Effectiveness of Core Stability Exercises on Foot Posture, Function and Limb Alignment in Flexible Flat Feet Patients
NCT Number: NCT06567509
Status: NOT_YET_RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Flexible Flatfoot
Interventions: OTHER: Core stability exercises and Short foot exercises|OTHER: Conventional foot exercises and short foot exercises
Sponsor: International Islamic University Malaysia
Sex: ALL
Age: ADULT
Enrollment: 20
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: SINGLE (OUTCOMES_ASSESSOR)|Primary Purpose: TREATMENT
Start Date: 2024-10-15
Completion Date: 2026-09-15

Summary:
Flexible flat foot is a very common musculoskeletal disorder of lower limbs in general population. Studies have reported that a flexible flat foot causes an alteration in the human body structures and lower limb kinetics due to a rotational torque in the tibia and femur which in turn affects the lumbar spine. This altered mechanics affects the musculature around the lumbar spine especially the core muscles. A strong link between core muscles and lower limb control, foot posture and pressure force has been found in previous studies. While the role of core muscles on lower limb posture and functions has been determined, there is lack of evidence on the benefits of core stabilization exercises on foot arch deficits. Hence, the proposed study will determine the exercise components of core muscles training that are relevant for the flat foot pathology and then will experiment its effects on the foot posture and function. The first step of the proposed study will begin with an extensive literature survey to identify the components of core stability training that have been recommended in the management of lower limbs dysfunction. Then, a protocol of core muscles training will be devised and followed up with a pilot study where the purpose will be to assess the feasibility of the training protocol. The final step of the proposed study will be an experimental study. The subjects for the experimental study will be selected based on predetermined inclusion and exclusion criteria and will be allocated alternately into experimental and control group. The experimental group will receive core stability training as an intervention. Whereas the control group will receive traditional conventional physiotherapy treatment. The foot posture, foot function and lower limb alignment will be assessed before and after the completion of treatment protocol. The data will be analyzed for any differences between group differences and between group differences. The outcomes of the proposed study may have an implication in the lower limb alignment and foot arch correction strategies.

Primary Outcome Measures: Foot Posture (Staheli plantar arch index), Staheli index will be calculated by a conventional footprint method. The footprints will be obtained using the standard method. Each subject will be seated and asked to stand up and press intensely over the inked rubber pad. Then will be asked to sit back to the initial position and lift their foot from the inked rubber pad. The subject will then be requested to stand steady on a plain white paper with equal pressure on both feet and then to sit again and lift his/her foot from the graph sheet. Staheli index will then be calculated as the ratio of maximal mid foot width to the maximal hind foot width. Footprint analysis using Staheli index is reported to be a valid and reliable tool., Will be assessed at baseline and after 6 weeks in both the groups.|Foot Posture (Rare foot angle), The rear foot angle (RFA) will be used to assess the calcaneal valgus. Four points will be marker in the lower limb with the subject is in standing position with talus in neutral position:

Base of calcaneus as mark 1, Subtalar joint (Centre of Achillies tendon attachment) as mark 2 and centre of posterior aspect of calf 15 cm above the 2nd mark as mark 3. A straight line will be drawn using a marker from point 2 to point 1. Then a line will be drawn from point 3 to point 2. The angle formed between the two lines with point 2 as fulcrum is the rare foot angle and will be measure using a universal goniometer., Will be assessed at baseline and after 6 weeks in both the groups.|Function (Foot function Index), Foot function index questionnaire which comprises of 23 questions in the domains of pain, disability and activity limitation will be used to assess the foot function. Each question is rated from 0 (no pain or difficulty) to 10 (greatest agony) which represent the foot function in the past week. Subjects will be rated in percentage., Will be assessed at baseline and after 6 weeks in both the groups.|Lower limb alignment (Q angle), The 'Q angle' will be measured by extending a line from anterior superior iliac spine of the pelvic bone to the center point of patella and extending another line from tibial tubercle of tibia to the center point of patella. The junction between these two lines is the 'Q angle' and will be measured using a universal goniometer., Will be assessed at baseline and after 6 weeks in both the groups.
Secondary Outcome Measures: Core Muscle Endurance (MacGill protocol): Isometric extensor test, Isometric extensor test:

The subject will lay down prone on the bed with his or her lower body from ankles to hips fixed to the testing bed. A chair of the height of the testing bed will be placed in front of the bed so that patient's upper body can be rested on. Then slowly the chair will be removed, and the patient will be asked to maintain the extension of trunk with two hands crossed over on the opposite shoulders. Time will be recorder using a stopwatch from the time the subject assumed the horizontal position till the patient deviates from the horizontal position or patient verbally quits the test.

• Isometric flexor test: The flexor endurance will be tested by asking the subject to lay in a sit-up posture with hips and knees flexed 90 degrees and the back resting against a wedge inclined at 60 degrees and hands of subject are on the opposite shoulders with toes strapped . The posterior wedge is pulled backwards 10 cm and the subject, Will be assessed at baseline and after 6 weeks in both the groups.|Core Muscle Endurance (MacGill protocol): Isometric flexor test, Isometric flexor test:

The flexor endurance will be tested by asking the subject to lay in a sit-up posture with hips and knees flexed 90 degrees and the back resting against a wedge inclined at 60 degrees and hands of subject are on the opposite shoulders with toes strapped. The posterior wedge is pulled backwards 10 cm and the subject is allowed to maintain the flexed posture as long as possible and the time from the removal of wedge till any postural deviation is noted using a stop watch. Deviation is noted if the back touches the wedge., Will be assessed at baseline and after 6 weeks in both the groups.|Core Muscle Endurance (MacGill protocol): Isometric flexor test (Side bridges test, left & right), Side bridges test (Left and right):

The subject is instructed to lie inside bridge position and place one elbow 90 degrees flexed below the shoulder, and the legs are extended in line with the trunk with one foot positioned in front of the another. the second hand is crossed and kept on the opposite shoulder. The test will then be started with the patient lifting his or her pelvis from the ground and maintaining this position and the failure will be if the back no longer remains straight or if the pelvis drops to the floor. The time will be noted using a stopwatch. The test is performed for both right side and left side., Will be assessed at baseline and after 6 weeks in both the groups.