BACKGROUND:Paediatric pes planus ('flat feet') is a common childhood condition with a reported prevalence of 14%. Flat feet can result in pain and altered gait. No optimal strategy for non-surgical management of paediatric flat feet has been identified. OBJECTIVES:To assess the effectiveness of non-surgical interventions for treatment of paediatric pes planus (flat feet). SEARCH STRATEGY:We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, Index to Theses, and Dissertation Abstracts (up to June 2009). SELECTION CRITERIA:All randomised and quasi-randomised trials of non-surgical interventions for paediatric pes planus were identified. The primary outcomes were pain reduction and adverse events; secondary outcomes included disability involving the foot, goniometric measurements, quality of life and patient comfort. DATA COLLECTION AND ANALYSIS:Two authors independently extracted data and assessed the risk of bias of included trials. MAIN RESULTS:Three trials involving 305 children were included in this review. Due to clinical heterogeneity, data were not pooled. All trials had potential for bias. Data from one trial (40 children with juvenile arthritis and foot pain) indicated that use of custom-made orthoses compared with supportive shoes alone resulted in significantly greater reduction in pain intensity (mean difference (MD) -1.5 points on a 10-point visual analogue scale (VAS), 95% CI -2.8 to -0.2; number need to treat to benefit (NNTB) 3, 95% CI 2 to 23), and reduction in disability (measured using the disability subscale of the Foot Function Index on a 100mm scale (MD -18.65mm, 95% CI -34.42 to -2.68mm). The second trial of seven to 11 year old children with bilateral flat feet (n = 178) found no difference in the number of participants with foot pain between custom-made orthoses, prefabricated orthoses and the control group who received no treatment. A third trial of one to five year olds with bilateral flat feet (n=129) did not report pain at baseline but reported the subjective impression of pain reduction after wearing shoes. No adverse effects were reported in the three trials. AUTHORS' CONCLUSIONS:The evidence from randomised controlled trials is currently too limited to draw definitive conclusions about the use of non-surgical interventions for paediatric pes planus. Future high quality trials are warranted in this field. Only limited interventions commonly used in practice have been studied and there is much debate over the treatment of symptomatic and asymptomatic pes planus.