Foot Muscle Strengthening Exercises for Pes Planovalgus

Istanbul University - Cerrahpasa32 enrolled

Overview

Pes planovalgus is a common foot condition affecting the child population. It is characterized by the partial or complete collapse of the medial longitudinal arch with rearfoot eversion and forefoot abduction, which is associated with changes in lower extremity kinematics during dynamic activity. The lower extremity chain includes the foot, ankle, knee, and hip joints, with the feet acting as the base of support. However, due to their small size, maintaining balance can be challenging. Any small dynamic change in the foot, as the support base, can impact overall body posture. The foot arch, which can be pronated or supinated, affects proprioceptive input by altering joint movement, contact area, and muscle strategy for stability. Pes planovalgus, characterized by excessive subtalar pronation, lead to instability and hypermobility, requiring more neuromuscular control to maintain balance. As a result, flat feet can cause pathomechanical issues and compensatory actions in the lower extremity chain, affecting overall body balance. The effectiveness of exercise interventions, particularly foot intrinsic muscle strengthening exercises, in increasing the medial longitudinal arch in individuals with pes planus has been investigated in numerous studies. It is widely accepted that both intrinsic and extrinsic muscle groups play a crucial role in the formation, maintenance, and enhancement of foot arches. However, there is a lack of studies specifically examining the effectiveness of exercises aimed at strengthening these muscles in children with pes planovalgus. Therefore, the purpose of this study is to compare the effects of two corrective exercise programs focused on the improvement of the medial longitudinal arch in children with pes planovalgus: one incorporating routine intrinsic muscle exercises and the other combining them with extrinsic muscle exercises.

Voluntary children who have been diagnosed with pes planovalgus will be included in the study. Signed voluntary consent will be obtained from caregivers. Participants will be divided into two groups. Study groups will be as follows: a) Intervention Group (Intrinsic\&Extrinsic Exercise), b) Control Group (Intrinsic Exercise).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

Eligibility

Sex: ALLMin age: 4 YearsMax age: 7 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Presence of bilateral pes planovalgus, * Being between 4-7 years of age, * Having a body mass index within normal limits Exclusion Criteria: * Having high femoral anteversion, internal tibial torsion and metatarsus adductus * Having leg length inequality * Having any neurological, rheumatic, musculoskeletal, metabolic and connective tissue disease * Having a history of pain, deformity or surgery related to the vertebral column and lower extremities * Having a cognitive, mental or serious psychiatric disease * Having been involved in any exercise program or sports activity in the last six months

Outcomes

Primary Outcomes

Single Leg Stance Test

It evaluates the participants' standing balance. The entire lower extremity will be positioned in full extension, while the other side will be positioned in 90 degree flexion of the lower extremity hip and knee. The time will be started when the participants' eyes are closed and the untested feet lose contact with the ground, and the time will be stopped when they put their feet back on the ground or when their body sway increases too much.

Time frame: change from baseline balance at 2 months

Timed-up and Go Test

TUG is a measure of dynamic balance and the risk of falling. It entails individuals rising from a chair, walking a distance of 3 feet, turning, and then sitting back down.

Time frame: change from baseline balance at 2 months

Secondary Outcomes

Range of Motion

For goniometric measurement, the pivot point will be placed on the lateral malleolus. The fixed arm will be held parallel to the lateral midline of the fibula. The mobile arm will follow the lateral midline of the 5th metatarsal bone.