DOCUMENT 23 FOI 25/26-1343 Research paper

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Orthoses for people with Autism Spectrum

Disorder

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1. Contents

Orthoses for people with Autism Spectrum Disorder ……………………………………………………….. 1

1. Contents ………………………………………………………………………………………………………….. 1

2. Summary …………………………………………………………………………………………………………. 1

2.1   2025 Research Review ............................................................................................ 2

3. Motor difficulties for people with Autism Spectrum Disorder ……………………………………. 2

4. Effectiveness of foot orthoses …………………………………………………………………………….. 6

4.1   What are foot orthoses? ........................................................................................... 6

4.2    Effectiveness of treatment ........................................................................................ 6

4.3   Foot orthoses for people with ASD ........................................................................... 9

5. References ………………………………………………………………………………………………….. 11

2. Summary

Research for this paper was originally completed in November 2021. An update was added in August 2025.

There is a lack of evidence for the effectiveness of foot orthoses for people with Autism Spectrum Disorder (ASD). However, there is some indication that foot orthoses can assist in

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treating and managing conditions associated with ASD. Foot orthoses may help reduce toe- walking. There is very little evidence that orthoses can assist with mobility in people diagnosed with Developmental Coordination Disorder (DCD), a condition associated with ASD. However, there is evidence that foot orthoses assist with the management of pain and associated function for a variety of other conditions such as flat feet, high arches, bunions, juvenile idiopathic arthritis, rheumatoid arthritis and knee pain. Quality of studies vary.

2.1 2025 Research Review

The prevalence of motor impairments in individuals with ASD is confirmed in recent research. These impairments can affect gait and balance among other things. There is also evidence that these impairments correlate with other symptoms of ASD such as impairments in social skills and language and functional delays. It remains unclear whether the motor impairments experienced by those with DCD have the same underlying sensorimotor mechanisms as the motor impairments experience by those with ASD. Toe-walking also continues to be reported as prevalent in individuals with ASD. However, studies on the functional impact of toe-walking produce contradictory results. In terms of ASD, the DSM-5-TR mentions odd gait, clumsiness, and other abnormal motor signs (e.g., walking on tiptoes).

Studies on the effectiveness of foot orthoses show improvements in gait-related parameters in individuals with various neuromuscular and musculoskeletal impairments. However, generalisability of these results is affected by small sample sizes, high risk of bias and low study quality. Current studies on the effect of orthotics on individuals with ASD have focused on resolving toe-walking. These studies often combine orthotics with another intervention such as serial casting or Botox injections. Results often show a decrease in toe-walking. Sample sizes are often small and blinding and randomisation are not used, making it difficult to generalise results.

3. Motor difficulties for people with Autism Spectrum

Disorder

2025 update: Research continues to confirm high rates of motor impairment in individuals with ASD, and motor impairments are a core feature of ASD according to research and peak and community bodies such as Embrace Autism, the Autism Research Institute, and the National Autistic Society (UK). The prevalence of motor impairments in individuals with ASD has been estimated to be between 35% and 95% (da Silva et al., 2025, p. 1; Miller et al., 2024, p. 2). In 2025, da Silva et al. published a scoping review of motor impairments in individuals with ASD looking at 19 studies of fair to good quality. Results showed that individuals with ASD may have a range of motor impairments including a reduction in stride, a lower cadence, greater variation in stride width, and a change in the ankle joint during the pre-swing phase. Cho et al. (2022) conducted an exploratory pilot study on 82 individuals with ASD which showed greater mediolateral deviation while walking, greater sway during normal, tandem, and single leg stance, a reduced walking speed and cadence, a greater arrhythmicity during jumping jack

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tasks and an impaired manual dexterity during finger tapping tasks compared to healthy controls. However, regarding motor impairments in individuals with ASD, the DSM-5-TR (2022) only mentions odd gait, clumsiness, and other abnormal motor signs (e.g., walking on tiptoes).

