Effects of Two Foot-Ankle Interventions on Foot Structure, Function, and Balance Ability in Obese People with Pes Planus

Du-Jin Park, Kyung-Sun Lee, Se-Yeon Park, Du-Jin Park, Kyung-Sun Lee, Se-Yeon Park

Abstract

Obese people are prone to foot deformities such as flat feet. Foot management programs are important to prevent them. This study investigated the effects of two foot-ankle interventions on balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions in obese people with pes planus for four weeks. The experiment was designed as a randomized controlled trial. Twenty-four participants who met the inclusion criteria were selected, and they were randomly assigned to either a short foot group (SFG) or proprioceptive neuromuscular facilitation group (PNFG) according to foot-ankle intervention. Two interventions were commenced three times a week for 20 min over four weeks. The tests were conducted at two intervals: pre-intervention and at four weeks. The tests were conducted in the following order: the patient-specific functional scale test (PSFS), an ultrasound of the plantar fascia, the navicular drop test, balance test, and the four-way ankle strength test. Two groups showed significant differences in balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions between pre-test and post-test (p < 0.05). PNFG had significantly higher dorsiflexor and invertor strength than SFG (p < 0.05). SF and PNF interventions were effective to improve balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions in obese people with pes planus. Additionally, PNF intervention is more beneficial in increasing the dorsiflexor and invertor strength compared to SF intervention.

Keywords: foot-ankle exercises; obesity; pes planus; proprioceptive neuromuscular facilitation; short foot.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of participants in this study. PNF, proprioceptive neuromuscular facilitation.
Figure 2
Figure 2
Questionnaire for foot function.
Figure 3
Figure 3
Short foot exercise: (A) sitting position; (B) standing position.
Figure 4
Figure 4
PNF exercise: (A) diagonal 1 flexion, (B) diagonal 1 extension, (C) diagonal 2 flexion, and (D) diagonal 2 extension.
Figure 5
Figure 5
Comparisons of dorsiflexor strength and evertor strength between the short-foot (SF) and proprioceptive neuromuscular facilitation (PNF) interventions. * p < 0.05.

