Effect of Insole Added to Exercise in Patients With Bilateral Flexible Flatfoot
Condition: Flat Feet; Flexible Flatfoot; Balance; Distorted; Muscle Weakness
MeSH terms: Muscle Weakness; Flatfoot
Study type: Interventional

Summary: 
      Pesplanus, commonly known as 'flatfoot,' is a common pathomechanical condition characterized
      by a lowered medial longitudinal arch (MLA) and exaggerated pronation. There are two general
      types of flatfoot : flexible flatfoot and rigid flatfoot Flexible flatfoot is the most common
      form of flat foot. In adult population, it was reported that prevalence of flexible flatfeet
      is 13.6%. It has been proved that there is static and dynamic balance deficit in the
      participants with flatfeet. The extrinsic muscles as posterior tibialis (TP) ) and intrinsic
      muscles as abductor hallucis (AbdH) act as active subsystem support for the MLA during
      weight-bearing, standing, and walking. Abnormal alignment of the foot may cause stretch
      weakness of the foot muscles by elongating beyond the neutral physiological resting position.
      leading to musculoskeletal dysfunction and overuse injuries. Insoles can assist in
      maintaining normal alignment of the foot, improve balance as it supports MLA which is
      essential to stabilize postural sway, they widen the contact surface of the sole of the foot
      improving stability.
    

Detailed description: 
      Insoles have been used to correct pathomechanical alterations that occur in patients with
      flexible flat feet, it was reported that they reduced ankle eversion, ankle inversion moment
      and reduced the load placed on the ankle invertor muscles which must act eccentrically to
      control over-pronation and support the arch. Insole with intrinsic foot muscle training has
      been reported to increase strength on flexor hallucis and cross-sectional area of the AbdH
      muscle in patient with pes planus. Therefore insole combined with short foot exercises is
      recommended for strengthening intrinsic foot muscles in pes planus.

      Wearing hard insole has been reported to improve postural stability as it limits and control
      the range of foot pronation, correct foot malalignment and promotes a neutral foot position.

      Many studies had investigated the effect of using insole alone or exercise program alone or
      comparing between them on flexible flat foot patients. Up to the knowledge of the primary
      investigator, this is the first study to investigate the effect of adding arch support insole
      to strengthening exercise of foot muscles (intrinsic or extrinsic) in terms of dynamic
      balance, foot function, and foot muscle strength (intrinsic or extrinsic).
    

Intervention name(s): Custom made insole; Strengthening exercises of extrinsic foot muscles; Strengthening exercises of intrinsic foot muscles; Standard insole
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Custom made arch support insole with semi-rigid arch support will be made using the casting method, plaster cast of both feet in a subtalar neutral position will be taken from each subject by highly specialized orthotist. The negative casts will be placed in calcaneal vertical position and custommolded orthosis will be fabricated to positive molds obtained from the negative casts with the goal to control the pronation movement of the foot; Participants will perform extrinsic foot muscles strengthening exercises with both ankles 3 times per week, 20 minutes for 8 weeks. they will be trained using a progressive resistance protocol using Thera-Band elasticated bands. Subjects will be progressed weekly throughout the training period according to progressive resistance protocol for dorsiflexors, planterflexors, evertors and investors muscles.; The patient will assume the same position as in intrinsic foot muscle assessment, then he will be instructed to hold the position for a count of 10 seconds and attempt to maintain the MLA as steady as possible during the entire time without any compensatory extrinsic foot muscle activity. Following the 10-seconds, slowly and with eccentric control allow the foot to pronate and the MLA to lower to a relaxed state .; Patient will be instructed to wear a standard prefabricated flat insole as a placepo treatment iniside his shoes for 2 months (8 weeks), 6 to 8 hours per day, and adhere to wearing the orthoses during outdoor walking and during extrinsic foot muscle training.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment