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.

Effect of Peroneus Longus Muscle Release on Abductor Hallucis Muscle Activity and Medial Longitudinal Arch before Toe-Tap Exercise in Participants with Flexible Pes Planus

Pes planus is a medical condition of the foot wherein there is a flattening or lowering of the medial longitudinal arch. The abductor hallucis muscle starts at the heel bone and attaches to the medial side of the first toe. Whenever it contracts, it plays a key role in elevating the medial longitudinal arch. Hence, the abductor hallucis muscle should be strong enough to control the depression on the medial longitudinal arch. The peroneus longus muscle plantarflexes the ankle and everts the ankle and subtalar joint. If this muscle contracts more than the abductor hallucis muscle does, the medial longitudinal arch of the foot is depressed. This study aimed to investigate the effect of myofascial release of the peroneus longus before performing the toe-tap exercise for strengthening the abductor hallucis muscle in participants with flexible pes planus. This cross-over study included 16 volunteers with flexible pes planus. The participants performed a toe-tap exercise before and after the myofascial release of the peroneus longus. During the toe-tap exercise, the muscle activity of the abductor hallucis and peroneus longus were measured using a Delsys Trigno Wireless Electromyography System. The angle of the medial longitudinal arch was measured using Image J software. Photos in the sagittal plane were used. The peroneus longus activity and medial longitudinal arch angles were significantly decreased. On the other hand, the activity of the abductor hallucis significantly increased after the myofascial release of the peroneus longus before performing the toe-tap exercise (p < 0.05). Individuals with flexible pes planus should be encouraged to perform myofascial release of the peroneus longus before the toe-tap exercise to improve the abductor hallucis activity and to elevate the medial longitudinal arch.

EFFECT OF LOWER LIMB PROXIMAL TO DISTAL MUSCLE IMBALANCE CORRECTION ON FUNCTIONAL PES PLANUS DEFORMITY IN YOUNG ADULTS

The pes planus deformity is seen more in adults. Pes planus or low foot medial longitudinal arch, contributes to lower extremity injury due to the muscular imbalance. This deformity causes proximal to distal muscle imbalance in lower limb. Effective correction of muscle imbalance is prime important in correction of pes planus. The purpose of the study was to find the effect of exercise in pes planus to correct the imbalance, improve the condition & prevent the injuries along with the long-term effect of the pes planus deformity. To study and find the effect of lower limb proximal to distal muscle imbalance correction in pes planus deformity in young adults. 40 people with functional pes planus deformity were randomly assigned to a group that received the baseline treatment for the muscle imbalance along with the intrinsic muscle strengthening exercises (experimental group) or a group that received only intrinsic muscle strengthening exercises (control group). Each group received 6 weeks treatment. Statistical analysis were performed using paired t test and unpaired t test. In pre-intervention, there was no statistically significant difference seen with p values for the navicular drop test for the right leg and left leg 0.1127, 0.1504 respectively. Ink test p values for the right leg, left leg 0.4184, 0.8719 respectively. While on comparing the post-interventional values using the unpaired t test, revealed that there was extremely significant difference seen with p value for both legs the navicular drop test was 0.0001 and for the ink test (right leg=0.0008, left leg=0.0318). Our study reported that muscular imbalance corrective exercises along with the intrinsic muscle strengthening was more effective in improving the condition and muscle imbalance caused by the pes planus. So, muscular imbalance corrective exercises and intrinsic muscle strengthening exercises should be recommended to correct the deformity or prevent the abnormalities in people with functional pes planus.