Studies also purport the high functional impactful of motor problems in individuals with ASD including its correlation with repetitive behaviour severity, language and functional delays, limited ability to engage in self-care behaviours, and current and future daily living skills (Bhat, 2023; Cho et al., 2022; Miller, 2024). A recent systematic review with two meta analyses also found that gross motor skills were moderately but significantly associated with social skills in children with ASD. The authors also explain that more research is needed to understand causality and directionality of the relationship (Wang et al., 2022). The 21 studies included in this meta-analysis had a mean total quality rating of 9.95 out of 13. A similar correlation was also found in a SPARK dataset analysis of 13,887 children by Bhat (2023).

Miller et al. (2024) call for motor impairments to be recognised as a feature of autism and for uniform structure to the assessment and treatment of motor problems in autism. They question whether a cooccurring diagnosis of DCD is the best approach for individuals with ASD and DCD-like symptoms and call for more research to understand whether motor impairments in individuals with ASD and motor impairments in individuals with DCD stem from the same or different underlying sensorimotor mechanisms (Miller et al., 2024).

Toe-walking continues to be reported as prevalent in individuals with ASD (Chapek & Kessler, 2025; Valagussa et al., 2024). Studies on its impact on quality of life have produced contradictory results. Caserta et al. (2022) found that the 27 participants with idiopathic toe- walking in their study exceeded Australian recommendations for physical activity but did not meet recommendations for screen time amounts or sleep times. On the other hand, Morrow et al. (2024) found that the 157 children in their study showed significant reductions in physical, school and play, and emotional domain scores using the Oxford Ankle Foot Questionnaire for Children (OXAFQ_C) when compared to healthy controls.

Original 2021 paper: ASD is a neurodevelopmental disorder characterised by difficulties in social interaction and social communication, including restrictive, repetitive, and inflexible patterns of behaviour (American Psychiatric Association, 2013; World Health Organisation, 2019).

DSM 5 notes that people with ASD can often also experience motor deficits such as clumsiness and problems with gait (American Psychiatric Association, 2013). Motor deficits are included as ‘additional features supporting diagnosis,’ though there is a growing body of evidence supporting the idea that motor deficits are a core feature of ASD (American Psychiatric Association, 2013; Bhat, 2020; Ming et al., 2007; Zampella et al., 2021).

In a study of 11,814 participants, Bhat et al. find 86.9% of children with ASD are at risk of motor impairments. Zampella et al. report that up to 76% of children with ASD meet the diagnostic criteria for Developmental Coordination Disorder (DCD). DCD is a motor disorder characterised by motor skills substantially below what is expected at a person’s age (Zampella

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et al., 2021). People with ASD are also at greater risk of low muscle tone (hypotonia) and apraxia (Ming et al., 2007; Shetreat-Klein et al., 2014).

Of particular interest is the prevalence of motor deficits that can affect gait. An earlier study on the prevalence of motor deficits in children with ASD finds 19% present with toe-walking, 9% with a gross motor delay and 2% with reduced ankle mobility (see Table 1). A later study finds 68% of children with ASD have some form of gait abnormality (see Table 2).

Children with ASD are at higher risk of toe-walking (Caserta et al., 2019; Ming et al., 2007; Shetreat-Klein et al., 2014). Estimates of the prevalence of toe walking in people with ASD range from 9% (Leyden et al., 2019) to 20% (Barrow et al., 2011; Ming et al., 2007; Valagussa et al., 2019). A 2015 review found considerable disagreement over the specifics of a pattern of gait in people with ASD, concluding that deviations in gait are a common symptom of ASD (Kindregan et al., 2015). This heterogeneity is echoed by Dufek et al. (2017), who observe that the participants in their study displayed varied patterns of gait but generally showed an increase in gait abnormalities.

