Comparison of Lower Extremity Biomechanics,Core Endurance, and Performance in Pes Planus : A Controlled Study
Condition: Pes Planus
MeSH terms: Flatfoot
Study type: Observational [Patient Registry]

Summary: 
      Pes planus is a deformity called "flatfoot" and is defined as the valgus of the hindfoot
      while loading the foot, the disappearance of the medial longitudinal arch in the midfoot, and
      the supination of the forefoot relative to the hindfoot. The aim of this study is to compare
      the subtalar angle, q angle, trunk muscle endurance, and performance of individuals with pes
      planus and healthy controls. Volunteer students between the ages of 18-35 will be included
      among the students studying at the Health Sciences University Gülhane Faculty of
      Physiotherapy and Rehabilitation. The feet of individuals who want to be included in the
      study will be examined by the researchers with the navicular drop test and the presence of
      pes planus will be determined according to this test. Subtalar Angle to determine the degree
      of rotation (Varus/Valgus) in the hindfoot, Q Angle for knee biomechanics, Navicular Drop
      Test to determine flat feet, Mcgill trunk Flexion, Extension, and Lateral Bridge Test to
      evaluate trunk endurance, Xbox to evaluate lower and upper extremity performance 360Kinect™
      game console will be used. In this study, statistical analyzes will be made with SPSS 21
      package program (IBM Corp., Armonk, NY, USA). Wilcoxon test or Mann Whitney U will be used
      after determining the conformity to the normal distribution in the comparison of the values
      before and after the exercises, individuals with and without flat feet. Results will be
      evaluated at the significance level of p<0.05. Cohen's d values will be calculated to
      determine the study effect size.
    

Detailed description: 
      The navicular drop test is a test used to measure the amount of pronation in the foot, which
      is obtained by subtracting the navicular height measured while standing with weight on the
      foot, from the navicular height measured in the sitting position without placing weight on
      the foot. While individuals are sitting on a chair with bare feet, the navicular tubercle
      will be marked on both feet and marked at the level of the navicular tubercle on a card on
      the floor. Then, the individual will be asked to stand up, and the navicular tubercle level
      will be marked again on the same card while giving full weight to the foot. The expression in
      millimeters of the distance between both lines will be recorded as the amount of navicular
      drop. The amount of navicular drop between 6 and 9 millimeters will be considered as normal
      MLA, and if it is 10 millimeters or more, it will be considered as pes planus. This test will
      be done for both the right foot and the left foot To measure the subtalar angle, the
      participants will be asked to lie face down with their feet hanging out of the bed. The
      subtalar neutral position (without the foot in pronation or supination) will be determined,
      and the calcaneal midline and the distal 1/3 tibial longitudinal midline will be marked with
      a line. The pivot point of the goniometer will be placed on the midline of the Achilles
      tendon and one arm will reference the distal 1/3 tibial longitudinal midline while one arm
      will refer to the calcaneal line and the deviation angle will be recorded. The deviation
      angle in the valgus direction will be given a negative (-) value, and the deviation angle in
      the varus direction will be given a positive (+) value. This measurement will be made for
      both the right foot and the left foot The Q angle is the angle between the line extending
      from the anterior superior iliac spine to the middle of the patella and the line drawn from
      the middle of the patella to the tibial tubercle. Measurements will be made by means of a
      goniometer. Its normal value is 8-14° (average 10°) in men and 11-20° (mean 15°) in women.
      Right Q angle and left Q angle will be measured with the patient in the supine position and
      without contracting the quadriceps Mcgill trunk flexion test is a test used to evaluate the
      endurance of trunk flexor muscles, McGill trunk extension test trunk extensor muscles, McGill
      lateral bridge test is a test used to evaluate the endurance of core muscles that provide
      lateral stability. In the Mcgill trunk flexion test, participants will be asked to cross
      their hands on their chest and will be positioned on the floor with their trunks flexed at
      60° and their knees flexed at 90°. Sixty degrees of body flexion will be provided by a
      stretcher with an adjustable head. It will be ensured that there is no support behind the
      person during the test. In the Mcgill trunk extension test, the participants will be
      positioned in the prone position with their spina iliaca anterior superior to the side of the
      bed. Participants will be asked to extend their upper body straight forward from the edge of
      the table and will be fixed above their knees with the help of a belt. Before the test
      starts, the upper extremity will be supported with the help of a stool placed on the floor to
      prevent fatigue. When ready for the test, the participant will be asked to raise their hands
      on the stool and cross them in front of their torso and stand parallel to the ground. In the
      Mcgill lateral bridge test, the participants will lie on their dominant side, place their
      foot on the other foot, cross their non-dominant arm over their chest and place them on the
      dominant shoulder, and the dominant forearm shoulder straps. The participant will be asked to
      stand on the elbow. As soon as the participant is ready, he will be asked to stand on his
      forearm with his body on a single line, and the stopwatch will be started, which will raise
      his hips. The person will be asked to maintain the positions for as long as possible. Before
      the tests, individuals will be shown how to do the tests and they will be given a trial for a
      few seconds. The stopwatch will be started and the test will be started, in case of any
      deterioration in its position, the stopwatch will be stopped and the test will be terminated.
      The elapsed time will be recorded in seconds. Mcgill trunk flexion-extension and lateral
      bridge tests were previously performed in healthy individuals and their validity and
      reliability were found to be high. (McGill trunk flexion intra-class correlation coefficient
      (ICC) = 0.97, McGill trunk extension intra-class correlation coefficient (ICC) = 0.97, McGill
      lateral bridge intra-class correlation coefficient (ICC) = 0.99) (37.38.39).

      Xbox 360Kinect™ game console was used for upper and lower extremity performance evaluation.
      Xbox Kinect; There is an infrared Kinect camera sensor that can detect user movements without
      the need for a special controller, the movements of the user in the virtual reality
      environment can be monitored in real-time on the screen. Before starting the play therapy,
      the patients were informed about the games by the physiotherapist and they were shown how to
      play the games. 100 m running game in Kinect Sport for 100 m running performance, single-leg
      jump game in Kinect Sport for single-leg jump performance, discus throw game for upper
      extremity performance. will be determined and the scores of the participants will be
      recorded. Kinect is a valid and reliable method for evaluating upper and lower extremity
      function In this study, statistical analyzes will be made with SPSS 21 package program (IBM
      Corp., Armonk, NY, USA). Wilcoxon test or Mann Whitney U will be used after determining the
      conformity to the normal distribution in the comparison of the values before and after the
      exercises, individuals with and without flat feet. Results will be evaluated at the
      significance level of p<0.05. Cohen's d values will be calculated to determine the study
      effect size.
    

Intervention name(s): Trunk performance and endurance lower extremity biomechanic
Intervention type(s): Behavioral
Intervention description(s): Trunk performance and endurance lower extremity biomechanic
Other intervention name(s): asymtopamtic healthy control Trunk performance and endurance lower extremity biomechanic
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Pes planus
      
Keywords: pes planus; trunk; subtalar angle; endurance; kinect