journal of Sports Medicine 2006;Dec; 34(12):1998‐2005.

Butler RJ, Hamill J, Davis I. Effect of footwear on high and low arched runners' mechanics during a prolonged run. Gait & Posture 2007;26(2):219‐25.

Kavros SJ. The efficacy of a pneumatic compression device in the treatment of plantar fasciitis. Journal of Applied Biomechanics 2005;21(4):404‐13.

Knapik JJ, Brosch LC, Venuto M, Swedler DI, Bullock SH, Gaines LS, et al. Effect on injuries of assigning shoes based on foot shape in air force basic training. American Journal of Preventive Medicine 2010;38(1 Suppl):S197‐211.

Molloy JM, Christie DS, Teyhen DS, Yeykal NS, Tragord BS, Neal MS, et al. Effect of running shoe type on the distribution and magnitude of plantar pressures in individuals with low‐ or high‐arched feet. Journal of the American Podiatric Medical Association 2009;99(4):330‐8.

Mubarak SJ, Van Valin SE. Osteotomies of the foot for cavus deformities in children. Journal of PediatricOrthopaedics 2009;29(3):294‐9.

Olmsted LC, Hertel J. Influence of foot type and orthotics on static and dynamic control. Journal of Sports Rehabilitation 2004;13:54‐6.

Simkin A, Leichter I, Giladi M, Stein M, Milgrom C. Combined effect of foot arch structure and an orthotic device on stress fractures. Foot and Ankle International 1989;10(1):25‐9.

Referencias adicionales

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estudios excluidos

Aktas S, Sussman MD. The radiological analysis of pes cavus deformity in Charcot Marie Tooth disease. Journal of Pediatric Orthopedics 2000;9(2):137‐40.

Badlissi F, Dunn JE, Link CL, Keysor JJ, McKinlay JB, Felson DT. Foot musculoskeletal disorders, pain, and foot‐related functional limitation in older persons. Journal of American Geriatric Society 2005;53(6):1029‐33.

Barrie JL, McLoughlin C, Robem N, Nuttal R, Lishman J, Wardle F, et al. Ankle instability in pes cavus. Journal of Bone and Joint Surgery (British Volume) 2001;83‐B(Suppl 3):339.

Google Scholar

Bennett PJ, Patterson C, Wearing S, Baglioni T. Development and validation of a questionnaire designed to measure foot‐health status. Journal of the American Podiatric Association 1998;88(9):419‐28.

Burns J, Crosbie J, Hunt A, Ouvrier R. The effect of pes cavus on foot pain and plantar pressure. Clinical Biomechanics 2005;20(9):877‐82.

Burns J, Redmond A, Crosbie J, Ouvrier R. Quantification of muscle strength and imbalance in neurogenic pes cavus, compared to health controls, using hand‐held dynamometry. Foot and Ankle International 2005;26(7):540‐4.

Carroll KL, Shea KG, Stevens PM. Posttraumatic cavovarus deformity of the foot. Journal of Pediatric Orthopedics 1999;19(1):39‐41.

Dahle LK, Mueller M, Delitto A, Diamond JE. Visual assessment of foot type and relationship of foot type to lower extremity injury. Journal of Orthopaedic and Sports Physical Therapy 1991;14(2):70‐4.

Dickson FD, Diveley RL. Functional disorders of the foot. Second Edition. Philadelphia: J.B. Lippincott Company, 1939.

Fortin PT, Guettler J, Manoli A. Idiopathic cavovarus and lateral ankle instability: recognition and treatment implications relating to ankle arthritis. Foot and Ankle International 2002;23(11):1031‐7.

Giannini S, Ceccarelli F, Benedetti MG, Faldini C, Grandi G. Surgical treatment of adult idiopathic cavus foot with plantar fasciotomy, naviculocuneiform arthrodesis, and cuboid osteotomy. A review of thirty‐nine cases. Journal of Bone and Joint Surgery (American Volume) 2002;84‐A(Suppl 2):62‐9.

