Foot Posture and Balance in Children With Flexible Flatfeet: Effects of Mud-walk

NCT07244172 | Recruiting DMC

• 1 other identifier: REC/RCR&AHS/SAMANMAQBOOL
• Study Type: interventional
• Target: 37
• Locations: 1 country
• Sites: 1

Brief Summary

The study will be a quasi-experimental study with a pre-post study design. 37 children with bilateral flexible flatfeet of age 6-11 years will be recruited by non-probability convenience sampling with pre and post assessment. The navicular height, foot posture, balance and functional performance of lower limb will be assessed through Navicular Drop Test, Foot Posture Index-6, Pediatric Berg Balance Scale and Single Leg Hop Test respectively. All recruited children will receive intervention for 30 minutes a day for 3 days a week for total 6 weeks. The exercise program will include warm up phase, walk on mud and cool down phase. Data will be analyzed through SPSS version 27.0.

Conditions

Flexible Flatfoot

Keywords

Balance; Flexible Flatfoot; Foot Posture; Foot Posture Index; Navicular Drop Test; Pediatric Berg Balance Scale

Outcome Measures

Primary Outcomes (3)

• Foot Posture Index-6 (FPI-6)

  FPI-6 is a clinical tool for quantifying foot positioning that uses established criteria. The FPI consists of the following six items, each graded on a scale of -2 to +2 referring to the position of the forefoot, midfoot and hindfoot, and the three planes of motion: 1. talar head palpation; 2. symmetry of supra and infra lateral malleolar curvature; 3. inversion/eversion of the calcaneus; 4. prominence in the region of the talus-navicular joint; 5. height of the medial longitudinal arch; 6. abduction/adduction of the forefoot. The FPI thus obtained ranges from -12 (highly supinated) to +12 (highly pronated). It can be * highly pronated (+10 to +12) * pronated (+6 to +9) * normal (0 to +5) * supinated (-1 to -4) * highly supinated (-5 to -12). FPI-6 demonstrates a perfect weighted kappa value (Kw = 0.86), with a high intra-rater reliability (ICC = 0.96)

  Baseline and 6th week

• Navicular Drop Test (NDT)

  Navicular Drop Test is used to evaluate the amount of foot pronation. It is considered as a reliable and valid tool to measure static navicular height. The navicular height is measured while the child is sitting with barefoot flat on a platform with 90◦ knee flexion and the subtalar joint in neutral position. The Navicular drop is recorded as the difference in navicular height between subtalar joint neutral position and relaxed standing. Navicular drop more than 9 mm represented a pronated foot type, 5-9 mm a neutral foot and less than 5 mm a supinated foot. This test's intra-rater and inter-rater reliability has been demonstrated to range from 0.73 to 0.96 .

  Baseline and 6th week

• Pediatric Berg Balance Scale (PBBS)

  A 14-item criterion-referenced measure that examines functional balance in the context of everyday tasks in the pediatric population. Each item level scores range from 0-4 which is determined by the ability to perform the assessed activity. Maximum score = 56 points with 56 points being a perfect score. Test-retest (ICC2,1 = 0.923), interrater (ICC2,1 = 0.972), and intra-rater (ICC2,1 = 0.895-0.998) are reliabilities of PBS. It has high internal consistency (Cronbach α = 0.94) .

  Baseline and 6th week

Secondary Outcomes (1)

• Single Leg Hop Test

  Baseline and 6th week

Study Arms (1)

Mud training

OTHER

The children will walk on within a rectangular boundary of "2 × 8 dimension" (2 feet by 8 feet) with 5 cm depth. The exercise program will have 3 phases: warm up, walk on mud and cool down. The warm up phase will consist of stretching of the hamstring muscles using the static technique. The main exercise program will include walk on mud in four manners and progression will be added after 3 weeks.

Other: mud-walk

Interventions

mud-walk OTHER

* The participants will walk on the mud within a rectangular boundary of "2 × 8 dimension" (2 feet by 8 feet) with 5 cm depth. * The exercise program will have 3 phases: warm up, walk on mud and cool down. * The warm up phase will consist of stretching of the hamstring muscles using the static technique. The main exercise phase will consist of 20 minutes of walk on mud in four manners with each manner for 5 minutes: 1. forward walk 2. back ward walk 3. sideways walk 4. S-shaped or figure-eight walk After 3 weeks, while walking in each manner the participants will pick up small objects (soft balls) with toes from mud and place them elsewhere. The cool down phase will consist of 5 minutes and will include * soaking feet in water * washing with soap * rinsing with clean water, * drying with towel * application of emollient

Mud training

Eligibility Criteria

• Age: 6 Years - 11 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17)

You may qualify if:

• Children with bilateral flexible flat feet
• Children aged 6-11 years
• Children who are not involved in any other trial
• FPI-6 score \>6

You may not qualify if:

• Children with rigid flatfeet
• Prior foot or ankle surgery
• Pain in lower extremities
• Overweight or obese
• Any other foot deformities
• Any neurological or neuromuscular disorder

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Imran Amjad

Lahore, Punjab Province, 5400, Pakistan

RECRUITING

Related Publications (1)

• Markowicz M, Skrobot W, Labuc A, Poszytek P, Orlikowska A, Perzanowska E, Krasowska K, Drewek K, Kaczor JJ. The Rehabilitation Program Improves Balance Control in Children with Excessive Body Weight and Flat Feet by Activating the Intrinsic Muscles of the Foot: A Preliminary Study. J Clin Med. 2023 May 9;12(10):3364. doi: 10.3390/jcm12103364.

  PMID: 37240471 BACKGROUND

MeSH Terms

Conditions

Flatfoot

Condition Hierarchy (Ancestors)

Talipes; Foot Deformities, Acquired; Foot Deformities; Musculoskeletal Diseases; Foot Deformities, Congenital; Lower Extremity Deformities, Congenital; Limb Deformities, Congenital; Musculoskeletal Abnormalities; Congenital Abnormalities; Congenital, Hereditary, and Neonatal Diseases and Abnormalities

Study Officials

• Saman Maqbool, MS-PT

  Riphah International University

  PRINCIPAL INVESTIGATOR

Central Study Contacts

IMRAN AMJAD, PhD

CONTACT

9233224390125; imran.amjad@riphah.edu.pk

Muhammad Asif Javed, MS-PT

CONTACT

923224209422; a.javed@riphah.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: OTHER
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: This quasi-experimental study aims to determine effects of mud-walk on foot posture and balance in children with flexible flatfeet. The study will involve 37 children with bilateral flexible flatfeet of age 6-11 years. The navicular height, foot posture, balance and functional performance of lower limb will be assessed through Navicular Drop Test, Foot Posture Index-6, Pediatric Berg Balance Scale and Single Leg Hop Test respectively. All recruited children will receive intervention for 30 minutes a day for 3 days a week for total 6 weeks. The exercise program will include warm up phase, walk on mud and cool down phase.

Study Record Dates

• First Submitted: November 17, 2025
• First Posted: November 24, 2025
• Study Start: October 22, 2025
• Primary Completion (Estimated): June 2, 2026
• Study Completion (Estimated): June 16, 2026
• Last Updated: November 24, 2025

Record last verified: 2025-11

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)