References

    1. Doytch N., Dave D.M., Kelly I.R. Global Evidence on Obesity and Related Outcomes: An Overview of Prevalence, Trends, and Determinants. East. Econ. J. 2014;42:7–28. doi: 10.1057/eej.2014.37.
    1. Korean Society for the Study of Obesity Obesity Fact Sheet 2016. [(accessed on 30 April 2017)]; Available online:
    1. Pourghasem M., Kamali N., Farsi M., Soltanpour N. Prevalence of flatfoot among school students and its relationship with BMI. Acta Orthop. Traumatol. Turc. 2016;50:554–557. doi: 10.1016/j.aott.2016.03.002.
    1. World Health Organization (WHO) Obesity: Preventing and Managing the Global Epidemic (Report of a WHO Consultation on Obesity) World Health Organization; Geneva, Switzerland: 1997. p. 98.
    1. World Health Organization (WHO) Obesity and Overweight 2016. [(accessed on 30 April 2017)]; Available online:
    1. Anandacoomarasamy A., Caterson I., Sambrook P., Fransen M., March L. The impact of obesity on the musculoskeletal system. Int. J. Obes. 2007;32:211–222. doi: 10.1038/sj.ijo.0803715.
    1. Paulis W.D., Silva S., Koes B.W., Van Middelkoop M. Overweight and obesity are associated with musculoskeletal complaints as early as childhood: A systematic review. Obes. Rev. 2014;15:52–67. doi: 10.1111/obr.12067.
    1. Butterworth P., Menz H.B., Urquhart D.M., Cicuttini F.M., Pasco J., Brennan S.L., Wluka A., Strauss B.J., Proietto J., Dixon J.B., et al. The association between obesity and foot pain: Metabolic, biomechanical or both? J. Foot Ankle Res. 2015;8:O5. doi: 10.1186/1757-1146-8-S2-O5.
    1. Stovitz S.D., Pardee P., Vazquez G., Duval S., Schwimmer J.B. Musculoskeletal pain in obese children and adolescents. Acta Paediatr. 2008;97:489–493. doi: 10.1111/j.1651-2227.2008.00724.x.
    1. Chougala A., Phanse V., Khanna E., Panda S. Screening of body mass index and functional flatfoot in adult: An observational study. Int. J. Physiother. Res. 2015;3:1037–1041. doi: 10.16965/ijpr.2015.133.
    1. Shibuya N., Jupiter D.C., Ciliberti L.J., VanBuren V., La Fontaine J. Characteristics of Adult Flatfoot in the United States. J. Foot Ankle Surg. 2010;49:363–368. doi: 10.1053/j.jfas.2010.04.001.
    1. Nielsen M.D., Dodson E.E., Shadrick D.L., Catanzariti A.R., Mendicino R.W., Malay D.S. Nonoperative Care for the Treatment of Adult-acquired Flatfoot Deformity. J. Foot Ankle Surg. 2011;50:311–314. doi: 10.1053/j.jfas.2011.02.002.
    1. Park S.-Y., Park D.-J. Comparison of Foot Structure, Function, Plantar Pressure and Balance Ability According to the Body Mass Index of Young Adults. Osong Public Health Res. Perspect. 2019;10:102–107. doi: 10.24171/j.phrp.2019.10.2.09.
    1. McKeon P., Hertel J., Bramble D., Davis I. The foot core system: A new paradigm for understanding intrinsic foot muscle function. Br. J. Sports Med. 2014;49:290. doi: 10.1136/bjsports-2013-092690.
    1. Unver B., Erdem E.U., Akbas E. Effects of Short-Foot Exercises on Foot Posture, Pain, Disability, and Plantar Pressure in Pes Planus. J. Sport Rehabil. 2020;29:436–440. doi: 10.1123/jsr.2018-0363.
    1. Haun C., Brown C.N., Hannigan K., Johnson S.T. The Effects of the Short Foot Exercise on Navicular Drop: A Critically Appraised Topic. J. Sport Rehabil. 2021;30:152–157. doi: 10.1123/jsr.2019-0437.
    1. Adler S.S., Beckers D., Buck M. PNF in Practice: An Illustrated Guide. 4th ed. Springer; Berlin/Heidelberg, Germany: 2014.
    1. Lee K.-S., Park D.-J. Three-Dimensional Ankle Exercise with Combined Isotonic Technique for an Obese Subject with Plantar Fasciitis: A Case Study. Medicina. 2020;56:190. doi: 10.3390/medicina56040190.
    1. Park D.-J., Hwang Y.-I. Comparison of the Intrinsic Foot Muscle Activities between Therapeutic and Three-Dimensional Foot-Ankle Exercises in Healthy Adults: An Explanatory Study. Int. J. Environ. Res. Public Health. 2020;17:7189. doi: 10.3390/ijerph17197189.
