American Orthopaedic Foot & Ankle Society

View all recommendations from this society

Released September 17, 2014

Don’t use shoe inserts for symmetric flat feet or high arches in patients without symptoms.

Symmetric flat feet or high arches are common conditions, and generally they are asymptomatic. The development of the arch is not related to external supports, and no evidence exists that any support is needed in asymptomatic patients.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their health care provider.

How The List Was Created

In order to formulate this list, the American Orthopaedic Foot & Ankle Society Evidence-Based Medicine Committee reviewed the society position statements on foot and ankle care and solicited expert opinion from specialty leaders including the AOFAS Board of Directors to prepare an initial list of topics for the Choosing Wisely website. The Board of Directors of the AOFAS reviewed the initial list and approved five statements for further development. The Evidence-Based Medicine Committee members reviewed the scientific literature on each statement and presented draft statements with supporting evidence to the committee for discussion. Committee members also reviewed the Choosing Wisely campaign website to ensure that there was no duplication in proposed content and for proper formatting. The committee evaluated each statement and edited the statement wording and supporting references. Once consensus was reached, the 2014 list was finalized by committee members. The finalized list was then reviewed and approved by the AOFAS Board of Directors. The AOFAS disclosure and conflict of interest policies may be found at

Evidence-Based Medicine Committee:
Sandra E. Klein, MD, Chair
Ian J. Alexander, MD
Avrill R. Berkman, MD
Patrick B. Ebeling, MD
Todd S. Kim, MD
Anthony Michael Perera, MBChB
Phinit Phisitkul, MD
Ruth L. Thomas, MD
Emilio Wagner, MD
James A. Meeker, MD

AOFAS Board of Directors:
Steven L. Haddad, MD, President
Bruce J. Sangeorzan, MD, President-Elect
Mark E. Easley, MD, Vice President
Thomas H. Lee, MD, Secretary
Jeffrey E. Johnson, MD, Treasurer
Lew C. Schon, MD, Immediate Past President
Judith F. Baumhauer, MD, MPH, Past President
Bruce E. Cohen, MD, Member-at-Large
Timothy R. Daniels, MD, Member-at-Large
Sheldon S. Lin, MD, Member-at-Large
Selene G. Parekh, MD, MBA, Member-at-Large


Dare DM, Dodwell ER. Pediatric flatfoot: cause, epidemiology, assessment, and treatment. Curr Opin Pediatr. 2014;26(1):93–100.

Evans AM, Rome K. A Cochrane review of the evidence for non-surgical inter ventions for flexible pediatric flat feet. Eur J Phys Rehabil Med. 2011;47(1):69–89.

Kitaoka HB, Luo ZP, Kura H, An KN. Effect of foot orthoses on 3-dimensional kinematic s of flatfoot: a cadaveric study. Arch Phys Med Rehabil. 2002;83(6):876–9.

Rome K, Ashford RL, Evans A. Non-surgical interventions for paediatric pes planus. Cochrane Database of Systematic Reviews 2010, Issue 7. Art. No.: CD006311. DOI: 10.1002/14651858.CD006311.pub2.

Staheli LT, Chew DE, Corbett M. The longitudinal arch. A survey of eight hundred and eighty-two feet in normal children and adults. J Bone Joint Surg Am. 1987;69(3):426–8.

Sullivan JA. Pediatric flatfoot: evaluation and management. J Am A cad Orthop Surg. 1999;7(1):44–53.