Google Scholar

Helliwell TR, Tynan M, Hayward M, Klenerman L, Whitehouse G, Edwards RH. The pathology of the lower leg muscles in pure forefoot pes cavus. Acta Neuropathologica 1995;89(6):552‐9.

Hennig EM, Milani TL. In‐shoe pressure distribution for running in various types of footwear. Journal of Applied Biomechanics 1995;11(3):299‐310.

Horne G. Pes cavovarus following ankle fracture. A case report. Clinical Orthopaedics and Related Research 1984;184:249‐50.

Korpelainen R, Orava S, Karpakka J, Siira P, Hulkko A. Risk factors for recurrent stress fractures in athletes. American Journal of Sports Medicine 2001;29(3):304‐10.

Manoli A, Graham B. The subtle cavus foot, "the underpronator," a review. Foot and Ankle International 2005;26(3):256‐63.

Pandey S. Neglected clubfoot. The Foot 2002;12(3):123‐41.

Perry JE, Ulbrecht JS, Derr JA, Cavanagh PR. The use of running shoes to reduce plantar pressures in patients who have diabetes. The Journal of Bone and Joint Surgery 1995;77(12):1819‐28.

Redmond A, Lumb PS, Landorf K. Effect of cast and noncast foot orthoses on plantar pressure and force during normal gait. Journal of the American Podiatric Medical Association 2000;90(9):441‐9.

Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the FootPosture Index. Clinical Biomechechanics 2006;21:89‐98.

Reilly KA, Barker KL, Shamley D, Sandall S. Influence of foot characteristics on the site of lower limb osteoarthritis. Foot and Ankle International 2006;27(3):206‐11.

Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons. Journal of Bone and Joint Surgery (British Volume) 1995;77(2):254‐7.

Statler TK, Tullis BL. Pes cavus. Journal of the American Podiatric Medical Association 2005;95(1):42‐52.

Williams DS, 3rd, McClay IS, Hamill J. Arch structure and injury patterns in runners. Clinical Biomechanics 2001;16(4):341‐7.

Wines AP, Chen D, Lynch B, Stephens MM. Foot deformities in children with hereditary motor and sensory neuropathy. Journal of Pediatric Orthopedics 2005;25(2):241‐4.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios excluidos

Burns 2006

Methods	Prospective randomized, single‐blind, sham controlled trial.
Participants	154 adults with chronic foot pain. Pes cavus was defined by a Foot Posture Index score of –2 or less, which is 2 standard deviations below the reported normal mean of +5 (Redmond 2006).
Interventions	Custom‐made foot orthoses versus sham orthoses.
Outcomes	Foot pain, functional limitation, health‐related quality of life, in‐shoe plantar pressure at 3 months.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Using a computer random number generator
Allocation concealment?	Low risk	Central allocation by telephone by a third party not involved in the study
Blinding? Participant	Low risk	Participants were blinded to treatment allocation for the duration of the study
Blinding? Investigator	High risk	Blinding of the investigator was not appropriate because of the potential need for ongoing contact with the participants concerning adverse effects
Blinding? Assessor	Low risk	No blinding, but primary outcome measure was self‐reported and not likely to be influenced by lack of blinding
Incomplete outcome data addressed? All outcomes	Low risk	Only one missing outcome data
Free of selective reporting?	Low risk	Protocol is available and all of the study’s pre‐specified (primary and secondary) outcomes that are of interest in the review have been reported in the pre‐specified way
Free of other bias?	Low risk	The study appears to be free of other sources of bias. Explicit inclusion criteria, no baseline differences

