Short-Foot Exercises for Pes Planovalgus
NCT Number: NCT06548750
Status: NOT_YET_RECRUITING
Study Type: INTERVENTIONAL
Phases: NA
Conditions: Pes Planus
Interventions: OTHER: Intrinsic and Ectrinsic Exercise|OTHER: Intrinsic Exercise
Sponsor: Istanbul University - Cerrahpasa (IUC)
Sex: ALL
Age: CHILD
Enrollment: 32
Study Design: Allocation: RANDOMIZED|Intervention Model: PARALLEL|Masking: SINGLE (INVESTIGATOR)|Primary Purpose: TREATMENT
Start Date: 2024-12
Completion Date: 2026-05
Locations: Bezmialem Vakif University, Istanbul, 34093, Turkey

Summary:
Pes planovalgus is a common foot condition affecting the child population. It is characterized by the partial or complete collapse of the medial longitudinal arch with rearfoot eversion and forefoot abduction, which is associated with changes in lower extremity kinematics during dynamic activity.

The lower extremity chain includes the foot, ankle, knee, and hip joints, with the feet acting as the base of support. However, due to their small size, maintaining balance can be challenging. Any small dynamic change in the foot, as the support base, can impact overall body posture. The foot arch, which can be pronated or supinated, affects proprioceptive input by altering joint movement, contact area, and muscle strategy for stability. Pes planovalgus, characterized by excessive subtalar pronation, lead to instability and hypermobility, requiring more neuromuscular control to maintain balance. As a result, flat feet can cause pathomechanical issues and compensatory actions in the lower extremity chain, affecting overall body balance.

The effectiveness of exercise interventions, particularly foot intrinsic muscle strengthening exercises, in increasing the medial longitudinal arch in individuals with pes planus has been investigated in numerous studies. It is widely accepted that both intrinsic and extrinsic muscle groups play a crucial role in the formation, maintenance, and enhancement of foot arches. However, there is a lack of studies specifically examining the effectiveness of exercises aimed at strengthening these muscles in children with pes planovalgus. Therefore, the purpose of this study is to compare the effects of two corrective exercise programs focused on the improvement of the medial longitudinal arch in children with pes planovalgus: one incorporating routine intrinsic muscle exercises and the other combining them with extrinsic muscle exercises.

Primary Outcome Measures: Single Leg Stance Test, It evaluates the participants' standing balance. The entire lower extremity will be positioned in full extension, while the other side will be positioned in 90 degree flexion of the lower extremity hip and knee. The time will be started when the participants' eyes are closed and the untested feet lose contact with the ground, and the time will be stopped when they put their feet back on the ground or when their body sway increases too much., change from baseline balance at 2 months|Timed-up and Go Test, TUG is a measure of dynamic balance and the risk of falling. It entails individuals rising from a chair, walking a distance of 3 feet, turning, and then sitting back down., change from baseline balance at 2 months
Secondary Outcome Measures: Range of Motion, For goniometric measurement, the pivot point will be placed on the lateral malleolus. The fixed arm will be held parallel to the lateral midline of the fibula. The mobile arm will follow the lateral midline of the 5th metatarsal bone., 2 times for 8 weeks|Thomas Test, The Thomas Test will be used to determine the shortness of the hip flexors. The Thomas test is performed with the patient in the supine position with the gluteal folds on the short side of the stretcher. The untested side lower extremity is pulled towards the abdomen by performing hip-knee flexion; the tested side extremity is checked to see if it is separated from the stretcher., 2 times for 8 weeks|Duncan-Ely Test, The Duncan-Ely test will be used to assess rectus femoris spasticity and shortness. In this test, the patient will be asked to lie in a prone position. The physiotherapist will attempt to quickly and passively bring the patient's knee joint on the side being assessed into full flexion. If the heel cannot touch the hip or the hip on the side being tested lifts off the stretcher, the test is considered positive., 2 times for 8 weeks|Popliteal Angle Assessment, It will be used to detect hamstring shortness. The patient will be in the supine position, the tested side hip-knee will be flexed to 90°, and then passive extension will be applied to the knee. Goniometric measurement will be made when the end-feel is felt in the patient's knee joint., 2 times for 8 weeks|Navicular Drop Test (NDT), It is one of the static foot assessment tools and represents the sagittal plane displacement of the navicular tuberosity in a neutral position. If the NDT is below 5 mm, the foot is in supination; if it is between 6-8 mm, the foot is neutral; and if it is above 9 mm, the foot is in pronation., 2 times for 8 weeks|Foot Posture Index-6 (FPI-6), FPI-6, which is a simple, fast and reliable method applicable to pediatric feet, defines the static postural analysis of the foot when equal load is applied to both feet during standing. Scores of 0-5 define normal foot; 6-9 define pes planovalgus and 10-12 define advanced pes planovalgus., 2 times for 8 weeks|6-minutes Walking Test, It is a useful test to assess functional exercise capacity. Patients are asked to walk as fast as they can down a straight 30-meter corridor for six minutes., 2 times for 8 weeks