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.

Kinesiophobia, fear of fall, neuropathic pain and navicular drop in rheumatoid arthritis- a correlation study

Background: Rheumatoid arthritis (RA) is one of the most common chronic health conditions and a leading cause of pain; joint damage and disability. Fear of fall and kinesiophobia are associated with activity limitations in RA patients because of pain and stiffness which affects the quality of life. Kinesiophobia and fear of fall are associated with pain. The pathogenics and chronicity of RA can lead to neuropathic pain. Hence the aim of this study was to assess pronation of foot and evaluate if there is any correlation between fear of fall, kinesiophobia and neuropathic pain in patients with rheumatoid arthritis.Methods: Subjects in the age group of 30-50 years were included after passing the EULAR criteria and were assessed for navicular drop by using the navicular drop test. Later they were assessed for fear of fall, kinesiophobia and neuropathic pain using fall efficacy scale, Tampa scale and LANSS questionnaire respectively.Results: Significant co-relation was found between kinesiophobia and fear of fall (p value =0.0046) and there were non-significant co-relations between all other factors.Conclusions: Participants with RA showed significant navicular drop where left subtalar joint was more affected than right. According to the LANSS score subjects showed lower concerns of neuropathic pain. Maximum number of subjects displayed high concerns of kinesiophobia and fear fall which proves the significant association between the factors.

The Impact of Foot Orthoses and Exercises on Pain and Navicular Drop for Adult Flatfoot: A Network Meta-Analysis

Background: Adult flatfoot leads to injury and decreased quality of life. The most widely applied noninvasive approaches are wearing foot orthoses or exercising. Both interventions raise controversy about reducing pain and neutralizing foot posture. This study investigated the impact of foot orthoses and exercise on pain and navicular drop (present for foot posture). Methods: Four databases were used: MEDLINE, PubMed, Web of Science, and Cochrane, from the earliest records to November 2020. Randomized controlled studies focused on adult flatfoot that evaluated the effect of exercise and foot orthoses on pain and navicular drop were extracted. We used data analysis to estimate the relative effect of heterogeneity using I2 and publication bias using funnel plots. Results: Ten studies were identified through to November 2020. Active interventions (AIs) were exercise and exercise combined with foot orthoses; passive interventions (PIs) were foot orthoses and added stretching. Both AIs and PIs decreased pain significantly (SMD −0.94, 95% CI −1.35, −0.54 and SMD −1.4, 95% CI −1.87, −0.92). The AIs reduced pain level better than PIs. Controversially, no treatment was found to affect navicular drop. Conclusion: Both exercise and foot orthoses can reduce pain but not realign foot posture. Exercise alone or combined with foot orthoses showed a better effect on adult flatfoot than only wearing foot orthoses. Active intervention was shown to have better efficacy in reducing pain than passive intervention.

Comparison of 3D Hip Joint Kinematics in People with Asymptomatic Pronation of the Foot and Non-Pronation Controls

Background: The impact of asymptomatic pronation on proximal joints during motion has not been well understood, and research on it remains limited. Therefore, the current study determines the effect of asymptomatic pronation of the foot on hip joint kinematics during gait. Methods: Forty participants were recruited for the study (20 with asymptomatic pronated feet and 20 with non-pronated feet). Foot assessment was conducted by navicular drop and rear- foot angle tests. Hip joint kinematics were measured via MVN Xsens system 3D-motion capture from sagittal, frontal and transverse planes during gait. An independent t-test was used to identify differences in kinematic variables. Results: Both groups were similar in characteristics, and there were no significant differences between the groups in age (P = 0.674) and BMI (P = 0.459). However, there was a significant difference in arch height (P = 0.001) and rear-foot angle (P = 0.001). Our findings showed there were insignificant differences between the asymptomatic pronated foot and non- pronated foot control groups in hip joint kinematics of sagittal (P = 0.618), frontal (P = 0.276), and transverse (P = 0.337) planes during a full gait cycle. Conclusion: Patients with asymptomatic pronation of the foot and non-pronation of the foot showed similar movement patterns of hip kinematics in all three planes. The findings of the present study highlight the need for clinicians to consider foot alignment when examining patients with asymptomatic pronation of the foot and non-pronation of the foot.

Correlation between Different Methods to Diagnose Foot Posture Condition

Background: Authors refer to different methods to assess subjects’ foot posture. All methods present several limitations depending on the examiner or the chosen test. This study aims to investigate the relationship between different tests and Footprints parameters to diagnose subjects with a flat and neutral foot. Methods: The sample consisted of 37 participants, where 16 were included in the flatfoot group and 21 in the neutral foot group. Only subjects who presented a Navicular Drop Test value of >9 mm were included in the flatfooted group. All participants were submitted to Resting Calcaneal Stance Position and plantar pressure platform assessment for Footprints analysis. Associations between all tests and Footprints parameters were determined by Pearson’s correlation analysis. Results: Regarding both groups, significant correlations between tests were moderate to nearly perfect to identified both conditions of foot posture. All correlations were statistically significant (p < 0.05). Conclusions: The diagnosis accuracy of foot posture condition can be compromised depending on the used test. The Navicular Drop Test and the Resting Calcaneal Stance Position were shown to mislead foot posture condition assessment, unlike Footprints parameters that can be important evaluation tools in a clinical environment.