Burns 2010

Methods	Prospective randomized, single‐blind, experimental trial.
Participants	10 children aged 3 to 14 years with Charcot‐Marie‐Tooth disease type 1A. Pes cavus was defined weight bearing by a Foot Posture Index score between –12 and –1 (Redmond 2006)
Interventions	One leg received intramuscular injections at six‐monthly intervals of botulinum toxin type‐A in the posterior tibialis and peroneus longus muscles, and one leg received no intervention.
Outcomes	Primary outcome was radiographic alignment at 24‐months. Secondary outcomes were objective clinical measures of foot structure, ankle flexibility and strength.
Notes
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	A simple randomization sequence was determined by coin‐toss
Allocation concealment?	Low risk	Central allocation by Paediatric Neurologist not involved in recruitment
Blinding? Participant	High risk	Each child/parent was aware of the leg selection for treatment
Blinding? Investigator	High risk	The injecting physician was aware of the leg selection for treatment
Blinding? Assessor	Low risk	The principal investigator conducting all outcome measures was blinded to the injected leg
Incomplete outcome data addressed? All outcomes	Low risk	No missing data
Free of selective reporting?	Low risk	Protocol is available and all of the study’s pre‐specified (primary and secondary) outcomes that are of interest in the review have been reported in the pre‐specified way
Free of other bias?	Low risk	The study appears to be free of other sources of bias. Explicit inclusion criteria, no baseline differences

Hertel 2005

Methods	Experimental, randomized cross‐over trial.
Participants	10 healthy young adults. Cavus feet were subjectively categorised as those having a high medial longitudinal arch accompanied by either excessive rearfoot varus and/or excessive forefoot valgus.
Interventions	Three off‐the‐shelf orthotic combinations (neutral post, medial post, lateral post) versus no orthotic device.
Outcomes	Electromyography of 3 muscles (vastus medialis, vastus lateralis and gluteus medius) during 3 activities (squat, step down and vertical jump).
Notes	No follow‐up.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Latin square design
Allocation concealment?	Unclear risk	Insufficient information to permit judgement
Blinding? Participant	High risk	No blinding
Blinding? Investigator	High risk	No blinding
Blinding? Assessor	High risk	No blinding
Incomplete outcome data addressed? All outcomes	Low risk	No missing data
Free of selective reporting?	Unclear risk	Insufficient information to permit judgement
Free of other bias?	Low risk	The study appears to be free of other sources of bias. Explicit inclusion criteria, no baseline differences

Wegener 2008

Methods	Experimental, randomized, single‐blind, cross‐over trial.
Participants	22 healthy athletic adults. Pes cavus was defined weight bearing by a Foot Posture Index score between –12 and –1 (Redmond 2006)
Interventions	Two common off‐the‐shelf running footwear models versus a control footwear.
Outcomes	In‐shoe plantar pressure during running.
Notes	No follow‐up.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Using a computer random number generator
Allocation concealment?	Low risk	Allocation by opaque envelopes
Blinding? Participant	Low risk	Participants were blinded to the manufacturer and model of each shoe condition to reduce preference bias
Blinding? Investigator	High risk	The chief investigator who recruited and assessed the participants was not blinded, to enable footwear fitting and data collection
Blinding? Assessor	High risk	The chief investigator who recruited and assessed the participants was not blinded, to enable footwear fitting and data collection
Incomplete outcome data addressed? All outcomes	Low risk	No missing data
Free of selective reporting?	Low risk	Study protocol is not available but it is clear that the published report (and thesis) include all expected outcomes
Free of other bias?	Low risk	The study appears to be free of other sources of bias. Explicit inclusion criteria, no baseline differences

Characteristics of excluded studies [ordered by study ID]

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estudios incluidos

Study	Reason for exclusion
Bellomo 1982	Not a randomized controlled trial.
Bus 2004	Not a randomized controlled trial and does not include pes cavus.
Butler 2005	Does not include participants with pes cavus
Butler 2006	Does not include participants with pes cavus
Butler 2007	Does not include participants with pes cavus
Kavros 2005	Pes cavus subgroup data (N = 7) not published. Author unwilling to provide additional data.
Knapik 2010	Does not include participants with pes cavus
Molloy 2009	Does not include participants with pes cavus
Mubarak 2009	Not a randomized controlled trial.
Olmsted 2004	Not a randomized controlled trial.
Simkin 1989	Excludes participants with pes cavus.