Table 1 The prevalence of motor deficits in ASD (Source: Ming et al., 2007)

Motor deficits	Age groups (years)	Hypotonia	Apraxia	Toe-walking	Reduced ankle mobility	Gross motor delay
Presence	All	79 (51%)	53 (34%)	30 (19%)	4 (2%) (all children had history of toe-walking)	14 (9%)
	2-6	52 (63%)	34 (41%)	21 (25%)	2 (2%)	10 (12%)
	7-18	27 (38%)	19 (27%)	9 (13%)	2 (3%)	4 (6%)
Absence	All	75 (49%)	101 (66%)	124 (81%)	150 (98%)	140 (91%)
	2-6	31 (37%)	49 (59%)	62 (75%)	81 (98%)	73 (88%)
	7-8	44 (62%)	52 (73%)	62 (87%)	69 (97%)	67 (94%)

Table 2 Gait abnormalities in children with Autism and their typically developing matched peers (percent) (Source: Shetreat-Klein et al., 2014)

Gait Abnormalities	Children with autism (n=38)	Peers (n=38)
Wide-based	33	0

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Gait Abnormalities	Children with autism (n=38)	Peers (n=38)
Apraxic	33	0
Posturing	25	11
Clumsy	20	0
Any abnormality (except toe-walking)	58	11
Toe-walking (observed on video only)	33	3
Any toe-walking (in office or on video)	45	3
Any gait abnormality (including any toe-walking)	68	13

Motor deficits in children can impact social interaction and communication (Zampella et al., 2021). However, the presence of motor deficits in individuals with ASD does not indicate that these individuals necessarily experience the deficit as an impairment or that they require a specific kind of support. As shown in Table 1, prevalence of motor deficits tends to reduce with age, although this is likely not the case for people diagnosed with DCD (Harris et al., 2015). Dietz and Khunsree argue that evidence for the harm of toe-walking is lacking and that beyond social stigma, toe-walking may ultimately be a benign condition (Dietz & Khunsree, 2012). On the contrary, Herrin and Geil argue that there are short and long term harms to toe-walking including:

• decreased walking velocity due to decreased stride length and cadence
• greater risks for falling
• greater effort than normal gait
• contracted Achilles tendon
• equinus position of the foot/ankle complex
• lumbar spine hyperlordosis
• deformities of bones and soft tissues in the feet
• abnormal adult gait (Herrin & Geil, 2016).

Leyden et al. (2019) note that some biomechanical and gait changes have been noted in people with toe-walking for years, though they temper this with the observation that long term consequences of toe-walking are generally unknown. In one study, participants walking barefoot displayed toe-walking behaviour in 36% of steps (Michalitsis et al., 2019). We did not

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find research to link frequency of toe-walking behaviour with real functional impact (i.e. research linking percentage of toe-walking footfalls with substantial mobility deficits).

While it is clear from the evidence that people with ASD experience problems with gait and motor skills at a higher rate than people without ASD, they do not receive treatment at a higher rate and continue to be under-diagnosed with motor impairments and DCD (Ming et al., 2007).

4. Effectiveness of foot orthoses

4.1 What are foot orthoses?

An orthosis or orthotic device is an “externally applied device used to compensate for impairments of the structure and function of the neuro-muscular and skeletal systems” (International Standards Organisation, 2020). Common lower limb orthoses include:

• toe – designed to wedge in between toes
• insoles – able to slip inside shoes, available custom made or prefabricated, can be heel, ¾ length or full length
• sub malleolar – covers the whole foot but stopping below the ankle
• supra malleolar – covers the whole foot and ankle
• ankle-foot – covers all or part of the foot, the ankle and stops just below the knee, can be articulated or solid, lined or padded and with or without a sole
• knee – covers knee joint and stops above the ankle and below the hip, can be custom moulded or prefabricated
• knee-ankle-foot – covers all or part of the foot, over the ankle and knee and stops just below the hip joint, can be articulated at ankle or knee, fully or partly custom moulded
• hip – usually covering lower back and hip joint stopping before the knee, custom moulded or prefabricated
• knee-hip-ankle-foot – covers all or part of the foot, over the ankle, knee and hip but should not obstruct movement of the spine (Black et al., 2010; Queensland Health, 2014).

