Effect of Foot Muscles Training and Foot Orthosis on the Medial Arch in Flatfoot Subjects

Effect of Intrinsic Foot Muscles Training and Foot Orthosis on the Medial Longitudinal Arch in Flexible Flatfoot Subjects

Orthotic therapy or exercise therapy is the standard conservative treatment for flexible flat foot. Little is known about the effectiveness of their interaction on managing flatfoot.

The study aims to evaluate the effect of insoles and short foot exercise on the height and area of the medial longitudinal arch of flexible flatfoot participants as well as the force and pressure.

Study Overview

• Status: Completed
• Conditions: Flexible Flatfoot
• Intervention / Treatment: Device: foot insole; Other: short foot exercise

Detailed Description

Study design: A parallel, active-control study design was used to conduct a single-blinded randomized controlled trial.

Method: The toe rising test, the "too many toes" sign, and the navicular drop test was used to select 30 participants with flexible flatfoot. Participants was randomly assigned either to an experimental group (n = 15) or a control group (n = 15). The experimental group received short foot exercises (SFE) and insoles, and the control group received only insoles. SFE was implemented 30 times for a duration of three minutes each day over the course of six weeks. The exercise progressed from sitting to standing and finally to one leg stance position within every two weeks. The participants wore shoes containing orthotic insoles for eight hours per day for six weeks. The EMED-x system was used to measure plantar pressure distribution (force, area, and pressure) at baseline and at two-week intervals throughout the six-week intervention. The Lower Extremity Functional Scale (LEFS) was used to evaluate restriction in participants' functional abilities, and the navicular drop test (NDT) was used to assess the medial longitudinal arch (MLA) height. Both variables were measured at baseline and at the sixth week.

Statistics: Mixed-effects ANOVA was used to test for significant interactions between the two groups across time and within-subject observations of the outcomes.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Saudi Arabia
  • Eastren
    • Dammam, Eastren, Saudi Arabia
      • Imam Abdulrahman bin Faisal University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 36 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Females and males aged between 18 and 36
• Bilateral symptomatic flexible flatfoot, with symptoms including foot pain and lower limb fatigue
• Participants must show positive physical examination findings, including a positive result for the "too many toes" sign, the navicular drop test, and the foot toe raising test (Carr et al., 2016). A positive result for the "too many toes" sign occurs when more toes can be seen on the lateral side of each foot due to external rotation and abduction of the feet, and the positive result for the toe rising test is the reconstruction of the medial longitudinal arch secondary to the tightness of the plantar fascia (Carr et al., 2016). A positive result for the navicular drop test is an arch height more than or equal to 10 mm(Aenumulapalli et al., 2017)

Exclusion Criteria:

• An anatomical discrepancy in leg length
• Pathologic or neurologic disorders of the feet
• A history of traumatic foot injury or surgery within the last six months
• History of wearing foot orthoses within the past two years

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: insole group; the control group receives insole only.	Device: foot insole; the subject was instructed to wear foot insole for 8 hours.
Experimental: exercise group; the experimental group receives exercise and insole.	Device: foot insole; the subject was instructed to wear foot insole for 8 hours.; Other: short foot exercise; the subject was instructed to perform exercise once a day 30 repetitions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The EMED (force-area-pressure)	The feet plantar pressure was measured at baseline and at two-week intervals throughout the six-week intervention.	6 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lower extremities functional scale, navicular drop test	The Lower extremities functional scale was used to evaluate restriction in participants' functional abilities, The score ranges from 0 to 80, and if it is higher indicating less functional restrictions. The navicular drop test was used to assess the medial longitudinal arch (MLA) height, A positive result for the navicular drop test is an arch height more than or equal to 10 mm. Both variables were measured at baseline and at the sixth week.	6 weeks