Data and analyses

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Comparison 1. Custom‐made foot orthoses versus sham

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in foot pain at three months Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.1 Comparison 1 Custom‐made foot orthoses versus sham, Outcome 1 Change in foot pain at three months.
1.1 Foot pain	1	154	Mean Difference (IV, Fixed, 95% CI)	10.90 [3.21, 18.59]

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Comparison 2. Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change of calcaneal‐first metatarsal angle Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	1.0 [‐2.31, 4.31]
Open in figure viewer Analysis 2.1 Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 1 Change of calcaneal‐first metatarsal angle.
2 Change of tibia‐calcaneal angle Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	1.1 [‐1.81, 4.01]
Open in figure viewer Analysis 2.2 Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 2 Change of tibia‐calcaneal angle.
3 Change of Foot Posture Index Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐1.5 [‐3.65, 0.65]
Open in figure viewer Analysis 2.3 Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 3 Change of Foot Posture Index.
4 Change of ankle dorsiflexion range of motion Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐2.20 [‐8.22, 3.82]
Open in figure viewer Analysis 2.4 Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 4 Change of ankle dorsiflexion range of motion.
5 Change of dorsiflexion foot strength Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	0.40 [‐20.44, 21.24]
Open in figure viewer Analysis 2.5 Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 5 Change of dorsiflexion foot strength.
6 Change of plantarflexion foot strength Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	10.90 [‐40.82, 62.62]
Open in figure viewer Analysis 2.6 Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 6 Change of plantarflexion foot strength.
7 Change of inversion foot strength Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	7.00 [‐26.21, 40.21]
Open in figure viewer Analysis 2.7 Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 7 Change of inversion foot strength.
8 Change of eversion foot strength Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐6.20 [‐32.98, 20.58]
Open in figure viewer Analysis 2.8 Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 8 Change of eversion foot strength.

Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Custom‐made foot orthoses versus sham, Outcome 1 Change in foot pain at three months.

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Analysis 2.1

Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 1 Change of calcaneal‐first metatarsal angle.

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Analysis 2.2

Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 2 Change of tibia‐calcaneal angle.

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Analysis 2.3

Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 3 Change of Foot Posture Index.

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Analysis 2.4

Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 4 Change of ankle dorsiflexion range of motion.

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Analysis 2.5

Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 5 Change of dorsiflexion foot strength.

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Analysis 2.6

Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 6 Change of plantarflexion foot strength.

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Analysis 2.7

Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 7 Change of inversion foot strength.

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Analysis 2.8

Comparison 2 Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text), Outcome 8 Change of eversion foot strength.

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Table 1. Custom foot orthoses on pain, function, quality of life and plantar pressure

Outcome measures	No. of participants	Sham orthoses	Custom orthoses	Statistical method	Effect size
Change in foot pain at three months	154	20.30 (22.70)	31.20 (25.80)	WMD (fixed), 95% CI	10.90 (3.21to 18.59)
Change in foot function at three months	154	14.60 (20.60)	25.60 (27.20)	WMD (fixed), 95% CI	11.0 (3.35 to 18.65)
Change in physical function at three months	154	2.60 (14.60)	12.10 (19.30)	WMD (fixed), 95% CI	9.50 (4.07 to 14.93)
Change in general health at three months	154	3.00 (20.80)	3.50 (18.40)	WMD (fixed), 95% CI	0.50 (‐5.70 to 6.70)
Change in vitality at three months	154	3.00 (15.20)	8.50 (17.80)	WMD (fixed), 95% CI	5.50 (0.26 to 10.74)
Change in social function at three months	154	6.20 (16.20)	8.70 (20.10)	WMD (fixed), 95% CI	2.50 (‐3.28 to 8.28)
Change in pressure‐time integral (N.s/cm2, whole foot) at baseline	154	‐1.60 (1.70)	‐4.50 (2.70)	WMD (fixed), 95% CI	‐2.90 (‐3.62 to ‐2.18)
Change in pressure‐time integral (N.s/cm2, rearfoot) at baseline	154	‐0.70 (0.80)	‐1.90 (1.40)	WMD (fixed), 95% CI	‐1.20 (‐1.56 to ‐0.84)
Change in pressure‐time integral (N.s/cm2, midfoot) at baseline	154	‐0.20 (0.60)	0.30 (2.20)	WMD (fixed), 95% CI	0.50 (‐0.02 to 1.02)
Change in pressure‐time integral (N.s/cm2, forefoot) at baseline	154	‐1.40 (2.00)	‐3.20 (2.90)	WMD (fixed), 95% CI	‐1.80 (‐2.59to ‐1.01)
Adverse events at three months	154	12/79	7/75	RR (fixed), 95% CI	0.61 (0.26 to 1.48)