4.2 Effectiveness of treatment

2025 Update: Caldeira Quaresma and McMonagle (2025) conducted a systematic review on the efficacy of lower limb orthoses on quality of life, well-being, and participation in individuals with stroke. Based on the 10 articles reviewed, the relationship between lower limb orthoses and quality of life is inconsistent, while the relationship between the use of orthoses and

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psychological well-being and participation is mostly positive. However, the level of evidence was low to acceptable for most studies with only two receiving a rating of high. The authors present information based on other studies that lower limb orthoses improve mobility, ambulation, gain, energy costs, balance and walking speed in people with stroke (Caldeira Quaresma & McMonagle, 2025, p. 388). Faccioli et al. (2025) conducted a systematic review and meta-analysis on the role of ankle-foot orthoses in improving gait in children and adolescents with neuromotor disability. The meta-analysis component, which focused only on 5 randomised controlled trials of individuals with cerebral palsy, showed ankle-foot orthoses are effective in increasing stride length, ankle dorsiflexion at initial contact and peak ankle dorsiflexion in stance while reducing cadence and the energy cost of walking. In terms of risk of bias, these studies showed only ‘some concerns’ according to Faccioli et al. Another systematic review (Pollen et al., 2025) explored the efficacy of 3D-printed ankle-foot orthoses on gait in patient with neuromuscular and/or musculoskeletal ankle impairments. 10 studies of fair to good quality were reviewed and included gait parameter outcome measures such as kinematics, kinetics, plantar pressure/force, and spatiotemporal data. Results showed a myriad of changes including increased gait velocity and cadence (see pp. 296-298 for more details). Bollepalli et al.’s 2025 systematic review of orthoses for in-toeing and out-toeing found that foot orthotics may be appropriate for mild gait abnormality management. The majority of studies included in this review were at low risk of bias while the remaining studies were at moderate risk of bias.

Various recent studies have shown that different types of orthoses may produce positive results for some populations. These include those with unilateral drop foot associated with multiple sclerosis (Pourhoseingholi & Tafti, 2025), plantar flexor weakness post-stroke (Skigen et al., 2024), patellofemoral knee pain (Simon et al., 2024) and hip osteoarthritis (King et al., 2024). However, these studies typically have small participant numbers (<30). Other complicating factors discussed in 5.2.1 also persist such as the different styles, design and manufacture methods of various orthoses and the variety and combination of materials used in orthoses under study. These variations make it difficult to compare studies, and difficult for results to be generalisable.

Original 2021 paper: Foot orthoses are a commonly prescribed treatment and management technique for a variety of lower body pain and functional/mobility issues. Orthoses, prescription footwear and physical therapy are often called ‘conservative’ treatments to contrast these with surgical interventions (Martikyan et al., 2018).

A 2008 Cochrane review of 11 randomised control trials found evidence that custom made insoles can reduce the pain associated with high arches (pes cavus), juvenile idiopathic arthritis, rheumatoid arthritis and bunions (hallux valgus). The review found mixed evidence that custom insoles reduce pain of plantar fasciitis (Hawke et al., 2008).

Results were mixed for different conditions. Use of custom insoles for at least 3 months decreases pain associated with high arches, improves function and quality of life (Burns et al., 2007; Hawke et al., 2008). Children experiencing juvenile idiopathic arthritis can benefit from

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custom insoles or prefabricated neoprene insoles. Both interventions were more effective than supportive footwear at reducing pain and disability and improving function. After 3 months of use, pain reduction was seen for patients with rear-foot pain associated with rheumatoid arthritis, but no change after 3 years compared with placebo. Improvements to function between treatment and control were not statistically significant. Custom insoles did not reduce pain in the metatarsophalangeal joint associated with rheumatoid arthritis any more than supportive shoes or non-custom orthoses. Custom insoles can help reduce pain associated with bunions. Surgery may be more effective at reducing pain though no statistically significant difference in function was found between the two treatments (Hawke et al., 2008).

