Effect of Short Foot Exercises on Patients with Flexible Flat Foot: A Pre-Post Experimental Study

Background: When one malleolus was lower than the other malleoli and calcaneal eversion with depressed medial longitudinal arch, pronated sub-talar joint and calcaneus assuming a valgus position underweight bearing condition, known as flatfoot or Pes Planus. Generally 20-30 % of the population between the age group 18-25 had the characteristic of a Pes Planus also known as flat foot. The intent of this experiment was to investigate the effect of 4 week Short Foot Exercise Program on intrinsic foot muscles leading to improvement in performance grade classified as from fair to good. Method: An experimental study conducted at Dr. D.Y. Patil College of physiotherapy, Pimpri, Pune comprising of 30 individuals using Simple Random sampling. Participants were divided into two groups 15 participant each Group A(15) was Conventional Therapy and Group B(15) was Short Foot Exercise progression. The subjects were each given a consent form. The purpose of the study was explained to all the participants and an informed consent was taken from each subject. Navicular Drop Test (r=0.92) was used as an Outcome Measure. Results: There was clinically and statistically significant difference in Group B(Short Foot Exercise Progression) than Group A(Conventional Therapy) (p<0.005 and mean of group A more than B) pre and post 2nd Week treatment and Post 4th week Treatment. Conclusion: The Short Foot Exercise is more effective in improving Medial Longitudinal Arch intrinsic muscle activation as compare to Conventional Group. The 4 week Short foot exercise program improved foot intrinsic muscle activity in people with flat foot. However Group B that is Short Foot Exercises shows better improvement in medial longitudinal arch than Group A That is Conventional Group. Key words: Pes Planus, Flat Foot, Navicular Drop Test, Foot biomechanics, 4 week Short Foot Exercise Progression.

Comparison of Gait parameters among the adults (18-24) with and without flatfoot – A Cross sectional study

Background: Flat foot is a common deformity in which the medial longitudinal arch is eliminated or reduced, subtalar joint is pronated and the calcaneus achieves valgus position under- weight bearing conditions. Any feet disorder can alter the biomechanics of the entire lower limb. The aim of the study was to compare the gait parameters (Cadence, stride length, step length and pace) among the adults (18-24) with and without flat foot. Methodology: It was a cross-sectional study with 3 months duration. Total 56 young adults (18-24) with and without flatfoot were recruited with purposive sampling method. the categorization of the type of arch using Arch-Height index. The Outcome measures were Gait parameters (cadence, distance walked in one minute, speed, step length, stride length) which were noted by pedometer of Smart watch and stride length, step length by using formula using cadence and distance findings. Result: Comparison analysis was done by using unpaired t-test. On comparison of various Gait parameters between normal and flat foot individuals such as cadence (p=0.7), distance walked in one minute (p= 0.96), speed (p=0.78), step length (p= 0.98), stride length (p= 0.92), there was no significant difference between two groups. Conclusion: The study concludes that there is no difference in gait parameters between flatfoot and normal foot.

Effects of extraosseous talotarsal stabilization on the biomechanics of flexible flatfoot subtalar joints in children: a finite element study

<p class="abstract"><strong>Background:</strong> Objective of the study was to generate an experimental foundation for the clinical application of extraosseous talotarsal stabilization (EOTTS) in treatment of flexible flatfeet in children by investigating the biomechanical characteristics of flexible flatfoot and the effects of EOTTS on hindfoot biomechanics.</p><p class="abstract"><strong>Methods:</strong> Three-dimensional finite element models of the foot and ankle complex were generated from computer tomography images of a volunteer’s left foot in three states: normal, flexible flatfoot, and post-EOTTS. After validation by X-ray, simulated loads were applied to the three models in a neutral position with both feet standing.</p><p class="abstract"><strong>Results:</strong> In the flexible flatfoot model, the contact stress on the subtalar joint increased and contact areas decreased, resulting in abnormal stress distribution compared to the normal model. However, following treatment of the foot with EOTTS, these parameters returned to close to normal. Subtalar joint instability leads to a flexible flat foot. Based on this study, it is proposed that EOTTS can restore the normal function of the subtalar joint in and is an effective treatment for flexible flatfoot in children. We and many clinical data studies provide evidence for sinus tarsi implants in pediatric patients. It is showed that the formation of flexible flatfoot is induced by subtalar joint instability.</p><p class="abstract"><strong>Conclusions:</strong> Because of the EOTTS provides the best biomechanical solution to subtalar joint instability, the EOTTS became an effective form for subtalar joint instability treatment.</p>

