## 4 Discussion  
A network meta-analysis approach was utilized to provide a comprehensive evaluation of the effectiveness of different interventions involving assistive devices for patients with pes cavus in this systematic review. The results provide evidence-based with higher quality guidelines for clinicians on intervention with assistive devices and prevention strategies for pes cavus. Notably, our initial search, which excluded duplicate options, found 432 articles with selected keywords in their abstract and title. Most articles compare experimental studies of clinical treatment, with a primary emphasis on evaluating surgical cases. After incorporating the assistive device aspect into our search, we found that only 12 articles mentioned assistive devices in the abstract. After further screening, we included only three articles that met all of the criteria. Some important findings of this review can be summarized as follows: Firstly, customized foot orthotics may be the best Intervention with assistive devices option to optimize plantar pressure distribution for feet with pes cavus. This advantage lines in both forefoot and midfoot regions. Moreover, lace-up ankle-support braces and semirigid braces may not be optimal in terms of achieving uniform foot pressure distribution similar to individuals with normal feet, but they may still be better than ordinary footwear. Finally, from the anatomical perspective, custom orthotics can help reduce MLA motion in pes cavus patients, but off-the-shelf foot orthotics are weaker in reducing MLA motion. The first finding of this analysis is that custom foot orthotics are effective in mitigating plantar pressure distribution in pes cavus patients. Some previous studies have demonstrated that customized foot orthotics can effectively intervene and prevent pes cavus, which is in line with the main findings of this review. For example, a study by [PERSON]'s team that was published in 1997 examined the gait patterns of individuals suffering from painful pes cavus [39] and found that the use of custom orthotics resulted in improved gait patterns and a wider distribution of loads across the plantar surface, indicating a successfully unloaded metatarsal area. In this study, the group that did not use this kind of orthotics was more likely to require surgical correction due to unsuccessful mechanical intervention, potentially caused by limited ability to alter mechanics in the absence of motion. The potential mechanism of the custom orthotics' effect on pain reduction might come from the wider contact surface area of the orthotics and the ability to control compensatory motion and unload the metatarsal heads, concluding that custom orthotics are an effective treatment option for improving gait patterns and reducing pain in patients with pes cavus. Moreover, a study conducted in 2021 provided evidence supporting the effectiveness of custom foot orthotics in altering the probability distribution of plantar pressure during walking. The researchers established a regression equation model and observed a significant change in the dynamic plantar pressure regression factor index after implementing foot orthotics. The study specifically focused on pes cavus patients and highlighted the substantial impact of custom foot orthotics on the regression factor