A 2011 Cochrane review into use of foot orthoses to treat knee pain found some evidence for a reduction in pain in the short term (6 weeks) but also an increase in problems like blisters and rubbing. There was no statistically significant difference in pain for patients treated with orthoses and those treated with physiotherapy. The patients who had physiotherapy scored higher on functional outcomes. However, the standard of evidence of the reviewed studies was VERY LOW on the GRADE scale (Hossain et al., 2011).

A 2010 Cochrane review into the use of non-surgical treatments for children with flat feet (pes planus) found some evidence that custom made orthoses could assist with the reduction in pain. However the quality of the evidence was compromised by small sample sizes, risk of bias and difficulty comparing data of the included studies. The authors note there is a lack of high quality evidence on the topic (Rome et al., 2010). A later study found some evidence that foot orthoses can improve knee alignment in people with flat feet (Jafarnezhadgero et al., 2018). However, the sample size of this randomly controlled trial was quite small at 15 participants.

Foot orthoses, either insoles, full foot or ankle-foot, are often used to treat toe-walking in people with good ankle range of motion and who are deemed capable of gait re-education (Caserta et al., 2019). Herrin et al. found use of ankle-foot orthoses controls toe walking but the effects do not last after treatment. The insole does not work as well as the ankle-foot orthosis but it is less restrictive and there is more uptake by children and their parents (Herrin & Geil, 2016). The quality of this randomly controlled trial suffers from lack of masking of any kind and stopping the study at 6 weeks instead of 6 months as originally stipulated (Caserta et al., 2019; Herrin & Geil, 2016). The authors argue their preliminary evidence supports a ‘sequential orthotic treatment’, where less restrictive orthoses (insoles) are trialled first and the patient can progressively move to more restrictive orthoses (ankle-foot) as required (Herrin & Geil, 2016).

4.2.1 Difficulties with determining effectiveness of foot orthoses

Even when high quality studies can be found on the benefits or harms associated with types of foot orthoses, it can still be difficult to draw conclusions about the effectiveness of foot orthoses in general. Orthoses designed for the same purpose come in different styles, use different design and manufacture methods and can be made from a variety and combination of materials including plastic, foam rubber, leather, cork, carbon fibre, and metal (Queensland

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Health, 2014). For example, results for one type of custom moulded carbon fibre insole may not generalise to other types of insole. Many studies do not specify the type of foot orthosis used (Dars et al., 2018). Available research uses different measures of effectiveness, making findings difficult to aggregate. Much of the research focusses on pain reduction and only secondarily on functional outcomes and quality of life. Much of the research on the effectiveness of orthoses involves children. We know that children often outgrow their podiatric issues even without treatment. This means long term studies should contend with age and development as a confounding variable (Meyr & Sansosti, 2020).

Also of note, much of the available research is designed to assess orthoses as a time-limited treatment option (Herrin & Geil, 2016). One study focussing on the long term effects of foot orthoses on walking kinematics limit the time-frame of the study to just 4 months (Jafarnezhadgero et al., 2018). I have not been able to find much research relevant to ongoing management of functional deficits (an exception is Hawke et al., 2008).

4.3 Foot orthoses for people with ASD

2025 update: A systematic review by Luginsland et al. (2024) focused on biomechanical gait interventions for individuals with ASD including orthopaedic interventions such as serial casting and/or ankle/foot orthoses. Only three studies in the review focused on orthoses. Participants with toe-walking who underwent both serial casting and foot orthoses showed improved overall kinematic and spatiotemporal parameters during gait. More specifically, participants who underwent serial casting followed by foot orthoses in two studies showed an increase in ankle dorsiflexion, while participants in another study who used just foot orthoses showed an increase in peak force of the hallux and first metatarsal heat and a reduction of plantar pressures. In terms of study quality and bias, none of the studies used randomisation, or blinding and all showed a low risk of reporting bias.

Wilder et al. (2022) evaluated shoe inserts in two children with ASD and toe-walking. Toe- walking was heavily reduced in one child via the use of shoe inserts. The second child also showed reduced toe-walking with the shoe inserts, but his toe-walking was further reduced by the hand-on-shoulder technique which involved one of the researchers placing gentle pressure on the participant’s shoulder if the participant began toe-walking. During follow-up probes, the levels of toe-walking in both participants did increase slightly compared to levels during the active intervention (insoles) phase but did not return to initial levels. It is worth noting that one of the participants had previously been treated with ankle orthotics without success (Wilder et al., 2022, p. 756).