Table 1. Custom foot orthoses on pain, function, quality of life and plantar pressure

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Table 2. Running footwear on plantar pressure

Outcome measure	No. of participants	1. Control	2. Asics Nimbus	3. Brooks Glycerin	Statistical method	Effect size (1 versus 2)	Effect size (1 versus 3)	Effect size (2 versus 3)
Peak pressure (kPa, whole foot)	22	513.4 (78.9)	399.4 (88.6)	361.2 (82.2)	WMD (Fixed), 95% CI	‐114.00 (‐163.58 to ‐64.42)	‐152.20 (‐199.81 to ‐104.59)	‐38.20 (‐88.70 to 12.30)
Peak pressure (kPa, rearfoot)	22	358.1 (173.8)	240.9 (91.9)	264.4 (90.5)	WMD (Fixed), 95% CI	‐117.20 (‐199.35 to ‐35.05)	‐93.70 (‐175.58 to ‐11.82)	23.50 (‐30.40 to 77.40)
Peak pressure (kPa, midfoot)	22	168.6 (68.1)	126.3 (31.0)	131.4 (34.4)	WMD (Fixed), 95% CI	‐42.30 (‐73.57to ‐11.03)	‐37.20 (‐69.08 to ‐5.32)	5.10 (‐14.25to 24.45)
Peak pressure (kPa, forefoot)	22	464.2 (106.4)	386.1 (100.0)	340.8 (89.4)	WMD (Fixed), 95% CI	‐78.10 (‐139.12to ‐17.08)	‐123.40 (‐181.47to ‐65.33)	‐45.30 (‐101.35to 10.75)
Pressure time integral (kPa.s, whole foot)	22	69.9 (12.4)	55.6 (12.2)	51.7 (9.7)	WMD (Fixed), 95% CI	‐14.30 (‐21.57to ‐7.03)	‐18.20 (‐24.78to ‐11.62)	‐3.90 (‐10.41to 2.61)
Pressure time integral (kPa.s, rearfoot)	22	19.8 (10.9)	17.2 (6.9)	18.8 (7.6)	WMD (Fixed), 95% CI	‐2.60 (‐7.99 to 2.79)	‐1.00 (‐6.55to 4.55)	1.60 (‐2.69 to 5.89)
Pressure time integral (kPa.s, midfoot)	22	15.3 (7.7)	14.4 (3.9)	14.8 (4.4)	WMD (Fixed), 95% CI	‐0.90 (‐4.51to 2.71)	‐0.50 (‐4.21to 3.21)	0.40 (‐2.06 to 2.86)
Pressure time integral (kPa.s, forefoot)	22	63.9 (13.2)	50.3 (12.3)	46.0 (9.6)	WMD (Fixed), 95% CI	‐13.60 (‐21.14 to ‐6.06)	‐17.90 (‐24.72 to ‐11.08)	‐4.30 (‐10.82 to 2.22)
Force (%Body Weight, whole foot)	22	226.2 (23.1)	217.1 (20.4)	219.4 (17.2)	WMD (Fixed), 95% CI	‐9.10 (‐21.98 to 3.78)	‐6.80 (‐18.83 to 5.23)	2.30 (‐8.85to 13.45)
Force (%Body Weight, rearfoot)	22	97.4 (43.3)	90.3 (34.9)	95.9 (30.3)	WMD (Fixed), 95% CI	‐7.10 (‐30.34 to 16.14)	‐1.50 (‐23.58 to 20.58)	5.60 (‐13.71 to 24.91)
Force (%Body Weight, midfoot)	22	25.6 (12.3)	30.0 (7.0)	28.6 (8.3)	WMD (Fixed), 95% CI	4.40 (‐1.51 to 10.31)	3.0 (‐3.20 to 9.20)	‐1.40 (‐5.94 to 3.14)
Force (%Body Weight, forefoot)	22	188.0 (21.5)	176.4 (24.3)	175.9 (20.6)	WMD (Fixed), 95% CI	‐11.60 (‐25.16 to 1.96)	‐12.10 (‐24.54 to 0.34)	‐0.50 (‐13.81 to 12.81)

