Gluteus medius muscle strengthening exercise effects on medial longitudinal arch height in individuals with flexible flatfoot: a randomized controlled trial

Phoomchai Engkananuwat, Rotsalai Kanlayanaphotporn, Phoomchai Engkananuwat, Rotsalai Kanlayanaphotporn

Abstract

This study aimed to compare the effects of 8 weeks of foot plus hip exercise to foot exercise alone on medial longitudinal arch (MLA) parameters; navicular drop (ND), arch height index (AHI), plantar pressure, static balance, and dynamic balance were measured at baseline, 4 weeks, and 8 weeks. A total of 52 healthy participants with bilateral flatfoot were randomly assigned into foot exercise (n=26) and foot plus hip exercise (n=26) group. At 4 weeks, the foot plus hip exercise group showed significantly less ND (P=0.002), plantar pressure at the medial forefoot (P=0.002), and mediolateral displacement (P=0.001) while showing a greater AHI (P=0.019) than the foot exercise group. At 8 weeks, there was also significantly less plantar pressure at the medial hindfoot (P=0.017) and less anteroposterior displacement (P=0.002) in the foot plus hip exercise group than in the foot exercise group. No significant differences between groups were found in dynamic balance. The addition of gluteus medius muscle strengthening exercise to foot exercise was more effective in supporting the MLA than performing foot exercise alone.

Keywords: Bilateral flatfoot; Foot exercise; Hip exercise; Medial longitudinal arch; Navicular drop.

Conflict of interest statement

CONFLICT OF INTEREST No potential conflict of interest relevant to this article was reported

Copyright © 2023 Korean Society of Exercise Rehabilitation.

Figures

Fig. 1
Fig. 1
Consolidated standards of reporting trials flow diagram.
Fig. 2
Fig. 2
Foot adduction and foot supination exercises.
Fig. 3
Fig. 3
Clamshell exercise. Progressions 1 to 3 were performed in side-lying with the exercising leg on top, hips flexed 45 degrees, knees slightly flexed, and feet together. Progression 1: participants externally rotated the top hip to move the top knee up and returned to starting position. Progression 2: participants kept knees together while internally rotating the top hip and returned to starting position. Progression 3: participants raised the top thigh parallel to the floor and lifted the foot toward the ceiling causing the hip to internally rotate before returning to starting position. Progression 4: participants performed the same exercise as progression 3 but with the top hip fully extended.