Effect of Plano-Valgus Foot on Lower-Extremity Kinematics and Spatiotemporal Gait Parameters in Children of Age 5–9

Aim of the study was to see how a definition of the flexible flat foot (FFF) influences the results of gait evaluation in a group of 49 children with clinically established FFF. Objective gait analysis was performed using VICON system with Kistler force platforms. The gait parameters were compared between healthy feet and FFF using two classifications: in static and dynamic conditions. In static condition, the ink footprints with Clarke’s graphics were used for classification, and in dynamic condition, the Arch Index from Emed pedobarograph while walking was used for classification. When the type of the foot was based on Clarke’s graphics, no statistically significant differences were found. When the division was done according to the Arch Index, statistically significant differences between flat feet and normal feet groups were found for normalized gait speed, normalized cadence, pelvic rotation, ankle range of motion in sagittal plane, range of motion of foot progression, and two parameters of a vertical component of the ground reaction force: FZ2 (middle of stance phase) and FZ3 (push-off). Some statically flat feet function well during walking due to dynamic correction mechanisms.

In Vivo Analysis of Hindfoot Joints Movement During Stance Phase in Stage Ⅱ Adult Acquired Flatfoot Deformity

Background This study aims to compare the kinematic characteristics of hindfoot joints of stage Ⅱ adult acquired flatfoot deformity (AAFD) and normal foot through two-dimension (2D) -three-dimension (3D) registration technology and a single fluoroscopic imaging system, thus to provide research basis to the pathogenesis, diagnosis and treatment of AAFD. Methods Then seven normal volunteers and eight volunteers with stage Ⅱ AAFD were recruited to take the CT scans for their bilateral feet in neutral positions, after that their lateral dynamic X-ray data during stance phase were collected including fourteen normal feet and ten flatfeet. A computer-aided simulated light source for 3D CT model was applied to obtain a virtual image, and it is matched with the dynamic X-ray images to make a registration in “Fluo” software, by which finally the spatial changes during the stance phase can be calculated. Results In the early stage of touching the ground and the middle stage of standing, the extension and external rotation valgus of the navicular bone of the flat foot was compared with that of the normal navicular bone, and there was no significant difference in the extension and external rotation valgus of the calcaneus between the cuboid phase and the normal navicular bone. In the late stance phase, the degree of varus relative to the distance of the navicular bone was smaller in the flat foot than in the normal foot but the degree of metatarsal flexion was not significantly different between the cuboid and the calcaneus, and the degree of varus was smaller in the calcaneus but the degree of metatarsal flexion was greater. Conclusion During the early and mid-stance phase, there are excessive motion in the subtalar and talonavicular joints in stage Ⅱ AAFD. During the late stance phase, the motion of subtalar and talonavicular joints are in the decompensated state. During the whole stance phase, the motion of calcaneocuboid joint has no significant difference in both normal foot and stage Ⅱ AAFD.

Association between subtalar articular surface typing and flat foot deformity: which type is more likely to cause flat foot deformity

Background Previous studies have shown a wide range of anatomical classifications of the subtalar joint (STJ) in the population and this is related to the different force line structures of the foot. Different subtalar articular surface morphology may affect the occurrence and development of flat foot deformity, and there are fewer studies in this area. The main objective of our study was to determine the association of different subtalar articular surface with the occurrence and severity of flat foot deformity. Methods We analyzed the imaging data of 289 cases of STJ. The articular surface area, Gissane’s angle and Bohler’s angle of subtalar articular surface of different types were counted. The occurrence and severity of flat foot deformity in different subtalar articular surface were judged by measuring the Meary angle of foot. Results We classified 289 cases of subtalar articular surface into five types according to the morphology. According to Meary angle, the flat foot deformity of Type I and Type IV are significantly severer than Type II (P < 0.05). Type II (7.65 ± 1.38 cm2) was significantly smaller than Type I (8.40 ± 1.79 cm2) in the total joint facet area(P < 0.05). Type III (9.15 ± 1.92 cm2) was smaller than Type I (8.40 ± 1.79 cm2), II (7.65 ± 1.38 cm2) and IV (7.81 ± 1.74 cm2) (P < 0.05). Type II (28.81 ± 7.44∘) was significantly smaller than Type I (30.80 ± 4.61 degrees), and IV (32.25 ± 5.02 degrees) in the Bohler’s angle (P < 0.05). Type II (128.49 ± 6.74 degrees) was smaller than Type I (131.58 ± 7.32 degrees), and IV (131.94 ± 5.80 degrees) in the Gissane’s angle (P < 0.05). Conclusions After being compared and analyzed the measurement of morphological parameters, joint facet area and fusion of subtalar articular surface were closely related to the severity of flat foot deformity and Type I and IV were more likely to develop severer flat foot deformity. Level of evidence Level III, retrospective comparative study.