    1. Munn J., Beard D.J., Refshauge K.M., Lee R.Y.W. Eccentric Muscle Strength in Functional Ankle Instability. Med. Sci. Sports Exerc. 2003;35:245–250. doi: 10.1249/01.MSS.0000048724.74659.9F.
    1. Park D.-J., Kim B.-J., Kim Y.-H., Park S.-Y. A three-week intervention emphasized diagonal eccentric contraction on balance and joint position sense and ankle strength in subjects with ankle instability: A randomized controlled trial. J. Back Musculoskelet. Rehabil. 2021;34:95–101. doi: 10.3233/BMR-200058.
    1. Hong S.M., Hur Y.I. Relationship between obesity and depression in Korean adults: Korea National Health and Nutrition Examination Survey 2014. Medicine. 2017;96:e9478. doi: 10.1097/MD.0000000000009478.
    1. Lange B., Chipchase L., Evans A. The Effect of Low-Dye Taping on Plantar Pressures, During Gait, in Subjects with Navicular Drop Exceeding 10 mm. J. Orthop. Sports Phys. Ther. 2004;34:201–209. doi: 10.2519/jospt.2004.34.4.201.
    1. Langley B., Cramp M., Morrison S.C. Clinical measures of static foot posture do not agree. J. Foot Ankle Res. 2016;9:1–6. doi: 10.1186/s13047-016-0180-3.
    1. Hislop H., Avers D., Brown M. Daniels and Wort Hingham’s Muscle Testing. 9th ed. Saunders Elsevier; St. Louis, MO, USA: 2013.
    1. Granado M.J., Lohman E.B., Gordon K.E., Daher N.S. Metatarsophalangeal joint extension changes ultrasound measurements for plantar fascia thickness. J. Foot Ankle Res. 2018;11:20. doi: 10.1186/s13047-018-0267-0.
    1. Stratford P., Gill C., Westaway M., Binkley J. Assessing disability and change on individual patients: A report of a patient specific measure. Physiother. Can. 1995;47:258–263. doi: 10.3138/ptc.47.4.258.
    1. Hefford C., Abbott J.H., Arnold R., Baxter G.D. The Patient-Specific Functional Scale: Validity, Reliability, and Responsiveness in Patients with Upper Extremity Musculoskeletal Problems. J. Orthop. Sports Phys. Ther. 2012;42:56–65. doi: 10.2519/jospt.2012.3953.
    1. Alkhadhrawi N., Alshami A. Effects of myofascial trigger point dry cupping on pain and function in patients with plantar heel pain: A randomized controlled trial. J. Bodyw. Mov. Ther. 2019;23:532–538. doi: 10.1016/j.jbmt.2019.05.016.
    1. Sulowska I., Oleksy Ł., Mika A., Bylina D., Sołtan J. The Influence of Plantar Short Foot Muscle Exercises on Foot Posture and Fundamental Movement Patterns in Long-Distance Runners, a Non-Randomized, Non-Blinded Clinical Trial. PLoS ONE. 2016;11:e0157917. doi: 10.1371/journal.pone.0157917.
    1. Lynn S.K., Padilla R.A., Tsang K.K. Differences in static- and dynamic-balance task performance after 4 weeks of intrinsic-foot-muscle training: The short-foot exercise versus the towel-curl exercise. J. Sport Rehabil. 2012;21:327–333. doi: 10.1123/jsr.21.4.327.
    1. Lee E., Cho J., Lee S. Short-Foot Exercise Promotes Quantitative Somatosensory Function in Ankle Instability: A Randomized Controlled Trial. Med. Sci. Monit. 2019;25:618–626. doi: 10.12659/MSM.912785.
    1. Janda V., Vavrova M. In: Sensory Motor Stimulation. Liebenson C., editor. Williams & Wilkins; Baltimore, MD, USA: 1990.
    1. Knellwolf T.P., Burton A.R., Hammam E., Macefield V.G. Firing properties of muscle spindles supplying the intrinsic foot muscles of humans in unloaded and freestanding conditions. J. Neurophysiol. 2019;121:74–84. doi: 10.1152/jn.00539.2018.
    1. Irving D.B., Cook J.L., Young M., Menz H.B. Obesity and pronated foot type may increase the risk of chronic plantar heel pain: A matched case-control study. BMC Musculoskelet. Disord. 2007;8:41. doi: 10.1186/1471-2474-8-41.