A 2022 study by Manfredi et al. discusses treatment of toe-walking in individuals with ASD using the “Cast and Go” protocol. This protocol involves a botulinum toxin injection, serial casting and orthoses associated with physiotherapy to achieve ankle neutral position. 22 children underwent treatment via this protocol with the outcome being the correction of the ankle dorsiflexion angle. Initially, the injection is performed and then casting is applied 4-7 days thereafter. Allied health professionals are then engaged to assist with plaster walking.

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Orthoses are used only nightly after plaster removal. Multiple consecutive casts could be employed for a maximum of 35-40 days. The whole protocol could be repeated after one year if the ankle dorsiflexion angle remained at more than 90 degrees, but the protocol could not be repeated more than 3 times (Manfredi et al., 2022, p. 4). In this study neutral angle position was achieved in all participants, with the maximum length of treatment being 50 months, and the average length 13 months.

In the 2023 response of the Australian Podiatry Association (APodA) to the draft version of the updated National Guideline for the Assessment and Diagnosis of Autism in Australia, APodA state that by prescribing appropriate orthotic devices, they can address motor challenges, improve motor function and enhance the overall quality of life for individuals with ASD. APodA also states that through the utilisation of devices such as shoe inserts and ankle-foot orthoses, podiatrists can help individuals with ASD manage sensory sensitivities and promote better mobility and balance. However, no recommendations regarding podiatry or orthoses are included in the National Guideline for the Assessment and Diagnosis of Autism (2023).

Original 2021 paper: We did not find any literature specifically focussing on prescription of foot orthoses for people with ASD. Valagussa et al (2018) mention only 2 studies that look at treatment of toe-walking in people with ASD. We found 3 papers that mention foot orthoses as a treatment option for people with ASD and none of them look at this option in depth (Ming et al., 2007; Valagussa et al., 2019; Martikyan et al., 2018).

A summary of evidence-based treatments for ASD endorsed by the European Society of Child and Adolescent Psychiatry only briefly mentions motor deficits and notes only occupational therapy as a possible treatment (Fuentes et al., 2021). Martikyan, Kaur, and Patel point out that consideration of the particularities of ASD which might complicate treatment of toe-walking are absent from the current literature (Martikyan et al., 2018). For example, Leyden, Frung and Frick conclude:

current [idiopathic toe-walking] treatment guidelines do not include specific recommendations for patients with comorbid conditions like ASD, and nonoperative treatments may be more challenging in patients with ASD if the patient has difficulty complying with instructions, sensitivity to tactile foot sensations/manipulation or is disturbed by the noise of cast saws. Medical treatment decisions should consider family preference, severity of the patient’s condition, as well as any comorbid conditions (Leyden et al., 2019).

As shown in 3. Motor difficulties for people with Autism Spectrum Disorder, people with ASD are at a much higher risk of DCD (Zampella et al., 2021). Podiatrists in Australia tend to think foot orthoses will be a viable treatment option for people with DCD. However, according to one analysis, podiatrists more familiar with DCD are less likely to prescribe orthoses (Smith et al., 2019). There is very little evidence to suggest foot orthoses will have positive outcomes for people with DCD.

