pronation distortion syndrome is a common postural distortion of the lower extremity, involving the anterior part of the leg. It may cause pain in the leg and disturbances in the tarsal part, in addition to distal and proximal parts. In this deformity, the head of the talus and navicular bones are rotated inward and downward, and the body's center of gravity shifts inward, resulting in flat feet. It is also associated with a union and increased pressure on the medial parts of the first and second metatarso phalangeal joints. The characteristics of pronation distortion syndrome due to excessive foot pronation include inward rotation of the tibia, internal rotation of the thighs associated with flat feet, genu valgum (knock-knee), and increased lordosis in case of hyperpronation. The randomized clinical trial study design will be used with the sample of 48 womens. The data will be collected from ganga ram hospital and mukhtara rafique welfare hospital by using convenient sampling technique.The inclusion criteria Ages 30-35 years, Female gender, BMI of overweight women (25-29.9). Foot pronation on observation, Navicular Drop Test more than 10mm (measured in weight bearing and non-weight bearing positions distance between ground and navicular tuberosity and difference calculated), Increased Q angle :females 15-18. The exclusion criteria is Other deformities such as tarsal coalition and vertical talus, BMI under weight,normal,obese.Any history of surgery involving both lower extremities.and Neuromuscular disorder(GBS,MG,Muscular dystrophies extremities)\|.The tools used is Numeric Pain Rating Scale (NPRS), Navicular drop test, Goniometer for Q angle measurement, and Lower extremity functional scale (LEFS). Data will be analyzed by using SPSS version 26,0.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
48
Technique In intrinsic foot muscle training, there are following exercises: 1. Toe spread out 2. First toe extension 3. Second to fifth toe extension The exercise would be performed in following positions 1. Sitting position for the first 2 weeks (3sec hold; 4 sets ×15 reps) 2. Standing position on the 3rd and 4th weeks (8sec hold; 4 sets × 8 reps) 3. One-leg standing position during the 5th and 6th week (20 sec hold;4 sets ×3 reps)
Hip abductor muscle training consists of the following two exercise 1. Resisted hip abduction 90° (2 sec hold; 3 sets × 10 reps) 2. Resisted hip abduction 45° (2 sec hold; 3 sets × 10 reps) Standard treatment * Shoe insoles (eight hours a day, medial longitudinal arch support,raised for by about 1.8 cm) * Stretching of Hamstrings and Calf muscles (3 times for 30 seconds hold) Number of Sessions Per Week : 3 times Per week for 6 weeks
Ganga Ram Hospital
Lahore, Punjab Province, Pakistan
RECRUITINGGoniometer
universal goniometer has been shown to have good to excellent reliability, and is more reliable than visual estimation especially with inexperienced examiners.The Q angle is formed between a line representing the resultant line of force of the quadriceps (connecting a point near the anterior superior iliac spine (ASIS) to the mid-point of the patella) and a line from the center of the patella to the center of the tibial tubercle. In women, the Q angle should be less than 22 degrees with the knee in extension and less than 9 degrees with the knee in 90 degrees of flexion.normal 14 to 16. In female 15 degree.
Time frame: baseline and fourth week
Numeric Pain Rating Scale
The Numeric Pain Rating Scale (NPRS) that is a unidimensional measure of pain intensity in adults,including those with chronic pain due to rheumatic diseases. The NPRS is a segmented numeric version of the visual analog scale (VAS) in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain.
Time frame: baseline and fourth week
Navicular Drop Test:
The ND test was performed to confirm whether subjects had flexibility flatfoot.The examiner measured the height of the navicular tuberosity from the ground with the subject being non-weight bearing.Subject then stood,with weight bearing equally on both feet,as the examinar remeasured the height of the navicular tuberosity.The difference in the height of the navicular tuberosity between weight bearing and non weight bearing situation was determined.A difference of 10\>mm was considered as flexibal flat foot.ND test have proven valid and reliable for the assessment of the medial arch.
Time frame: baseline and fourth week
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