Mixed Comparison of Intervention with Assistive Devices for Plantar Pressure Distribution and Anatomical Characteristics in Adults with Pes Cavus: Systemic Review with Network Meta-Analysis

Abstract

Background: Pes cavus is a multiplanar foot deformity with an abnormal plantar pressure distribution and an overhigh medial longitudinal arch (MLA). Its causes are complex. In the past, people have usually focused on clinical surgery for pes cavus. However, this is not necessarily the best choice for some patients with non-ongoing or mild symptoms. In the 21st century, studies have just begun to focus on assistive devices intervention for pes cavus, which has been proven to be an effective non-surgical treatment. However, the effectiveness of assistive devices for patients with arched feet of any etiology has not been evaluated and evidence-based guidelines for clinical treatment options are lacking. Methods: A systematic review and network meta-analysis were performed, employing a comprehensive search across the databases of Web of Science, PubMed, as well as Scopus. The selected studies adhered to specific eligibility criteria, which included: (1) involving patients with pes cavus; (2) interventions with assistive devices; and (3) outcome measures of plantar pressure distribution and anatomical characteristics (MLA). Meanwhile, the standard mean difference was selected as the effect size. Results: A total of three studies were selected, and the authors achieved an agreement on the risk of bias with a kappa value equal to 0.74. According to the results of network meta-analysis, customized foot orthotics compared to other devices (lace-up ankle-support brace, semirigid brace) demonstrated the highest likelihood of being the most effective in optimizing plantar-pressure distribution among pes cavus patients. On the other hand, wearing hard custom foot orthotics compared to other devices (soft custom foot orthotics, off-the-shelf orthotics) showed the greatest potential in improving the medial longitudinal arch (MLA) of pes cavus patients. Discussion: Although becoming better than wearing regular footwear, wearing lace-up ankle-support braces or semirigid braces might not be optimal choices for treatments of pes cavus with the potential mechanism that the internal force created by the fixation of the proximal joint might be much less than the ground reaction force loaded on the distal segments that touch the ground. It could be concluded that foot orthotics show great potential in treating pes cavus under non-surgical conditions. This systematic review could provide valuable evidence for future research and clinical practice. Other: The PROSPERO Registration Number is CRD42022349687.