Effects of conservative interventions on plantar pressure in individuals with flat foot: a systematic review and meta-analysis

Pes planus involves the collapse of the medial longitudinal arch, altering gait and plantar pressure and leading to pain and injury. This review aimed to evaluate the effects of conservative interventions on plantar pressure in flatfoot patients. Four databases were searched from inception to 20 February 2025. Two reviewers screened studies using predefined criteria and the Downs and Black scale. Eligible designs included randomized controlled trials, quasi-experimental, and observational studies. Mean differences with 95% CIs were synthesized using a random-effects model, and evidence strength was graded using modified van Tulder criteria. Twenty-eight studies (5–80 participants; total n = 815) involving young to middle-aged adults with flexible flatfoot were included, and most showed moderate methodological quality. Exercise significantly reduced medial-heel pressure (MD − 12.61; 95% CI − 21.23 to − 3.98; strong evidence; 2 RCTs) but showed no significant change in midfoot pressure (MD 0.62; 95% CI − 4.41 to 5.65; 2 RCTs). Taping reduced medial-forefoot peak pressure (MD − 3.40; 95% CI − 5.78 to − 1.03; strong evidence; 5 studies) and did not change lateral-heel pressure (MD -1.26 ; 95% CI -5.11 to 2.58; strong evidence; 5 studies). Taping increased second-toe pressure by 28.2% (MD 3.69; 95% CI 1.64 to 5.75; 2 studies) and third-to-fifth-toe pressure by 34.7% (MD 3.21; 95% CI 1.85 to 4.56; 2 studies), while reducing middle forefoot by 18.2% (MD − 6.33; 95% CI − 8.95 to − 3.71; moderate evidence; 2 studies) and lateral forefoot by 12.4% (MD − 1.24; 95% CI − 2.14 to − 0.34; moderate evidence; 3 studies). Insoles increased medial-midfoot pressure by 61% (MD 29.15; 95% CI 17.23 to 41.06; 2 studies) but did not significantly change first-metatarsal (MD 8.79; 95% CI − 11.75 to 29.33; 2 studies) and lateral-midfoot pressures (MD 5.93; 95% CI − 26.31 to 38.16; 2 studies). Overall, conservative interventions may modify plantar-pressure distribution and provide short-term relief (primarily from acute/single-session taping and insole studies, with exercise effects observed over periods up to 8 weeks), but long-term efficacy remains unclear. Protocol registration: CRD42024621107.