Comparison of Exercise Effects in Individuals With Flatfoot

NCT06313125 | Completed

• 1 other identifier: E-77082166-302.08.01-796166
• Study Type: interventional
• Target: 56
• Locations: 1 country
• Sites: 1

Brief Summary

Flexible flatfoot deformity, also known as flexible pes planus, is a common pathological condition characterized by decreased medial longitudinal arch height, eversion of the calcaneus and abduction of the forefoot, especially during loading. Conservative treatments are generally considered as the first step in treatment. In conservative treatments, exercise methods are one of the most frequently used interventions. It has been reported that exercise can improve functional outcomes such as navicular drop, plantar pressure distribution, foot posture, balance, and muscle strength in adults with flexible flatfoot. Although it is known that intrinsic muscle strengthening exercises are a frequently used intervention method in foot pathologies, there is a deficiency in the literature regarding studies investigating the effect of the combination of the most basic foot intrinsic muscle strengthening exercises with different exercise interventions on targeted clinical gains. However, the effect of three-dimensional foot-ankle exercise on flat feet is unknown. Additionally, there are a limited number of studies in the literature investigating the effects of hip abductor and external rotator muscle strength training on foot posture in individuals with flat feet. The aim of this thesis study, planned in the light of this information, is to determine the effects of three-dimensional foot-ankle extension exercises and hip abductor-external rotator muscle strengthening exercise primarily on navicular drop and MLA height in individuals with flexible flat feet; Secondly, it is to examine and compare the effects of static foot posture, hip abductor/external rotator, ankle circumference and intrinsic muscle strength on the functional performance of the lower extremity (endurance, dynamic balance and single leg forward jumping performance). To our knowledge, this study will be the first randomized controlled study to examine and compare the effects of two different exercise interventions that exercise the proximal and distal regions in flatfoot rehabilitation, and the results obtained will contribute to the development of better exercise and treatment programs in this population. In individuals with flat feet, when hip abductor/external rotator strengthening exercises or 3D foot-ankle extension exercises in the PNF pattern are added to short-foot exercise, MLA structure, muscle strength and lower extremity function will be improved more, and when these exercises are combined with short-foot exercise, they are comparable to intrinsic muscle strengthening exercises alone. The investigators hypothesized that it would produce superior clinical results.

Conditions

Flat Foot [Pes Planus] (Acquired), Unspecified Foot

Outcome Measures

Primary Outcomes (1)

• Medial longitudinal arch height-Navicular Drop Test

  To detect flatfoot MLA height will be evaluated by the Navicular Drop Test. According to this test result, if the MLA height is between 5-9 mm, the foot is in neutral position; If it is 4 mm or lower, the foot is in supination; If the value is 10 mm or more, a classification can be made as the foot is in pronation. This result will also be used when determining the inclusion criteria, and values of 10 mm and above will be interpreted as low arc.

  6 weeks

Secondary Outcomes (3)

• Static foot posture-Foot Posture Index-6

  6 weeks

• Foot structure-Photopodometric analysis

  6 weeks

• Recording demographic and clinical information on the evaluation form

  1 week

Study Arms (3)

Foot-ankle exercise group

EXPERIMENTAL

In the foot-ankle exercise group, three-dimensional foot-ankle extension exercises will be applied in the Proprioceptive Neuromuscular Facilitation (PNF) pattern, in diagonal 1 and 2 directions and short-foot exercise.

Other: 3-dimensional foot-ankle extension exercises; Other: Short-foot exercise

Hip exercise group

ACTIVE COMPARATOR

Clam exercise will be given to this group as a hip abductor and external rotator strengthening exercise. In addition, short-foot exercise will be applied.

Other: Clam exercise; Other: Short-foot exercise

Control group

ACTIVE COMPARATOR

The control group will do only short-foot exercise.

Other: Short-foot exercise

Interventions

3-dimensional foot-ankle extension exercises OTHER

In three-dimensional foot-ankle extension exercises, an elastic band will be used to create resistance to the movement and the intensity/severity of the exercise will be between 13 (somewhat difficult) and 15 (difficult) according to the perceived difficulty level on the Borg scale. Exercises will begin with red (light) tape; Progression will be achieved by moving to a higher level band color \[green (medium) and blue (difficult) in that order\] every two weeks. Exercises will be performed 3 days a week (2 days supervised, 1 day at home), in 3 sets of 10 repetitions, and a 1-minute rest period will be given between sets to reduce fatigue. Short-foot exercises will be performed in 3 sets of 15 repetitions, with a 45-second rest period between sets, every day a week (2 days/week with a physiotherapist; 5 days/week at home) for 6 weeks.