    1. Dowling G.J., Murley G.S., Munteanu S., Smith M.M.F., Neal B.S., Griffiths I.B., Barton C.J., Collins N.J. Dynamic foot function as a risk factor for lower limb overuse injury: A systematic review. J. Foot Ankle Res. 2014;7:53. doi: 10.1186/s13047-014-0053-6.
    1. Snook A.G. The Relationship between Excessive Pronation as Measured by Navicular Drop and Isokinetic Strength of the Ankle Musculature. Foot Ankle Int. 2001;22:234–240. doi: 10.1177/107110070102200311.
    1. Mulligan E.P., Cook P.G. Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function. Man. Ther. 2013;18:425–430. doi: 10.1016/j.math.2013.02.007.
    1. Pabón-Carrasco M., Castro-Méndez A., Vilar-Palomo S., Jiménez-Cebrián A.M., García-Paya I., Palomo-Toucedo I.C. Randomized Clinical Trial: The Effect of Exercise of the Intrinsic Muscle on Foot Pronation. Int. J. Environ. Res. Public Health. 2020;17:4882. doi: 10.3390/ijerph17134882.
    1. Field A.P. Discovering Statistics Using IBM SPSS Statistics: And Sex and Drugs and Rock ‘n’ Roll. 4th ed. SAGE Publications; London, UK: 2015.
    1. Spink M.J., Fotoohabadi M.R., Wee E., Hill K., Lord S.R., Menz H.B. Foot and Ankle Strength, Range of Motion, Posture, and Deformity are Associated with Balance and Functional Ability in Older Adults. Arch. Phys. Med. Rehabil. 2011;92:68–75. doi: 10.1016/j.apmr.2010.09.024.
    1. Murley G.S., Menz H.B., Landorf K.B. Foot posture influences the electromyographic activity of selected lower limb muscles during gait. J. Foot Ankle Res. 2009;2:35. doi: 10.1186/1757-1146-2-35.
    1. Park D.J., Park S.Y. Comparison of subjects with and without pes planus during short foot exercises by measuring muscular activities of ankle and navicular drop height. J. Korean Soc. Phys. Med. 2018;13:107–113. doi: 10.13066/kspm.2018.13.3.133.
    1. Johnson C.H., Christensen J.C. Biomechanics of the first ray part I. The effects of peroneus longus function: A three-dimensional kinematic study on a cadaver model. J. Foot Ankle Surg. 1999;38:313–321. doi: 10.1016/S1067-2516(99)80002-7.
    1. Fiolkowski P., Brunt D., Bishop M., Woo R., Horodyski M. Intrinsic pedal musculature support of the medial longitudinal arch: An electromyography study. J. Foot Ankle Surg. 2003;42:327–333. doi: 10.1053/j.jfas.2003.10.003.
    1. Soysa A., Hiller C., Refshauge K., Burns J. Importance and challenges of measuring intrinsic foot muscle strength. J. Foot Ankle Res. 2012;5:29. doi: 10.1186/1757-1146-5-29.
    1. Angin S., Crofts G., Mickle K.J., Nester C.J. Ultrasound evaluation of foot muscles and plantar fascia in pes planus. Gait Posture. 2014;40:48–52. doi: 10.1016/j.gaitpost.2014.02.008.
    1. Hashimoto T., Sakuraba K. Strength Training for the Intrinsic Flexor Muscles of the Foot: Effects on Muscle Strength, the Foot Arch, and Dynamic Parameters Before and After the Training. J. Phys. Ther. Sci. 2014;26:373–376. doi: 10.1589/jpts.26.373.
    1. Karabay N., Toros T., Hurel C. Ultrasonographic Evaluation in Plantar Fasciitis. J. Foot Ankle Surg. 2007;46:442–446. doi: 10.1053/j.jfas.2007.08.006.
    1. Simons D.G., Travell J.G., Simons L.S. Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. 2nd ed. Williams & Wilkins; Baltimore, MD, USA: 1999.
    1. McPoil T.G., Martin R.L., Cornwall M.W., Wukich D.K., Irrgang J.J., Godges J.J. Heel pain—Plantar fasciitis: Clinical practice guidelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J. Orthop. Sports Phys. Ther. 2008;38:A1–A18. doi: 10.2519/jospt.2008.0302.
    1. Ashton-Miller J.A., Ottaviani R.A., Hutchinson C., Wojtys E.M. What best protects the inverted weight bearing ankle against further inversion? Evertor muscle strength compares favorably with shoe height, athletic tape, and three orthoses. Am. J. Sports Med. 1996;24:800–809. doi: 10.1177/036354659602400616.

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