Effect of Core Stability Versus Ankle Foot Strengthening Exercise in the Management of Knee Osteoarthritis

March 22, 2026 updated by: Shaikh Nabi Bukhsh Nazir, Dow University of Health Sciences
Knee osteoarthritis (KOA) is a degenerative joint disease causing pain, stiffness, and reduced quality of life. While treatments often focus on drugs or surgery, noninvasive exercises like core stabilization and ankle/foot strengthening show potential but lack comparative studies. Understanding anatomical factors like Achilles tendon (AT) thickness is crucial for targeted rehabilitation, though measurement reliability remains an issue. This study aims to compare the effects of these exercises on KOA symptoms and evaluate the use of digital calipers for AT thickness measurement, aiming to enhance clinical management of KOA.

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Detailed Description

The objective of the study is:

  1. To determine the interrater and intrarater reliability of digital calliper to measure the side to side Achilles tendon thickness.
  2. To determine the impact of 24 sessions of core stability translated in gait ambulation.
  3. determines the relationships between Achilles tendon thickness (ATT), knee symptoms/functions, and foot alignment in knee OA patients, considering their interconnected biomechanical nature.
  4. compare the effects of core stability and ankle-foot strengthening exercises on clinical outcomes in KOA patients

Study Type

Interventional

Enrollment (Estimated)

100

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

  • Pakistan
    • Sindh
      • Karachi, Sindh, Pakistan
        • BIPTRM

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

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • 40 years old, had been diagnosed with KOA based on ACR, and

    • having Grade II or III osteoarthritis by K/L criteria.

Exclusion Criteria:

  • post-traumatic osteoarthritis
  • lower limb sensorimotor dysfunction,
  • Any history of knee fracture/ tumor/ infection and hip/knee surgery.
  • Total Knee Replacement patients.
  • Neurological disease.
  • Patient received physical therapy treatment from last 6 months.
  • Inflammatory Arthritis (Rheumatoid Arthritis)
  • Use of any intra-articular injections (steroid/ hyaluronic acid/ PRP.) from last 3-6 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: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Foot-ankle strengthening exercise
resistance exercises with proper warm up and cool down
Other: foot-ankle strengthening exercise
  1. Isometric quadriceps exercises involving knee extension
  2. Maximum isometric exercise for the quadriceps
Experimental: Core Stability

Core Stability exercises:

Bridging Lateral Step up etc
Other: core stability exercise
  1. Isometric quadriceps exercises involving knee extension
  2. Maximum isometric exercise for the quadriceps

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Knee Injury and Osteoarthritis Outcome Score (KOOS) Questionnaire
Time Frame: 8 weeks
Changes from baseline, KOOS score consist of five patient-relevant dimensions that are scored separately: Pain (nine items); Symptoms (seven items); ADL Function (17 items); Sport and Recreation Function (five items); Quality of Life (four items). A Likert scale is used and all items have five possible answer options scored from 0 (No problems) to 4 (Extreme problems) and each of the five scores is calculated as the sum of the items included. This scale consist of total 42-items and score of this scale range from 0 (severe knee pathology) to 100 (no knee problem). This tool has been use to assess the pain, symptoms, activities level, function in knee osteoarthritis patients. It is a valid tool for Knee Osteoarthritis patients ; validity ranges up-to (0.80-0.89).
8 weeks
Visual Analogue Scale (VAS) at rest
Time Frame: 8 weeks
Changes from baseline, Visual Analogue Scale (VAS) is the most commonly used scale in which the pain rate ranges from 0 (no pain) to 10 (worst pain). The level of knee perception of pain is assessed by using the VAS.
8 weeks
Stair climb test
Time Frame: 8 weeks
change from baseline, time taken to ascend and descend the stairs
8 weeks
Knee flexion range of motion
Time Frame: 8 weeks
Change from baseline, flexion was assessed with a goniometer
8 weeks
knee extension range of motion
Time Frame: 8 weeks
change from baseline, extension was assessed with goniometer
8 weeks
Achilles tendon thickness
Time Frame: 8 weeks
Change from baseline, tendon thickness was measured was assessed with digital calliper
8 weeks
30 second chair test
Time Frame: 8 weeks
change from baseline, The 30 Second Sit to Stand Test is also known as 30 Second Chair Stand Test (30CST), was initially designed for testing leg strength and endurance in older adults.
8 weeks
Timed up and go test
Time Frame: 8 weeks
The Timed Up and Go Test (TUG) assesses mobility, balance, walking ability, and fall risk in older adults
8 weeks
40 meter walk test
Time Frame: 8 weeks
Instruct patient to walk as quickly, but as safely as possible, without running, along 10m walkway, past the taped line, & then turn around cone & return.
8 weeks
Gastrocnemius muscle strength
Time Frame: 8 weeks
Patient to perform plantar flexion in the form of single-limb heel raise
8 weeks
navicular/foot ratio
Time Frame: 8 weeks
The midfoot alignment was assessed using the navicular/foot ratio, which is calculated as the ratio of the navicular height to the total foot length.
8 weeks
Ankle range of motion
Time Frame: 8 weeks
The dorsiflexion range of ankle movement was evaluated using the knee-to-wall lunge technique
8 weeks

Collaborators and Investigators

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

Sponsor

Dow University of Health Sciences

Investigators

  • Principal Investigator: SHAIKH NABI BUKHSH NAZIR, PhD Scholar, Dow University of Health Sciences/ Baqai Medical University

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)

July 22, 2023

Primary Completion (Estimated)

March 31, 2026

Study Completion (Estimated)

April 30, 2026

Study Registration Dates

First Submitted

January 2, 2025

First Submitted That Met QC Criteria

January 4, 2025

First Posted (Actual)

January 9, 2025

Study Record Updates

Last Update Posted (Actual)

March 25, 2026

Last Update Submitted That Met QC Criteria

March 22, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • BMU/Approval?

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

product manufactured in and exported from the U.S.

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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