Prevalence of lower limb deformities among primary school students

Background Lower limb deformities could affect child's quality of life and may worsen with time. This work aims to study the prevalence of lower limb deformities among primary school students in our governorate. Methods This cross-sectional descriptive study was carried out on 4689 students attending 12 public primary schools during the academic year 2019–2020.Complete clinical examination was done for picking of cases of genu varum, genu valgum, genu recurvatum, flat foot, pes cavus, hallux valgus, in-toeing, and lower limb discrepancy, and x-ray on both feet, pelvis, and full-length lower limb was requested. Results This cross-sectional descriptive study included 4689 students. The prevalence of lower limb (LL) deformities was 16.61%. One hundred twenty-three (2.62%) children had a positive history of musculoskeletal pain, 0.09% had genu varum, 0.11% had genu valgum, 0.75% had Genu recurvatum, 0.03% had LL discrepancy, 13.86% had flexible flat foot, 1.22% had rigid flat foot, 0.23% had pes cavus, 1.04 % had in-toeing, 0.06% had hallux varus, and 0.11% had hallux valgus. Conclusions Lower limb deformities are a considerable problem in primary school students that need early diagnosis because it could affect child’s future, health, and career. Further studies are needed to investigate spinal deformity, vit D level, calcium level, foot wear, and school bag weight as hidden factors.

Medium-term Results of Body Balance Trainings in Primary School-Aged Children with Generalized Joint Hypermobility and Symptomatic Mobile Flat Foot: Cohort Study

Background. Mobile flat foot etiology and its correlations with postural imbalance remain topical issues for now, especially in children with generalized joint hypermobility. Additionally, it is poorly known that complaints prevail in children with mobile flat foot and joint hypermobility, and whether existing complaints are associated with foot deformation.Objective. The aim of the study is to estimate medium-term effects of body balance trainings on the height of longitudinal arch of the foot and on the complaints structure in primary school-aged children with generalized joint hypermobility.Methods. The study included 114 primary school-aged children (7–11 years old) with mobile symptomatic flat foot who were divided into four groups: I — control group of children who did not perform training; II — children who performed standard complex of rehabilitation exercises recommended for flat foot; III — children who performed a specially designed complex of exercises for body balance training; IV — children exercised on unstable platform. The foot examination included: clinical assessment of feet shape and position (FPI-6 scale), visual and manual mobility tests, computer scanning with calculation of anthropometric indices (basic anthropometric parameters were calculated from scanned foot images). Clinical evaluation of balance was carried out according to the BESS (Balance Error Scoring System) scale and computer pedobarometry. Assessment of complaints structure was carried out according to the Oxford Child Foot Condition Questionnaire.Results. Children of control group significantly increased the number of errors in performing tests compared to the baseline data (p = 0.034) according to the BESS scale. No statistically significant changes were obtained in children of the second group (p = 0.08). Total number of errors committed by children of third and fourth groups on unstable platform decreased by 2.9 times and 3.4 times, respectively (p = 0.022 and p = 0.044). Decrease in partial load on medial longitudinal arch of foot in step cycle in average by 2.0–3.5 times compared to baseline parameters was revealed in children of third and fourth groups. Moreover, children of third and fourth groups have shown improvement in parameters regarding the shape and position of the feet by average of 1.3–1.7 times higher compared to the parameters of the feet of children performing standard complex of rehabilitation exercises (p = 0.036).Conclusion. This study has shown the efficacy of body balance training in increasing the height of longitudinal arch of the foot and good dynamics in the structure of complaints in primary school-aged children with generalized joint hypermobility and symptomatic mobile flat foot.