Table 2. Running footwear on plantar pressure

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Table 3. Off‐the‐shelf foot orthoses on upper leg EMG during selected exercises

Outcome measure	No. of participants	1. No orthoses	2. Medial orthoses	3. Neutral orthoses	4. Lateral orthoses	Statistical method	Effect size (1 versus 2)	Effect size (1 versus 3)	Effect size (1 versus 4)
Vastus Medialis EMG during squat	10	1.14 (0.98)	1.19 (0.94)	1.24 (1.15)	1.22 (1.00)	WMD (fixed), 95% CI	0.05 ‐0.79 to 0.89)	0.10 (‐0.84 to 1.04)	0.08 (‐0.79 to 0.95
Vastus Medialis EMG during stepdown	10	0.99 (0.67)	1.33 (1.36)	1.27 (1.23)	1.42 (1.49)	WMD (fixed), 95% CI	0.34 (‐0.60 to 1.28)	0.28 (‐0.59 to 1.15)	0.43 (‐0.58to 1.44)
Vastus Medialis EMG during vertical jump	10	1.15 (0.54)	1.32 (0.88)	1.26 (0.70)	1.28 (0.73)	WMD (fixed), 95% CI	0.17 (‐0.47to 0.81)	0.11 (‐0.44to 0.66)	0.13 (‐0.43to 0.69)
Vastus Lateralis EMG during squat	10	1.07 (0.63)	0.95 (0.42)	0.99 (0.47)	0.97 (0.47)	WMD (fixed), 95% CI	‐0.12 (‐0.59to 0.35)	‐0.08 (‐0.57to 0.41)	‐0.10 (‐0.59to 0.39)
Vastus Lateralis EMG during stepdown	10	0.98 (0.56)	1.08 (0.60)	1.09 (0.65)	1.13 (0.70)	WMD (fixed), 95% CI	0.10 (‐0.41to 0.61)	0.11 (‐0.42to 0.64)	0.15 (‐0.41to 0.71)
Vastus Lateralis EMG during vertical jump	10	1.31 (1.31)	1.25 (0.62)	1.27 (0.62)	1.28 (0.54)	WMD (fixed), 95% CI	‐0.06 (‐0.96to 0.84)	‐0.04 (‐0.94 to 0.86)	‐0.03 (‐0.91to 0.85)
Gluteus Medius EMG during squat	10	0.66 (0.26)	0.67 (0.24)	0.69 (0.26)	0.70 (0.30)	WMD (fixed), 95% CI	0.01 (‐0.21to 0.23)	0.03 (‐0.20 to 0.26)	0.04 (‐0.21to 0.29)
Gluteus Medius EMG during stepdown	10	0.62 (0.23)	0.74 (0.39)	0.72 (0.33)	0.74 (0.44)	WMD (fixed), 95% CI	0.12 (‐0.16 to 0.40)	0.10 (‐0.15 to 0.35)	0.12 (‐0.19to 0.43)
Gluteus Medius EMG during vertical jump	10	0.90 (0.34)	1.02 (0.41)	0.96 (0.35)	1.05 (0.45)	WMD (fixed), 95% CI	0.12 (‐0.21to 0.45)	0.06 (‐0.24to 0.36)	0.15 (‐0.20to 0.50)

Table 3. Off‐the‐shelf foot orthoses on upper leg EMG during selected exercises

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Table 4. Botulinum toxin type‐A on radiographic alignment, Foot Posture Index, ankle dorsiflexion range of motion, foot strength

