Finite element analysis of foot-insole biomechanics for insole design: a systematic review

Objective To synthesise finite element analysis (FEA) evidence on how insole design features influence foot biomechanics, and to identify implications for insole manufacture and the clinical management of foot disorders. Methods Web of Science, ScienceDirect, and PubMed were searched. Studies meeting the eligibility criteria were reviewed in full text. A best-evidence synthesis was used to determine the strength of evidence. For each included study, we extracted and compared the research objective, insole parameters, finite element model configuration, loading and boundary conditions, model validation and outcome measures to identify common modelling and experimental practices. Results As of December 2025, this review included 45 research articles. The mean methodological quality score was 23.91; 27 studies were classified as high quality and 18 as low quality. Inter-rater reliability was good (ICC[3, 1] = 0.856, 95% confidence interval 0.752–0.918). Conclusion Limited evidence indicates that conforming insoles may reduce plantar pressure, although the optimal conformity index remains unclear. Wedge and arch-support insoles can improve foot alignment, but their parameters require careful tuning to avoid excessive soft-tissue loading. Low-modulus materials and plug-and-hole structures in high-load plantar regions may reduce local pressure. Edge gradients or multiple small plugs and holes may limit secondary pressure peaks. Increasing insole thickness and reducing material stiffness can also relieve plantar pressure, but both strategies appear to have an upper threshold. Evidence remains sparse for nonfeatured, metatarsal, heel and comprehensive insoles, and optimal configurations for wedge, arch-support and multihole or multiplug designs have not been established. Systematic Review Registration identifier [CRD420251251042].