Effectiveness of Manuel Therapy Methods in Pes Planus

Comparison of the Immediate Effects of Different Manual Therapy Methods in Physically Active Individuals With Pes Planus

The aim of this study is to compare the immediate effects of joint-oriented manual therapy and soft tissue-oriented manual therapy on dorsiflexion angle, static and dynamic balance, muscle-tendon mechanical properties, and thermal variables in physically active individuals with flexible pes planus. The research will be conducted between November 2025 and January 2026 at Hacettepe University, Faculty of Physical Therapy and Rehabilitation. Individuals aged 18-35 years with a Tegner Activity Score between 4 and 6 will be included. Participants will be allocated into three groups: soft tissue-oriented manual therapy group, joint-oriented manual therapy group, and control group. Following randomization, the respective intervention will be applied to the intervention groups, while no intervention will be administered to the control group. Assessments will include the dorsiflexion range of motion (weight-bearing lunge test), myotonometric measurements (Myoton-Pro), static balance (Kinvent force platform), dynamic balance (Y-balance test), and thermographic imaging (FLIR E52). The outcomes of this study are expected to contribute to understanding the immediate effectiveness of manual therapy approaches applied in asymptomatic pes planus and to identify the method providing optimal benefit. Furthermore, the differences observed between individuals with pes planus and healthy controls will serve as a guide for clinical assessments of pes planus.

Study Overview

• Status: Completed
• Conditions: Pes Planus
• Intervention / Treatment: Other: joint mobilization; Other: myofascial release

• Study Type: Interventional
• Enrollment (Actual): 33
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye), 06100
    • Hacettepe University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria for all Groups:

• Navicular Drop Test ≥ 10 mm
• Foot Posture Index (FPI) > 6
• Tegner Activity Scale score between 4 and 6 (inclusive)
• Age between 18 and 35 years

Exclusion Criteria for All Groups:

• Diagnosis of posterior tibial tendinopathy by an orthopedic surgeon
• Presence of plantar fasciitis or moderate/severe hallux valgus
• History of lower extremity surgery or trauma
• Presence of neurological, metabolic, or other musculoskeletal disorders that may affect gait or balance performance
• Receipt of any treatment for pes planus within the past year
• Body mass index (BMI) greater than 30 kg/m²
• Regular participation in sports activities

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: control; control group without intervention
Experimental: joint mobilization group; subtalar and midtarsal joint mobilization in patients with flexible pes planus	Other: joint mobilization; subtalar and midtarsal joint mobilization
Experimental: myofascial release group; calf and plantar fascia release in patients with flexible pes planus	Other: myofascial release; calf and plantar fascia release

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
static balance	1 Static Balance Measurement Static balance will be assessed using the Kinvent K-Plates (Kinvent, Montpellier, France), a reliable portable force plate with a 1000 Hz sampling rate. Participants will stand on one leg with hands on hips and the other leg flexed, focusing on a point 5 m away for 10 s. The test will be repeated with eyes closed. Postural oscillations (mm) and center of pressure (COP) (mm) data will be reported instantly via the mobile app. Each condition will be measured three times.	2 months
dynamic balance	Dynamic Balance Measurement Dynamic balance will be assessed using the Y-Balance Test platform (Move2Perform, Evansville, USA). Participants will reach in anterior, posteromedial, and posterolateral directions while maintaining single-leg stance, hands on hips. The maximum reach distance(cm) in each direction will be recorded. After practice trials, three valid attempts per direction will be completed. Results will be expressed as normalized composite scores(%) relative to limb length.	2 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
myotonometric muscle tone	Muscle tone (Hz), will be assessed using the Myoton-Pro myotonometer (Myoton SA, Tallinn, Estonia; ICC: 0.76-0.86). Measurements will be taken from the Tibialis Anterior, Medial and Lateral Gastrocnemius, Soleus, Achilles tendon, and Plantar Fascia. The 3 mm probe will be applied perpendicularly to the skin (<3% error). Each site will be tested in standardized positions (supine or prone) and measured three times to obtain mean values for each mechanical property.	2 months
myotonometric muscle stiffness	Muscle stiffness (N/m) will be assessed using the Myoton-Pro myotonometer (Myoton SA, Tallinn, Estonia; ICC: 0.76-0.86). Measurements will be taken from the Tibialis Anterior, Medial and Lateral Gastrocnemius, Soleus, Achilles tendon, and Plantar Fascia. The 3 mm probe will be applied perpendicularly to the skin (<3% error). Each site will be tested in standardized positions (supine or prone) and measured three times to obtain mean values for each mechanical property.	2 months
ankle dorsiflexion range of motion	Ankle dorsiflexion ROM will be assessed with the Weight-Bearing Lunge Test (WBLT), a reliable method (ICC > 0.90). Participants will lunge toward a wall, keeping the heel in contact with the floor. The maximum distance (cm) from the great toe to the wall at which the knee touches without heel lift will be recorded. At this final position, a digital inclinometer will be placed on the tibia's midline to determine the tibial inclination angle (°). Measurements will be taken on both limbs under identical conditions.	2 months
skin surface thermographic measurement	Skin surface temperature (°C) will be assessed using a FLIR E52 thermographic camera (240×180 px infrared resolution, 50 mK sensitivity). Images will be captured in a controlled environment (23 ± 1°C; 40-60% humidity) and analyzed offline with Flir ResearchIR Max 4. Participants will acclimate for 15 min before testing. The emissivity will be set at 0.98, rainbow palette (27-35°C scale) applied, and the camera placed 1 m away, perpendicular to the skin. In the prone position, plantar fascia and sole temperatures will be recorded; in standing, calf and Achilles tendon regions will be imaged, with the highest temperature (°C) documented for each area.	2 months

Collaborators and Investigators

• Sponsor: Hande Guney Deniz
• Investigators: Study Director: Hande Guney-Deniz, Prof. Dr, Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Departmen of Musculoskeletal Physiotherapy and Rehabilitation, Ankara, Türkiye

Study record dates

Study Major Dates

• Study Start (Actual): December 20, 2025
• Primary Completion (Actual): February 8, 2026
• Study Completion (Actual): February 15, 2026

Study Registration Dates

• First Submitted: November 29, 2025
• First Submitted That Met QC Criteria: January 3, 2026
• First Posted (Actual): January 8, 2026

Study Record Updates

• Last Update Posted (Actual): April 7, 2026
• Last Update Submitted That Met QC Criteria: April 1, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: stiffness; balance; range of motion; pes planus; manuel therapy
• Additional Relevant MeSH Terms: Talipes; Musculoskeletal Diseases; Musculoskeletal Abnormalities; Congenital Abnormalities; Lower Extremity Deformities, Congenital; Limb Deformities, Congenital; Foot Deformities; Foot Deformities, Acquired; Foot Deformities, Congenital; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Flatfoot; Therapeutics; Complementary Therapies; Physical Therapy Modalities; Rehabilitation; Therapy, Soft Tissue; Musculoskeletal Manipulations; Massage; Myofascial Release Therapy
• Other Study ID Numbers: pesplanus2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Will be shared with a plausible reason.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

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