Also known as: Short-foot exercise

Foot-ankle exercise group

Clam exercise OTHER

In three-dimensional foot-ankle extension exercises and clam exercise, an elastic band will be used to create resistance to the movement and the intensity/severity of the exercise will be between 13 (somewhat difficult) and 15 (difficult) according to the perceived difficulty level on the Borg scale. Exercises will begin with red (light) tape; Progression will be achieved by moving to a higher level band color \[green (medium) and blue (difficult) in that order\] every two weeks. Exercises will be performed 3 days a week (2 days supervised, 1 day at home), in 3 sets of 10 repetitions, and a 1-minute rest period will be given between sets to reduce fatigue. Short-foot exercises will be performed in 3 sets of 15 repetitions, with a 45-second rest period between sets, every day a week (2 days/week with a physiotherapist; 5 days/week at home) for 6 weeks.

Also known as: Short-foot exercise

Hip exercise group

Short-foot exercise OTHER

In clam exercise, an elastic band will be used to create resistance to the movement and the intensity/severity of the exercise will be between 13 (somewhat difficult) and 15 (difficult) according to the perceived difficulty level on the Borg scale. Exercises will begin with red (light) tape; Progression will be achieved by moving to a higher level band color \[green (medium) and blue (difficult) in that order\] every two weeks. Exercises will be performed 3 days a week (2 days supervised, 1 day at home), in 3 sets of 10 repetitions, and a 1-minute rest period will be given between sets to reduce fatigue. Short-foot exercises will be performed in 3 sets of 15 repetitions, with a 45-second rest period between sets, every day a week (2 days/week with a physiotherapist; 5 days/week at home) for 6 weeks.

Control group; Foot-ankle exercise group; Hip exercise group

Eligibility Criteria

• Age: 18 Years - 50 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Age range is 18-50 years
• Navicular drop amount is 10 mm or more
• Getting a value of +6 points or above from the Foot Posture Index

You may not qualify if:

• Orthopedic and rheumatological diseases of the spinal region and lower extremities
• Surgery history of the spine and lower extremities
• Neurological and systemic disorders
• Describing lower extremity and/or lower back pain in the last 6 months
• Disorders that may affect cognitive and balance (otitis media, visual impairment, etc.)
• Having received any physiotherapy and rehabilitation treatment for flat feet or hips in the last year
• Body mass index being above normal values (18-24.9 kg/m2)
• Having rigid flat feet and hallux rigidus-limitus deformity
• Doing regular sports or exercise

Sponsors & Collaborators

• Mustafa Kemal University: lead

Study Sites (1)

Gazi University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation

Ankara, Çankaya, 06540, Turkey (Türkiye)

Location

Related Publications (5)

• Huang C, Chen LY, Liao YH, Masodsai K, Lin YY. Effects of the Short-Foot Exercise on Foot Alignment and Muscle Hypertrophy in Flatfoot Individuals: A Meta-Analysis. Int J Environ Res Public Health. 2022 Sep 22;19(19):11994. doi: 10.3390/ijerph191911994.

  PMID: 36231295 BACKGROUND

• Unver B, Erdem EU, Akbas E. Effects of Short-Foot Exercises on Foot Posture, Pain, Disability, and Plantar Pressure in Pes Planus. J Sport Rehabil. 2019 Oct 18;29(4):436-440. doi: 10.1123/jsr.2018-0363. Print 2020 May 1.

  PMID: 30860412 BACKGROUND

• Engkananuwat P, Kanlayanaphotporn R. Gluteus medius muscle strengthening exercise effects on medial longitudinal arch height in individuals with flexible flatfoot: a randomized controlled trial. J Exerc Rehabil. 2023 Feb 23;19(1):57-66. doi: 10.12965/jer.2244572.286. eCollection 2023 Feb.

  PMID: 36910682 BACKGROUND

• Choi JH, Cynn HS, Yi CH, Yoon TL, Baik SM. Effect of Isometric Hip Abduction on Foot and Ankle Muscle Activity and Medial Longitudinal Arch During Short-Foot Exercise in Individuals With Pes Planus. J Sport Rehabil. 2020 Jul 27;30(3):368-374. doi: 10.1123/jsr.2019-0310.

  PMID: 32717719 BACKGROUND

• Esen DH, Duman T, Tas S, Karatas N. Three-dimensional foot-ankle exercise versus clam exercise in addition to short-foot exercise in individuals with flexible flatfoot: a randomized controlled trial. Physiother Theory Pract. 2025 Oct;41(10):2043-2054. doi: 10.1080/09593985.2025.2492166. Epub 2025 Apr 17.

  PMID: 40244701 DERIVED

Related Links

• The effects of Dynamic® taping on vertical jumps in adolescent volleyball players with low medial longitudinal arch

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: The evaluator researcher and participants will be blinded to group allocation.
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: MSc, PT, Principal Investigator

Model Details: There will be three groups in the study. Short-foot exercise for the control group; short-foot and 3-dimensional foot-ankle exercise for the foot-ankle group; short-foot and clam exercise will be applied for the hip group.

Study Record Dates

• First Submitted: March 2, 2024
• First Posted: March 15, 2024
• Study Start: February 21, 2024
• Primary Completion: March 31, 2024
• Study Completion: May 1, 2024
• Last Updated: June 3, 2024

Record last verified: 2024-05

Locations

TU (1)