Effect of Medial Wedge on Static Balance in Pronated Feet
Condition: Foot; Deformity, Valgus, Congenital; Foot; Deformity, Valgus (Acquired); Foot Deformities; Flatfoot
MeSH terms: Flatfoot; Foot Deformities; Foot Deformities, Congenital; Congenital Abnormalities
Study type: Observational

Summary: 
      The use of heel wedges is often recommended as a clinical routine in individuals with foot
      pronation. However, there is a lack of information for examining the immediate effect of
      supports used to restore foot biomechanics on balance. The aim of our study is to examine the
      immediate effect of calcaneal support in the frontal plane on static balance in individuals
      with increased pronated foot. In this study, the fore-hind foot load distribution in static
      bipedal stance will be examined in healthy young adults. Then, static balance measurements
      will be made on one leg with and without support (medial heel wedge). For the evaluation of
      static balance on one leg, x-y mean, ellipse surface, A-P index measurements and romberg test
      will be used. In addition, the pain of individuals will be questioned and their foot postures
      will be evaluated. Healthy young adult individuals with a subtalar angle of 5 degrees and
      above in the weighted position will be included in the evaluations. Evaluations of the
      participants are planned to take approximately 15 minutes.
    

Detailed description: 
      In a normal foot, the subtalar joint is pronated from heel strike to sole contact, which
      makes the midtarsal joint and forefoot flexible. Between sole contact and toe lift, the
      subtalar joint becomes supinated and the foot turns into a rigid lever (1,2). Hindfoot
      overpronation can be defined as pronation of the subtalar joint during gait phases in which
      supination is normal. It can cause problems such as abnormal pronation in the foot, increased
      flexibility, deterioration in load distribution, hallux valgus and heel spurs, and postural
      disorders involving the leg, knee, hip and spine (3). In addition, the increase in rear foot
      pronation negatively affects the physical performance of individuals such as jumping and
      running (4). Commonly used conservative methods to prevent pronation in the subtalar joint
      include exercises to support the medial arch, strengthen muscles and ligaments, electrical
      stimulation, insoles, wedges, and applications such as flexible and inflexible taping
      techniques (1,5).

      Medial wedge is a method frequently preferred by physiotherapists in terms of ease of use
      among the methods used in the routine. It is thought that the contact of the medial
      longitudinal arch support of the insole with the foot prevents the increase in pronation of
      the foot and reduces the load on the arch structures. The medial longitudinal arch support
      transfers the load on the heel region to the midfoot and the decrease in maximum pressure in
      the 2nd and 3rd metatarsal regions is explained by the insoles turning the foot towards
      supination. It is stated that excessive pronation of the hindfoot and the secondary
      deformities it may cause can be prevented by the use of simple supports applied under the
      foot.

      The foot is located at the most distal point and acts as the support base for this kinematic
      chain. For this reason, the smallest dynamic change in the foot affects the balance of the
      whole body (6). Balance is the ability to keep the body's center of gravity within the
      acceptable limits of the support surface during activities such as sitting, standing or
      walking, and it is a complex process that includes versatile sensory, motor and biomechanical
      components (7).

      It is known that foot deformities in seniors negatively affect balance and cause falls (8).
      Along with the changes in the gravity line in neurological diseases, problems are seen in
      maintaining the balance starting from the sitting level and in situations that require a
      change in movement. Conditions such as loss of balance or inability to maintain body position
      in athletes may prevent the athlete from performing the expected performance, as well as
      cause injuries (9). Balance improvement has an important place in every field of
      physiotherapy. Improving balance, increasing function in the athlete, improving performance;
      To ensure the continuity of mobility in neuromuscular diseases and neurological problems, to
      increase the quality of life; in healthy individuals, it is important to prevent injuries. In
      this study, the immediate effect of the medial heel wedge on static balance and weight
      distribution in individuals with pronated foot was investigated.
    

Intervention name(s): Medial calcaneal wedge
Intervention type(s): Other
Intervention description(s): Immediate effect of medial calcaneal wedge for static balance and weight distribution
Observational model: Case-Only
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Young adults who has pronated foot
      
Keywords: Foot Orthoses; Postural Balance; Subtalar Joint