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5. References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (5th edition). American Psychiatric Association Publishing. https://www.psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (R). (5th edition). American Psychiatric Association Publishing. Diagnostic and statistical manual of mental disorders _ DSM-5 ( PDFDrive.com ).pdf

Australian Podiatry Association. (2023). 2023 Draft version of the (updated) National Guideline for the Assessment and Diagnosis of Autism in Australia Response by Australian Podiatry Association (APodA). https://www.podiatry.org.au/documents/item/2953

Barrow, W. J., Jaworski, M., & Accardo, P. J. (2011). Persistent Toe Walking in Autism. Journal of Child Neurology, 26(5), 619–621. https://doi.org/10.1177/0883073810385344

Bhat, A. (2023). Multidimensional motor performance in children with autism mostly remains stable with age and predicts social communication delay, language delay, functional delay, and repetitive behavior severity after accounting for intellectual disability or cognitive delay: A SPARK dataset analysis. Autism Research, 16(1), 208–229. https://doi.org/10.1002/aur.2870

Bhat, A. N. (2020). Is Motor Impairment in Autism Spectrum Disorder Distinct From Developmental Coordination Disorder? A Report From the SPARK Study. Physical Therapy, 100(4), 633–644. https://doi.org/10.1093/ptj/pzz190

Black J. A., & Matheson, I. (2010). Orthoses. In: P. Frowen, M. O’Donnell, J. Gordon Burrow, D. L. Lorimer (Eds.). Neale’s disorders of the foot clinical companion. (pp. 435-451). Elsevier. https://www.google.com.au/books/edition/Neale_s_Disorders_of_the_Foot_Clinical_C/v 4zWDf1fso4C?hl=en&gbpv=1&dq=Neale%E2%80%99s+disorders+of+the+foot+clinical +companion&pg=PA37&printsec=frontcover

Bollepalli, H., White, C. J. K., Kodra, J. D., & Liu, X.-C. (2025). An Evaluation of Orthotics on In-Toeing or Out-Toeing Gait. Healthcare (Basel), 13(5), 531. https://doi.org/10.3390/healthcare13050531

Burns, J., Landorf, K. B., Ryan, M. M., Crosbie, J., & Ouvrier, R. A. (2007). Interventions for the prevention and treatment of pes cavus. Cochrane Database of Systematic Reviews, 2010(12), CD006154. https://doi.org/10.1002/14651858.CD006154.pub2

Caldeira Quaresma, D., & McMonagle, C. (2025). The efficacy of lower limb orthoses on quality of life, well-being, and participation following stroke: A systematic review. Prosthetics and Orthotics International, 49(4), 388–399. https://doi.org/10.1097/PXR.0000000000000389

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Caserta, A., Reedman, S., Morgan, P., & Williams, C. M. (2022). Physical activity and quality of life in children with idiopathic toe walking: a cross sectional study. BMC Pediatrics, 22(1), Article 544. https://doi.org/10.1186/s12887-022-03583-w

Caserta, A. J., Pacey, V., Fahey, M. C., Gray, K., Engelbert, R. H., & Williams, C. M. (2019). Interventions for idiopathic toe walking. Cochrane Database of Systematic Reviews, 2019(10), CD012363. https://doi.org/10.1002/14651858.CD012363.pub2

Chapek, M., & Kessler, J. (2025). The Prevalence of Persistent Toe Walking in Children With and Without Autism Spectrum Disorder and the Odds of Subsequent Surgery. The Journal of Foot and Ankle Surgery, 64(1), 16–20. https://doi.org/10.1053/j.jfas.2024.08.005

Cho, A. B., Otte, K., Baskow, I., Ehlen, F., Maslahati, T., Mansow-Model, S., Schmitz-Hübsch, T., Behnia, B., & Roepke, S. (2022). Motor signature of autism spectrum disorder in adults without intellectual impairment. Scientific Reports, 12(1), Article 7670. https://doi.org/10.1038/s41598-022-10760-5

da Silva, S. H., Felippin, M. R., de Oliveira Medeiros, L., Hedin-Pereira, C., & Nogueira- Campos, A. A. (2025). A scoping review of the motor impairments in autism spectrum disorder. Neuroscience and Biobehavioral Reviews, 169, Article 106002. https://doi.org/10.1016/j.neubiorev.2025.106002

Dars, S., Uden, H., Banwell, H. A., & Kumar, S. (2018). The effectiveness of non-surgical intervention (Foot Orthoses) for paediatric flexible pes planus: A systematic review: Update. PloS One, 13(2), e0193060. 1-17. https://doi.org/10.1371/journal.pone.0193060

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