Effects of Sand Exercise Program On Foot Posture , Navicular Drop and Dynamic Balance in Children With Pronated Foot

This randomized controlled trial investigates the effects of combining sand training with navicular drop interventions on foot posture and dynamic balance in children aged 6-11 with pronated feet. Pronated foot posture, marked by inward foot rolling and a lowered arch, can impair gait and balance. Early intervention is key to preventing long-term issues. Twenty participants will be divided into experimental and control groups. Over eight weeks, the experimental group will perform sand and towel curl exercises, while the control group will do towel curls only. Foot posture, navicular drop, and balance will be assessed using the FPI-6, Navicular Drop Test, Y Balance Test, and Feiss Line Test at baseline, 4 weeks, and 8 weeks. The study aims to evaluate the added benefits of sand training in improving pediatric foot health.

Study Overview

• Status: Completed
• Conditions: Pronated Foot
• Intervention / Treatment: Other: Sand Activites; Other: Towel Curl Exercises; Other: (TCE)

Detailed Description

The effects of sand training exercises combined with navicular drop interventions on dynamic balance and foot posture in children aged 6 to 11 years with pronated feet. Pronated foot posture, characterized by the inward rolling of the foot and a lowered medial arch, is prevalent in pediatric populations and can lead to altered gait mechanics and reduced dynamic balance. Early intervention is crucial to prevent long-term deformities and improve overall foot health. The study aims to provide evidence-based insights into the benefits of integrating proprioceptive training with specific sand exercises program targeting the navicular bone, thereby enhancing foot posture and dynamic balance in affected children.

This randomized controlled trial (RCT) will involve 20 participants divided into an experimental group and a control group to assess the effects of an 8-week exercise program on foot health in children with pronated feet. The experimental group will perform sand activities and towel curl exercises three times a week, while the control group will only perform towel curl exercises. The study will measure foot posture, navicular drop, and dynamic balance using the Foot Posture Index (FPI-6), Navicular Drop Test, Y Balance Test, and Feiss Line Test, with assessments conducted at baseline, 4 weeks, and 8 weeks post-intervention. This study aims to provide evidence on the effects of combining sand training with towel curl exercises for determining foot posture.

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54900
      • Rising Sun Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Children aged [6-11] years with bilateral pronated feet.
• Both gender
• No recent foot injury or lower extremity pain from last six months
• Has no history of foot and ankle surgery lifetime
• All eligible children were assessed with the Feiss line method

Exclusion Criteria:

• the presence of pain in the foot at the time of physical examination
• injury to the lower limbs, such as musculoskeletal injuries, during the previous 6 months congenital structural abnormalities, cerebral palsy, motor dysfunction prior surgery affecting the foot

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A; Clinical experimental: For group A each session last 50 minutes daily for 8 weeks 3 times per week during a 8-week period	Other: Sand Activites; Exercises included walking, jogging, striding, bounding, galloping, and short sprints.Exercise intensity (running speed) was controlled using a stopwatch and predefined running distances on the sand-based exercise court.; Other: Towel Curl Exercises; The experimental group will perform Towel Curl Exercises Sand .In Week 1-4 the exercises will conducted without weights while in weeks 5-8 the exercise included the use of dumbbells weighing 2kg.this exercises will conducted in a sitting position on a slick surface.
Active Comparator: Group B; Clinical experimental: For group B each session lasted for 5 minutes. The exercise was performed in three sets per week, with each set lasting 5 minutes. Participants performed the exercise 20-25 times for 8 weeks	Other: Sand Activites; Exercises included walking, jogging, striding, bounding, galloping, and short sprints.Exercise intensity (running speed) was controlled using a stopwatch and predefined running distances on the sand-based exercise court.; Other: (TCE); The control group will only perform towel curl exercises In Week 1-4 the exercises will conducted without weights while in weeks 5-8 the exercise included the use of dumbbells weighing 2kg.this exercises will conducted in a sitting position on a slick surface.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feiss line Test	The Feiss Line Test assesses the medial longitudinal arch by drawing a line from the medial malleolus to the first metatarsophalangeal joint. The navicular tuberosity should lie on or near this line; displacement below indicates arch lowering. A perpendicular distance from the navicular to this line is measured-positive if above, negative if below. The test shows high reliability, with inter-tester ICC of 0.94 and intra-tester ICC of 0.91, indicating consistent measurements across and within testers.	base line ,4th week ,8th week
Foot Posture Index (FPI -6 )	Foot posture is assessed using the Foot Posture Index (FPI-6) with the subject barefoot in a relaxed standing position. It evaluates six criteria across the forefoot, midfoot, and hindfoot, including talar head palpation, malleolar curvature, calcaneal position, talonavicular prominence, medial arch height, and forefoot alignment. Scores range from -12 (highly supinated) to +12 (highly pronated). The FPI-6 is a quick, simple, and reliable tool, showing strong intra-rater reliability (ICC 0.81-0.92) and good inter-rater reliability (ICC 0.69), especially in pediatric assessments.	base line ,4th week ,8th week
Navicular Drop Measurement	The Navicular Drop Test (NDT) measures foot pronation by comparing navicular height in a seated subtalar neutral position to its height in relaxed standing. It shows moderate to good intra-rater reliability, with ICC values ranging from 0.61 to 0.79, making it a useful clinical tool for assessing pronation	base line ,4th week ,8th week
Dynamic Balance Assessment	The Star Balance Test (or Y-Balance Test) assesses dynamic balance by having participants reach in three directions-anterior, posteromedial, and posterolateral-while balancing on one foot. The test is performed clockwise for the right foot and counterclockwise for the left. Reach distance is recorded, and errors require a retest. It shows good interrater reliability with ICC values of 0.80-0.85 and a standard error of 3.1-4.2 cm.	base line ,4th week ,8th week

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Eishah M Saeed, MS-PPT, Riphah International University

Publications and helpful links

General Publications

• Alam F, Raza S, Moiz JA, Bhati P, Anwer S, Alghadir A. Effects of selective strengthening of tibialis posterior and stretching of iliopsoas on navicular drop, dynamic balance, and lower limb muscle activity in pronated feet: A randomized clinical trial. Phys Sportsmed. 2019 Sep;47(3):301-311. doi: 10.1080/00913847.2018.1553466. Epub 2018 Dec 5.

Study record dates

Study Major Dates

• Study Start (Actual): April 17, 2025
• Primary Completion (Actual): June 17, 2025
• Study Completion (Actual): June 18, 2025

Study Registration Dates

• First Submitted: April 24, 2025
• First Submitted That Met QC Criteria: April 24, 2025
• First Posted (Actual): May 2, 2025

Study Record Updates

• Last Update Posted (Actual): February 25, 2026
• Last Update Submitted That Met QC Criteria: February 23, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: foot posture; navicular drop; Pronated foot; sand exercise program
• Other Study ID Numbers: REC//RER/AHS/24/0733

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