Collaborators and Investigators

• Sponsor: Imam Abdulrahman Bin Faisal University

Publications and helpful links

General Publications

• Abdel-Fattah, M.M., Hassanin, M.M., Felembane, F.A., Nassaane, M.T., 2006. Flat foot among Saudi Arabian army recruits: prevalence and risk factors. East. Mediterr. Health J. Rev. Sante Mediterr. Orient. Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit 12, 211-217. Abousayed, M.M., Tartaglione, J.P., Rosenbaum, A.J., Dipreta, J.A., 2016. Classifications in Brief: Johnson and Strom Classification of Adult-acquired Flatfoot Deformity. Clin. Orthop. 474, 588-593. Aenumulapalli, A., Kulkarni, M.M., Gandotra, A.R., 2017. Prevalence of Flexible Flat Foot in Adults: A Cross-sectional Study. J. Clin. Diagn. Res. JCDR 11, AC17-AC20. Allen, M.K., Glasoe, W.M., 2000. Metrecom Measurement of Navicular Drop in Subjects with Anterior Cruciate Ligament Injury. J. Athl. Train. 35, 403-406. Alnahdi, A.H., Alrashid, G.I., Alkhaldi, H.A., Aldali, A.Z., 2016. Cross-cultural adaptation, validity and reliability of the Arabic version of the Lower Extremity Functional Scale. Disabil. Rehabil. 38, 897-904. Aminian, G., Safaeepour, Z., Farhoodi, M., Pezeshk, A.F., Saeedi, H., Majddoleslam, B., 2013. The effect of prefabricated and proprioceptive foot orthoses on plantar pressure distribution in patients with flexible flatfoot during walking. Prosthet. Orthot. Int. 37, 227-232. Banwell, H.A., Mackintosh, S., Thewlis, D., 2014. Foot orthoses for adults with flexible pes planus: a systematic review. J. Foot Ankle Res. 7, 23. Buldt, A.K., Forghany, S., Landorf, K.B., Levinger, P., Murley, G.S., Menz, H.B., 2018. Foot posture is associated with plantar pressure during gait: A comparison of normal, planus and cavus feet. Gait Posture 62, 235-240. https://doi.org/10.1016/j.gaitpost.2018.03.005 Carr, J.B., Yang, S., Lather, L.A., 2016. Pediatric Pes Planus: A State-of-the-Art Review. Pediatrics 137, e20151230. Chen, Y.-C., Lou, S.-Z., Huang, C.-Y., Su, F.-C., 2010. Effects of foot orthoses on gait patterns of flat feet patients. Clin. Biomech. Bristol Avon 25, 265-270. Cheng, Y., Yang, H., Ni, L., Song, D., Zhang, H., 2015. Stress fracture of the distal fibula in flatfoot patients: case report. Int. J. Clin. Exp. Med. 8, 6303-6307. Chuter, V., Spink, M., Searle, A., Ho, A., 2014. The effectiveness of shoe insoles for the prevention and treatment of low back pain: a systematic review and meta-analysis of randomised controlled trials. BMC Musculoskelet. Disord. 15, 140. https://doi.org/10.1186/1471-2474-15-140 Daniels, T.R., Lau, J.T., Hearn, T.C., 1998. The effects of foot position and load on tibial nerve tension. Foot Ankle Int. 19, 73-78. https://doi.org/10.1177/107110079801900204 Dars, S., Uden, H., Kumar, S., Banwell, H.A., 2018. When, why and how foot orthoses (FOs) should be prescribed for children with flexible pes planus: a Delphi survey of podiatrists. PeerJ 6, e4667. https://doi.org/10.7717/peerj.4667 Giacomozzi, C., 2010. Appropriateness of plantar pressure measurement devices: A comparative technical assessment. Gait Posture 32, 141-144. https://doi.org/10.1016/j.gaitpost.2010.03.014 Hafer, J.F., Lenhoff, M.W., Song, J., Jordan, J.M., Hannan, M.T., Hillstrom, H.J., 2013. Reliability of plantar pressure platforms. Gait Posture 38, 544-548. https://doi.org/10.1016/j.gaitpost.2013.01.028 Hatfield, G.L., Cochrane, C.K., Takacs, J., Krowchuk, N.M., Chang, R., Hinman, R.S., Hunt, M.A., 2016. Knee and ankle biomechanics with lateral wedges with and without a custom arch support in those with medial knee osteoarthritis and flat feet. J. Orthop. Res. Off. Publ. Orthop. Res. Soc. 34, 1597-1605. https://doi.org/10.1002/jor.23174 Hegedus, E.J., Cook, C., Fiander, C., Wright, A., 2010. Measures of arch height and their relationship to pain and dysfunction in people with lower limb impairments. Physiother. Res. Int. 15, 160-166. https://doi.org/10.1002/pri.459 Hsieh, R.-L., Peng, H.-L., Lee, W.-C., 2018. Short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children: A randomized controlled trial. Medicine (Baltimore) 97, e10655. https://doi.org/10.1097/MD.0000000000010655 Huang, Y.-C., Wang, L.-Y., Wang, H.-C., Chang, K.-L., Leong, C.-P., 2004. The relationship between the flexible flatfoot and plantar fasciitis: ultrasonographic evaluation. Chang Gung Med. J. 27, 443-448. Imhauser, C.W., Abidi, N.A., Frankel, D.Z., Gavin, K., Siegler, S., 2002. Biomechanical evaluation of the efficacy of external stabilizers in the conservative treatment of acquired flatfoot deformity. Foot Ankle Int. 23, 727-737.

Study record dates

Study Major Dates

• Study Start (Actual): October 27, 2018
• Primary Completion (Actual): March 1, 2020
• Study Completion (Actual): March 1, 2020

Study Registration Dates

• First Submitted: July 2, 2020
• First Submitted That Met QC Criteria: July 16, 2020
• First Posted (Actual): July 21, 2020

Study Record Updates

• Last Update Posted (Actual): July 21, 2020
• Last Update Submitted That Met QC Criteria: July 16, 2020
• Last Verified: July 1, 2020

More Information

Terms related to this study

• Keywords: Insole; Orthotic; Flatfoot; Short-foot exercise
• Additional Relevant MeSH Terms: Congenital Abnormalities; Musculoskeletal Diseases; Musculoskeletal Abnormalities; Limb Deformities, Congenital; Foot Deformities; Foot Deformities, Acquired; Foot Deformities, Congenital; Lower Extremity Deformities, Congenital; Talipes; Flatfoot
• Other Study ID Numbers: PGS-2018-03-184

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No