Outcome Measure	No. of participants	Control Leg	BoNT‐A Leg	Statistical Method	Effect Size
Change of calcaneal‐first metatarsal angle	10	‐3.2 (4.2)	‐2.2 (3.3)	WMD (fixed), 95% CI	1.00 (‐2.31 to 4.31)
Change of tibia‐calcaneal angle	10	‐2.1 (3.7)	‐1.0 (2.9)	WMD (fixed), 95% CI	1.10 (‐1.81 to 4.01)
Change of Foot Posture Index	10	1.3 (2.5)	‐0.2 (2.4)	WMD (fixed), 95% CI	‐1.50 ‐3.65 to 0.65)
Change of ankle dorsiflexion range of motion	10	5.3 (7.4)	3.1 (6.3)	WMD (fixed), 95% CI	‐2.20 ‐8.22 to 3.82)
Change of dorsiflexion foot strength	10	19.5 (22.7)	19.9 (24.8)	WMD (fixed), 95% CI	0.40 (‐20.44 to 21.24)
Change of plantarflexion foot strength	10	50.6 (58.1)	61.5 (59.9)	WMD (fixed), 95% CI	10.90 (‐40.82 to 62.62)
Change of inversion foot strength	10	28.8 (40.4)	35.8 (35.2)	WMD (fixed), 95% CI	7.00 (‐26.21 to 40.21)
Change of eversion foot strength	10	31.0 (34.5)	24.8 (26.0)	WMD (fixed), 95% CI	‐6.20 (‐32.98 to 20.58)

Table 4. Botulinum toxin type‐A on radiographic alignment, Foot Posture Index, ankle dorsiflexion range of motion, foot strength

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Comparison 1. Custom‐made foot orthoses versus sham

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change in foot pain at three months Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

1.1 Foot pain	1	154	Mean Difference (IV, Fixed, 95% CI)	10.90 [3.21, 18.59]

Comparison 1. Custom‐made foot orthoses versus sham

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Comparison 2. Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Change of calcaneal‐first metatarsal angle Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	1.0 [‐2.31, 4.31]

2 Change of tibia‐calcaneal angle Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	1.1 [‐1.81, 4.01]

3 Change of Foot Posture Index Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐1.5 [‐3.65, 0.65]

4 Change of ankle dorsiflexion range of motion Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐2.20 [‐8.22, 3.82]

5 Change of dorsiflexion foot strength Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	0.40 [‐20.44, 21.24]

6 Change of plantarflexion foot strength Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	10.90 [‐40.82, 62.62]

7 Change of inversion foot strength Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	7.00 [‐26.21, 40.21]

8 Change of eversion foot strength Show forest plot	1	20	Mean Difference (IV, Fixed, 95% CI)	‐6.20 [‐32.98, 20.58]

Comparison 2. Botulinum toxin type‐A versus control (note number of participants refers to legs not people ‐ see text)

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Referencias

Referencias de los estudios incluidos en esta revisión

Burns 2006 {published data only}

Burns 2010 {published and unpublished data}

Hertel 2005 {published and unpublished data}

Wegener 2008 {published and unpublished data}

Referencias de los estudios excluidos de esta revisión

Bellomo 1982 {published data only}

Bus 2004 {published data only}

Butler 2005 {unpublished data only}

Butler 2006 {published data only}

Butler 2007 {published data only}

Kavros 2005 {published data only}

Knapik 2010 {published data only}

Molloy 2009 {published data only}

Mubarak 2009 {published data only}

Olmsted 2004 {published data only}

Simkin 1989 {published data only}

Referencias adicionales

Aktas 2000

Badlissi 2005

Barrie 2001

Bennett 1998

Burns 2005a

Burns 2005b

Carroll 1999

Dahle 1991

Dickson 1939

Fortin 2002

Giannini 2002

Helliwell 1995

Hennig 1995

Horne 1984

Korpelainen 2001

Manoli 2005

Pandey 2002

Perry 1995

Redmond 2000

Redmond 2006

Reilly 2006

Sachithanandam 1995

Statler 2005

Williams 2001

Wines 2005

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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