Can foot orthoses be an effective supplement to brace therapy for adolescent idiopathic scoliosis? A systematic review and meta-analysis of randomized controlled trials

Abstract

Background

The golden time for treatment of adolescent idiopathic scoliosis (AIS) is short, and how to effectively improve treatment outcomes to avoid surgery has been a focus of medical attention. Scoliosis orthoses are the preferred method of conservative treatment for AIS, but there are limitations in efficacy. Foot orthoses (FO) have gained traction in treating musculoskeletal disorders, potentially enhancing traditional brace therapy and offering renewed hope for AIS patients.

Objective

This study aimed to investigate whether a treatment regimen combined with FO would have a more positive impact on patients with AIS than using a scoliosis orthosis alone.

Methods

PubMed, Web of Science, Embase, Cochrane Library, Scopus, CNKI, and Wanfang Data were searched for relevant randomized controlled trials (RCTs) published up to August 20, 2024. The risk of bias was assessed using the Cochrane Risk of Bias Tool. The quality of the outcomes was evaluated using the Grading, Assessment, Development, and Evaluation of Letters of Recommendation (GRADE). Statistical analyses were performed using Review Manager 5.3.

Results

Compared with scoliosis orthosis treatment alone, combined FO treatment significantly improved bilateral whole-foot pressure distribution（SMD = −0.38, 95% CI = [−0.70, −0.07], P = 0.02) and monopedal medial heel to lateral heel pressure ratio (M/L)（MD = −0.14, 95% CI = [−0.24, −0.04], P = 0.007), but failed to significantly improve the Cobb angle in patients with AIS（MD = −1.88, 95% CI = [−3.87, −0.10], P = 0.06) and the centre of pressure excursion index (CPEI)（MD = −1.36, 95% CI = [−2.85, −0.12], P = 0.07), also had no significant effect on quality of life. The RCTs exhibited a low risk of bias overall, with evidence quality ranging from low to moderate. No significant adverse effects were reported.

Conclusion

FO is a safe and effective intervention. Although its significant impact on improving the Cobb angle, CPEI, or quality of life was not definitively demonstrated, FO successfully optimised plantar pressure distribution and bilateral M/L balance. These improvements contribute to better static balance and postural stability in patients, suggesting FO as a promising complement to brace therapy.