Foot Muscle Strengthening Exercises for Pes Planovalgus

August 8, 2025 updated by: Aysenur Erekdag, Istanbul University - Cerrahpasa

Intrinsic vs Combined Foot Muscle Strengthening for Pes Planovalgus in Preschoolers: A Randomized Controlled Trial

Pes planovalgus is a common foot condition affecting the child population. It is characterized by the partial or complete collapse of the medial longitudinal arch with rearfoot eversion and forefoot abduction, which is associated with changes in lower extremity kinematics during dynamic activity.

The lower extremity chain includes the foot, ankle, knee, and hip joints, with the feet acting as the base of support. However, due to their small size, maintaining balance can be challenging. Any small dynamic change in the foot, as the support base, can impact overall body posture. The foot arch, which can be pronated or supinated, affects proprioceptive input by altering joint movement, contact area, and muscle strategy for stability. Pes planovalgus, characterized by excessive subtalar pronation, lead to instability and hypermobility, requiring more neuromuscular control to maintain balance. As a result, flat feet can cause pathomechanical issues and compensatory actions in the lower extremity chain, affecting overall body balance.

The effectiveness of exercise interventions, particularly foot intrinsic muscle strengthening exercises, in increasing the medial longitudinal arch in individuals with pes planus has been investigated in numerous studies. It is widely accepted that both intrinsic and extrinsic muscle groups play a crucial role in the formation, maintenance, and enhancement of foot arches. However, there is a lack of studies specifically examining the effectiveness of exercises aimed at strengthening these muscles in children with pes planovalgus. Therefore, the purpose of this study is to compare the effects of two corrective exercise programs focused on the improvement of the medial longitudinal arch in children with pes planovalgus: one incorporating routine intrinsic muscle exercises and the other combining them with extrinsic muscle exercises.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Voluntary children who have been diagnosed with pes planovalgus will be included in the study. Signed voluntary consent will be obtained from caregivers. Participants will be divided into two groups. Study groups will be as follows: a) Intervention Group (Intrinsic&Extrinsic Exercise), b) Control Group (Intrinsic Exercise).

Study Type

Interventional

Enrollment (Actual)

32

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey
      • Istanbul, Turkey, 34093
        • Bezmialem Vakif University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Child

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Presence of bilateral pes planovalgus,
  • Being between 4-7 years of age,
  • Having a body mass index within normal limits

Exclusion Criteria:

  • Having high femoral anteversion, internal tibial torsion and metatarsus adductus
  • Having leg length inequality
  • Having any neurological, rheumatic, musculoskeletal, metabolic and connective tissue disease
  • Having a history of pain, deformity or surgery related to the vertebral column and lower extremities
  • Having a cognitive, mental or serious psychiatric disease
  • Having been involved in any exercise program or sports activity in the last six months

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention Group
Individuals with a diagnosis of pes planovalgus who underwent supervised exercise under the guidance of a physiotherapist for 8 weeks, 1 day a week.
Other: Intrinsic and Ectrinsic Exercise
Intrinsic and extrinsic muscle strengthening exercises
Active Comparator: Control Group
Individuals with a diagnosis of pes planovalgus who underwent supervised exercise under the guidance of a physiotherapist for 8 weeks, 1 day a week.
Other: Intrinsic Exercise
Intrinsic muscle strengthening exercises

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Single Leg Stance Test
Time Frame: change from baseline balance at 2 months
It evaluates the participants' standing balance. The entire lower extremity will be positioned in full extension, while the other side will be positioned in 90 degree flexion of the lower extremity hip and knee. The time will be started when the participants' eyes are closed and the untested feet lose contact with the ground, and the time will be stopped when they put their feet back on the ground or when their body sway increases too much.
change from baseline balance at 2 months
Timed-up and Go Test
Time Frame: change from baseline balance at 2 months
TUG is a measure of dynamic balance and the risk of falling. It entails individuals rising from a chair, walking a distance of 3 feet, turning, and then sitting back down.
change from baseline balance at 2 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Range of Motion
Time Frame: 2 times for 8 weeks
For goniometric measurement, the pivot point will be placed on the lateral malleolus. The fixed arm will be held parallel to the lateral midline of the fibula. The mobile arm will follow the lateral midline of the 5th metatarsal bone.
2 times for 8 weeks
Thomas Test
Time Frame: 2 times for 8 weeks
The Thomas Test will be used to determine the shortness of the hip flexors. The Thomas test is performed with the patient in the supine position with the gluteal folds on the short side of the stretcher. The untested side lower extremity is pulled towards the abdomen by performing hip-knee flexion; the tested side extremity is checked to see if it is separated from the stretcher.
2 times for 8 weeks
Duncan-Ely Test
Time Frame: 2 times for 8 weeks
The Duncan-Ely test will be used to assess rectus femoris spasticity and shortness. In this test, the patient will be asked to lie in a prone position. The physiotherapist will attempt to quickly and passively bring the patient's knee joint on the side being assessed into full flexion. If the heel cannot touch the hip or the hip on the side being tested lifts off the stretcher, the test is considered positive.
2 times for 8 weeks
Popliteal Angle Assessment
Time Frame: 2 times for 8 weeks
It will be used to detect hamstring shortness. The patient will be in the supine position, the tested side hip-knee will be flexed to 90°, and then passive extension will be applied to the knee. Goniometric measurement will be made when the end-feel is felt in the patient's knee joint.
2 times for 8 weeks
Navicular Drop Test (NDT)
Time Frame: 2 times for 8 weeks
It is one of the static foot assessment tools and represents the sagittal plane displacement of the navicular tuberosity in a neutral position. If the NDT is below 5 mm, the foot is in supination; if it is between 6-8 mm, the foot is neutral; and if it is above 9 mm, the foot is in pronation.
2 times for 8 weeks
Foot Posture Index-6 (FPI-6)
Time Frame: 2 times for 8 weeks
FPI-6, which is a simple, fast and reliable method applicable to pediatric feet, defines the static postural analysis of the foot when equal load is applied to both feet during standing. Scores of 0-5 define normal foot; 6-9 define pes planovalgus and 10-12 define advanced pes planovalgus.
2 times for 8 weeks
6-minutes Walking Test
Time Frame: 2 times for 8 weeks
It is a useful test to assess functional exercise capacity. Patients are asked to walk as fast as they can down a straight 30-meter corridor for six minutes.
2 times for 8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Istanbul University - Cerrahpasa

Investigators

  • Principal Investigator: Deniz Tuncer, PhD, Bezmialem Vakif University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 2, 2024

Primary Completion (Actual)

January 15, 2025

Study Completion (Actual)

February 5, 2025

Study Registration Dates

First Submitted

August 8, 2024

First Submitted That Met QC Criteria

August 8, 2024

First Posted (Actual)

August 12, 2024

Study Record Updates

Last Update Posted (Actual)

August 13, 2025

Last Update Submitted That Met QC Criteria

August 8, 2025

Last Verified

August 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • DT2024-AE

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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