References

    1. Açak M. The effects of individually designed insoles on pes planus treatment. Sci Rep. 2020;10:19715.
    1. Aenumulapalli A, Kulkarni MM, Gandotra AR. Prevalence of flexible flat foot in adults: a cross-sectional study. J Clin Diagn Res. 2017;11:17–20.
    1. 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;47:301–311.
    1. Angin S, Crofts G, Mickle KJ, Nester CJ. Ultrasound evaluation of foot muscles and plantar fascia in pes planus. Gait Posture. 2014;40:48–52.
    1. Barn R, Rafferty D, Turner DE, Woodburn J. Reliability study of tibialis posterior and selected leg muscle EMG and multi-segment foot kinematics in rheumatoid arthritis associated pes planovalgus. Gait Posture. 2012;36:567–571.
    1. Boren K, Conrey C, Le Coguic J, Paprocki L, Voight M, Robinson TK. Electromyographic analysis of gluteus medius and gluteus maximus during rehabilitation exercises. Int J Sports Phys Ther. 2011;6:206–223.
    1. Buldt AK, Allan JJ, Landorf KB, Menz HB. The relationship between foot posture and plantar pressure during walking in adults: a systematic review. Gait Posture. 2018;62:56–67.
    1. Butler RJ, Hillstrom H, Song J, Richards CJ, Davis IS. Arch height index measurement system: establishment of reliability and normative values. J Am Podiatr Med Assoc. 2008;98:102–106.
    1. Choi JH, Cynn HS, Yi CH, Yoon TL, Baik SM. Effect of isometric hip abduction on foot and ankle muscle activity and medial longitudinal arch during short-foot exercise in individuals with pes planus. J Sport Rehabil. 2020;30:368–374.
    1. Chuter VH, Janse de Jonge XA. Proximal and distal contributions to lower extremity injury: a review of the literature. Gait Posture. 2012;36:7–15.
    1. Cote KP, Brunet ME, Gansneder BM, Shultz SJ. Effects of pronated and supinated foot postures on static and dynamic postural stability. J Athl Train. 2005;40:41–46.
    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.
    1. Fukumoto Y, Asai T, Ichikawa M, Kusumi H, Kubo H, Oka T, Kasuya A. Navicular drop is negatively associated with flexor hallucis brevis thickness in community-dwelling older adults. Gait Posture. 2020;78:30–34.
    1. Gribble PA, Hertel J, Plisky P. Using the Star Excursion Balance Test to assess dynamic postural-control deficits and outcomes in lower extremity injury: a literature and systematic review. J Athl Train. 2012;47:339–357.
    1. Hillstrom HJ, Song J, Kraszewski AP, Hafer JF, Mootanah R, Dufour AB, Chow BS, Deland JT., 3rd Foot type biomechanics part 1: structure and function of the asymptomatic foot. Gait Posture. 2013;37:445–451.
    1. Jonely H, Brismée JM, Sizer PS, Jr, James CR. Relationships between clinical measures of static foot posture and plantar pressure during static standing and walking. Clin Biomech (Bristol, Avon) 2011;26:873–879.
    1. Kim JS, Lee MY. The effect of short foot exercise using visual feedback on the balance and accuracy of knee joint movement in subjects with flexible flatfoot. Medicine (Baltimore) 2020;99:e19260.
    1. Kodithuwakku Arachchige SNK, Chander H, Knight A. Flatfeet: biomechanical implications, assessment and management. Foot (Edinb) 2019;38:81–85.
    1. Kulig K, Burnfield JM, Requejo SM, Sperry M, Terk M. Selective activation of tibialis posterior: evaluation by magnetic resonance imaging. Med Sci Sports Exerc. 2004;36:862–867.
    1. Mulligan EP, Cook PG. Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function. Man Ther. 2013;18:425–430.
    1. Newell T, Simon J, Docherty CL. Arch-taping techniques for altering navicular height and plantar pressures during activity. J Athl Train. 2015;50:825–832.
    1. Okamura K, Fukuda K, Oki S, Ono T, Tanaka S, Kanai S. Effects of plantar intrinsic foot muscle strengthening exercise on static and dynamic foot kinematics: a pilot randomized controlled single-blind trial in individuals with pes planus. Gait Posture. 2020;75:40–45.
    1. Okamura K, Kanai S, Fukuda K, Tanaka S, Ono T, Oki S. The effect of additional activation of the plantar intrinsic foot muscles on foot kinematics in flat-footed subjects. Foot (Edinb) 2019;38:19–23.
    1. Otis JC, Gage T. Function of the posterior tibial tendon muscle. Foot Ankle Clin. 2001;6:1–14.
    1. Pita-Fernandez S, Gonzalez-Martin C, Alonso-Tajes F, Seoane-Pillado T, Pertega-Diaz S, Perez-Garcia S, Seijo-Bestilleiro R, Balboa-Barreiro V. Flat foot in a random population and its impact on quality of life and functionality. J Clin Diagn Res. 2017;11:22–27.
    1. Pohl MB, Farr L. A comparison of foot arch measurement reliability using both digital photography and calliper methods. J Foot Ankle Res. 2010;3:14.
    1. Riskowski JL, Dufour AB, Hagedorn TJ, Hillstrom HJ, Casey VA, Hannan MT. Associations of foot posture and function to lower extremity pain: results from a population-based foot study. Arthritis Care Res (Hoboken) 2013;65:1804–1812.
    1. Sell KE, Verity TM, Worrell TW, Pease BJ, Wigglesworth J. Two measurement techniques for assessing subtalar joint position: a reliability study. J Orthop Sports Phys Ther. 1994;19:162–167.
    1. Smyth NA, Aiyer AA, Kaplan JR, Carmody CA, Kadakia AR. Adult-acquired flatfoot deformity. Eur J Orthop Surg Traumatol. 2017;27:433–439.
    1. Snyder KR, Earl JE, O’Connor KM, Ebersole KT. Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clin Biomech (Bristol, Avon) 2009;24:26–34.
    1. Soomro RR, Karimi H, Gillani SA. Reliability of hand-held dynamometer in measuring gluteus medius isometric muscle strength in healthy population. Pak J Med Sci. 2022;38:1238–1242.
    1. Sulowska I, Oleksy L, 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.
    1. Tahmasebi R, Karimi MT, Satvati B, Fatoye F. Evaluation of standing stability in individuals with flatfeet. Foot Ankle Spec. 2015;8:168–174.
    1. Tareco JM, Miller NH, MacWilliams BA, Michelson JD. Defining flatfoot. Foot Ankle Int. 1999;20:456–460.
    1. Tong JW, Kong PW. Association between foot type and lower extremity injuries: systematic literature review with meta-analysis. J Orthop Sports Phys Ther. 2013;43:700–714.
    1. Toullec E. Adult flatfoot. Orthop Traumatol Surg Res. 2015;101(1 Suppl):S11–S17.
    1. Unver B, Erdem EU, 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.
    1. Vicenzino B, McPoil T, Buckland S. Plantar foot pressures after the augmented low dye taping technique. J Athl Train. 2007;42:374–380.
    1. Wei Z, Zeng Z, Liu M, Wang L. Effect of intrinsic foot muscles training on foot function and dynamic postural balance: A systematic review and meta-analysis. PLoS One. 2022;17:e0266525.
    1. Xiong S, Goonetilleke RS, Witana CP, Weerasinghe TW, Au EY. Foot arch characterization: a review, a new metric, and a comparison. J Am Podiatr Med Assoc. 2010;100:14–24.
    1. Yazici G, Varol F, Volkan Yazıcı M, Çıtaker S. Reliability of make and break tests in assessing intrinsic foot muscle strength using a handheld dynamometer in young healthy adults. Turk J Physiother Rehabil. 2020;31:263–269.
    1. Zurawski AL, Kiebzak WP, Kowalski IM, Sliwinski G, Sliwinski Z. Evaluation of the association between postural control and sagittal curvature of the spine. PLoS One. 2020;15:e0241228.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다