Short Foot Exercises With Respiratuar Exercises
Condition: Exercise; Flatfoot
MeSH terms: Flatfoot
Study type: Interventional

Summary: 
      Pes planus is a common foot problem since childhood, which may include loss of height of the
      medial longitudinal arch, which is the most important arch supporting the foot, valgus of the
      hindfoot, and abduction of the midfoot relative to the hindfoot. Muscle shortness, increased
      joint laxity with obesity, W-shaped sitting, male gender and genetic background are among the
      factors that can increase the incidence and severity of pes planus in the pediatric
      population. It has been shown in different studies that pes planus is carried into adulthood
      at a rate of 4-23%. It is known that there is oxygen consumption from the body during muscle
      contraction. For this reason, it has been shown in the literature that muscle oxygenation is
      better and the performance of the individual is better in exercises combined with breathing
      exercises in the exercise program. Therefore, the investigators hypothesized whether foot
      shortening exercises combined with breathing would have an effect on muscular activation
      during foot shortening exercises. It is seen that there is a limited number of studies in the
      literature evaluating the effect of breathing exercises and combined foot exercises on the
      activation of the muscles around the feet. For this reason, the aim of this study is to
      examine the effect of combined respiratory foot shortening exercises on the muscular
      activations of the foot circumference in individuals with flat feet. Two-way repeated
      analyses of variance will use to determine the statistical significance of Abductor Hallucis
      Longus, Tibialis Anterior, and Peroneus Longus electromyography activity. Participants: Ten
      participants with pes planus.The participants will perform Short Foot Exercises with and
      without respiratory exercises in sitting and standing positions. Main Outcome Measures:
      Surface electromyography will use to measure the activity of the Abductor Hallucis Longus,
      Tibialis anterior, Peroneus Longus. Respiratory exercises may be an effective method for
      reducing compensatory Tibialis Anterior activity and increasing Abductor Hallucis Longus
      muscle activity during Short Foot Exercises for individuals with pes planus.
    

Detailed description: 
      Ten volunteer individuals with flat feet, studying at the Faculty of Health Sciences, will be
      included in the study. The feet of the individuals who want to be included in the study will
      be examined by the researchers with the Navicular drop test. Individuals' age, height,
      weight, gender, shoe size will be questioned. Flat feet of individuals will be determined by
      the Navicular Drop test. 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. Afterward, the individual was asked to stand up, and the
      navicular tubercle alignment would be re-marked on the same card while giving full weight to
      the foot. The expression in mm of the distance between both lines will be recorded as the
      amount of navicular drop. The amount of navicular drop between 6 and 9 mm will be considered
      as normal Medial Longitudinal Arch, and if it is 10 mm or more, it will be considered as pes
      planus. Individuals will be divided into two groups according to the Navicular drop test.
      This research will consist of two groups, one group of individuals with flat feet and one
      group of individuals without flat feet. In both groups, foot shortening exercises will be
      applied in two different situations. The first case is the activation of the foot
      circumference muscles during the foot shortening exercises, and the second situation is the
      activation of the foot circumference muscles during the combination of the foot shortening
      exercises with the breathing exercises. Foot shortening exercise, in this exercise that works
      the small intrinsic muscles of the foot in isolation, the subjects will be asked to raise the
      medial foot and hold it in this position for 5 seconds while sitting on the ground with the
      feet in the subtalar neutral position, trying to bring the heel and fingers closer to each
      other. During the movement, the fingers will be warned not to bend participants' fingers to
      avoid a contraction in the long flexor muscles, while Participants will be asked to do 3
      repetitions. After the individuals are given 5 minutes to rest the participants' feet,
      participants will be asked to combine the same exercise with breathing exercises. When the
      exercise is terminated, the situation will be returned to the start position. Muscular
      activations of the Tibialis anterior, Abductor Hallucis, and Peroneus Longus muscles will be
      measured with superficial kinesiological electromyography (EMG) device. The electrode sites
      will be prepared for the EMG signal by shaving and cleaning the skin with cotton dipped in
      alcohol to minimize output impedance and allow proper electrode bonding. Disposable Ag/AgCl
      superficial electrodes will be placed approximately 2 cm apart in the direction of the muscle
      fibers. Electrodes will be placed parallel to the muscle fibers at points recommended by
      Surface ElectroMyoGraphy for the Non-Invasive Assessments of Muscles (SENIAM). A detailed
      description of the electrode placements is as follows:

      EMG electrodes for Abductor Hallucis will be attached from the anterior edge of the medial
      malleolus approximately 1-2 cm posterior to the navicular tuberosity, located just in front
      of the vertical line. For the Tibialis Anterior, the electrodes will be placed in the area
      corresponding to the one-third between the tip of the head of the fibula and the medial
      malleolus. For the Peroneus Longus muscle, the electrodes will be placed at 25% of the
      distance between the tip of the head of the fibula and the tip of the lateral malleolus.

      In order to measure the maximum voluntary contraction values from the determined muscle
      groups, separate EMG measurements will be performed with 3 repetitions of maximal contraction
      of 5 seconds, with a resting period of 30 seconds between each of them. As a result of these
      measurements, the average of these 3 repetitions performed at the maximum activation level
      for each muscle of the individuals will be taken. Afterward, surface EMG measurements will be
      taken from the same muscle groups for 10 seconds during the foot shortening exercises while
      breathing and without breathing. According to the maximum voluntary contraction for each
      muscle, the muscle activation rates will be determined during the foot shortening exercises
      with and without breathing [activity muscle activation amount / Maximal voluntary contraction
      * 100 (% Maximum voluntary contraction)]. The sampling rate of the EMG signal will be set to
      1000 Hz. A 20 Hz Butterworth High-Pass filter will be applied to all EMG recordings and RMS
      100 ms will be selected and filtered for smoothing. Measured data will be analyzed using
      Noraxon MyoResearch XP software (version 1.08; Noraxon Inc, Scottsdale, AZ).
    

Intervention name(s): exercise; respiratory
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Short foot exercises without respiratory exercises; Short foot exercises with respiratory exercises
Other intervention name(s): short foot exercise; Short foot exercise
Allocation: Randomized
Intervention model: Single Group Assignment
Intervention model description: Two-way repeated analyses of variance were used to determine the statistical significance of muscles electromyography activity
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: pes planus; respiratory; exercise; short foot exercise