Role of customized insoles in improving foot biomechanics and posture in individuals with Down Syndrome a scoping review

INTRODUCTION: Down Syndrome (DS) is a genetic disorder that affects approximately 1 in every 700 births worldwide, which is associated with a number of physical and DS patients are frequently affected by musculoskeletal problems related to generalized joint laxity, low muscle tone and high BMI. In particular, musculoskeletal foot disorders and flat feet (FF) are prevalent in DS patients and affect ambulation, foot biomechanics and posture. Foot orthoses (FO) have been proposed as a potential intervention to improve foot function and posture in children and adult affected by Down syndrome, although their effectiveness is unclear. The aim of this study was to map the evidence regarding the efficacy of FO on FF and, broadly, on foot biomechanics and posture in individuals with DS. EVIDENCE ACQUISITION: Four databases (MEDLINE, Cochrane Central, Scopus, PEDro) were searched until May 2023. Only studies that considered FO were included. All interventions and contexts were considered. No restrictions were applied regarding language, study design and publication type. Grey literature and reference lists of included articles were not identified. The results were presented in numerical and thematic form. EVIDENCE SYNTHESIS: From 32 initial registrations, 5 studies fulfilled the inclusion criteria. The results showed that FO are effective in improving foot biomechanics and posture. However, the quality of the evidence was generally low and further high-quality studies are needed to confirm these results. CONCLUSIONS: This is the first scoping review to provide a comprehensive overview on the effectiveness of customized insoles in patients affected by Down syndrome. Customized insoles represent a non-invasive and low-cost intervention able to improve foot function and posture. Currently the quality of the evidence is limited, and further research is needed.