Physical and Mechanical Therapies for Lower Limb Problems in Children With Juvenile Idiopathic Arthritis: A Systematic Review With Meta-Analysis.

Children with juvenile idiopathic arthritis (JIA) can develop foot, ankle, and lower limb pain, and this systematic review with meta-analysis asked whether physical therapies (like strengthening or exercise) or mechanical therapies (like foot orthoses) help. Reviewers screened 4876 titles and abstracts and included 11 randomised clinical trials, four on foot orthoses and seven on physical therapies. Pooled data from the foot orthoses studies showed statistically and clinically significant reductions in foot and ankle pain at 3 months, reported by both parents and children, with this effect sustained beyond 3 months. Physical therapies such as Pilates and underwater exercise showed statistically and clinically significant reductions in lower limb pain during the 3-month intervention period, but these trials were limited by a lack of blinding, and it remains unclear whether benefits persist longer term.

If your child has juvenile idiopathic arthritis (JIA) and experiences pain in the feet, ankles, or legs, you might wonder what kinds of treatments have actual evidence behind them. Researchers pulled together 11 randomised trials on this question, screening nearly 4876 studies to find them.

Four trials looked at foot orthoses (shoe inserts), and seven looked at physical therapies like Pilates or exercises done in water. When the foot orthoses studies were combined, they showed a statistically and clinically significant reduction in foot and ankle pain after 3 months, according to both parents and children, and this improvement lasted beyond that point. The physical therapy studies also showed significant pain reduction during the first 3 months, but these trials had a notable limitation: participants and assessors weren't blinded to which treatment they received, which can make results less reliable.

It's also not yet known whether the physical therapy benefits continue after 3 months, so longer-term evidence is still needed.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This systematic review with meta-analysis synthesised 11 randomised clinical trials addressing physical and mechanical interventions for lower limb problems in children with JIA, following screening of 4876 titles and abstracts. Four trials evaluated foot orthoses and seven evaluated physical therapies such as Pilates and underwater exercise, with pain as the primary outcome and disability, functional ability, and quality of life as secondary outcomes. Meta-analysis of the foot orthoses trials demonstrated statistically and clinically significant reductions in parent-reported (-11.08, 95% CI -20.25 to -1.90) and child-reported (-21.45, 95% CI -30.18 to -12.73) foot and ankle pain at 3 months compared to control, with effects maintained beyond that timepoint.

Physical therapy trials also showed statistically and clinically significant reductions in lower limb pain during the 3-month intervention period, though the authors note these findings are hampered by a lack of blinding, a design limitation that increases risk of bias and warrants cautious interpretation. Data on outcomes beyond 3 months for physical therapies were not available, leaving durability of effect unresolved.

Overall, this body of evidence supports foot orthoses for short and longer-term foot and ankle pain reduction, while physical therapy evidence remains preliminary given methodological constraints.