Association of flat foot with obesity in middle-aged individuals

Flat foot can be classified as a foot with collapsed or minimally developed longitudinal arches. Another term used for flat foot is pes planus in which the medial longitudinal arch of the foot has collapsed. The frequency of flat foot is not explained properly as there is a lack of comprehensive definition, better method to classify and proper radiographic criteria for defining a flat foot. Due to obesity, there is an increase in forces at weight-bearing areas of the lower limb and feet. Long term continuous loading effect, specifically related to the feet region due to obesity, has not been extensively evaluated. To find the association of flat foot with obesity in middle-aged Individuals. A total of 120 subjects in the age range of 30 to 50 years were recruited with 60 subjects in each two groups formed on the basis of BMI indexes as Group A (Normal with BMI score 17.5 – 22.99) and Group B (Obese with BMI score >28). Navicular Drop Test and Waist/Hip ratio were measured using Brody’s method and inch tape method, respectively and the correlation between Navicular drop and W/H ratio was evaluated thereafter in both the groups. The result of the study demonstrated that there is a statistically significant positive correlation between navicular drop test and W/H ratio in both the groups, with a stronger association in the obese group (r=0.7 at p=0.05). This study concluded that there is a strong correlation between flat foot and body weight in middle-aged individuals. Hence individuals should be physically active to maintain their body weight in order to avoid any biomechanical alteration in feet structures.

Prevalence of flat foot among medical students and its impact on quality of life and functionality

Background: Flat foot also called pes planus/fallen arches is common deformity in adults. The present study was undertaken to investigate the prevalence of flat foot among medical students and to find out the association of flat foot with age, gender, body mass index (BMI), foot length and its impact on quality of life and functionality.Methods: A total of 300 medical students of age group 17-23 years were investigated for the presence of flat foot by using navicular drop (ND) test, arch index (AI) and foot posture index (FPI). The data obtained was subjected to statistical analysis using SPSS software.Results: Prevalence of bilateral flat foot was 11.6% (8.3% were females and 3.3% were males). Unilateral was 3% (2% were females and 1% were males) and the correlation of ND, AI, FPI with gender, age was not significant and with BMI, weight was highly significant.Conclusions: Our study showed the presence of bilateral flat foot in 11.6% and unilateral in 3% students. Flat foot is associated with BMI, weight and slightly associated with foot length, height and it is not associated with age, gender. Flat foot effected the quality of life and functionality of the students whose BMI is more.

The Effects of the Short Foot Exercise on Navicular Drop: A Critically Appraised Topic

Clinical Scenario: Deformation of the arch, as measured by navicular drop (ND), is linked to lower-extremity musculoskeletal injuries. The short foot exercise (SFE) has been used to strengthen the intrinsic foot muscles that support the arch. Clinical Question: Does the SFE decrease ND in healthy adults? Summary of Key Findings: Three studies that examined the use of the SFE on ND were included. A randomized control trial that compared the SFE to a towel-curl exercise and a control group found no significant differences between the 3 groups. A randomized control trial compared the SFE to the use of arch support insoles in individuals with a flexible flatfoot and found a significant improvement in the SFE group. A prospective cohort study, without a control group, reported a significant decrease in ND following a 4-week SFE intervention without a regression at an 8-week follow-up. Overall, two of the three studies reported a significant reduction in ND following an SFE. Clinical Bottom Line: There is preliminary data supporting the use of the SFE to decrease ND—particularly in individuals with a flexible flatfoot. However, issues with the study designs make it difficult to interpret the data. Strength of Recommendation: Due to limited evidence, there is grade B evidence to support the use of the SFE to decrease ND.

Hip-Focused Neuromuscular Exercise Provides Immediate Benefits in Foot Pronation and Dynamic Balance: A Sham-Controlled Cross-Over Study

Context: Knowledge on how to utilize a kinetic chain approach in foot and ankle rehabilitation is important. Objective: The aim of this study was to investigate the immediate effects of hip-focused neuromuscular exercise on foot pronation and single-leg neuromuscular control. Design: Cross-over study. Setting: University laboratory. Participants: This cross-over study included 44 asymptomatic volunteers with foot pronation. Interventions: All participants performed (1) a hip-focused neuromuscular exercise and (2) a sham exercise in randomized order. Main Outcome Measures: Foot pronation was assessed by the navicular drop test, and lower-extremity neuromuscular control was assessed by the Modified Star Excursion Balance Test and frontal plane projection angle during single-leg squat before and after the experiments. Results: Navicular drop test scores were significantly lower after the hip-focused neuromuscular exercise than after the sham exercise (mean difference [95% CI] = 2.84 [−1.08 to 6.77], P = .003). Modified Star Excursion Balance Test scores in the anterior (P = .008), posteromedial (P = .04), and posterolateral (P < .001) directions were significantly increased after hip-focused neuromuscular exercise. No statistically significant condition × time interaction was found for the frontal plane projection angle (P > .05). However, a main effect of time (P = .003) indicated that less dynamic knee valgus occurred during single-leg squat after both experiments. Conclusions: Hip-focused neuromuscular exercise produced immediate alterations in foot pronation and dynamic balance. Thus, the hip-focused neuromuscular exercise may be used to control foot posture in foot rehabilitation integrated with a kinetic chain approach and could be an effective prevention and treatment strategy.