Effect of Incorporating Short-Foot Exercises in the Balance Rehabilitation of Flat Foot: A Randomized Controlled Trial

Muscle Strengthening Exercises for the Foot and Ankle: A Scoping Review Exploring Adherence to Best Practice for Optimizing Musculoskeletal Health

BACKGROUND

Foot and ankle muscle strengthening exercises are common interventions for many musculoskeletal conditions that are associated with pain and limited function in the lower limb. The scientific literature has a multitude of strengthening exercises recommended, and they have been criticized for not adhering to best practice and for being poorly reported. The aims of this scoping review were to (i) describe what foot and ankle strengthening exercises have been recommended in the scientific literature, (ii) compare the prescription of these exercises to best practice recommendations, and (iii) assess the completeness of the reporting of these exercises and exercise programs.

METHODS

This scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. A systematic search of peer-review journal articles was conducted on 23 February 2023. Study designs that were included were experimental, quasi-experimental, feasibility, pilot studies, and observational. For each study included in the review, study design and participant details such as age, sex, and conditions treated were noted. To describe the foot and ankle strengthening exercises, each exercise was noted, which included its name, the number of sets and repetitions recommended, the load type and its magnitude, and whether there were any progression strategies. Exercises were grouped according to primary movement and a general exercise descriptor. To compare to best practice, each program's prescription parameters of frequency, intensity, and time were compared to the American College of Sports Medicine's (ACSM) guidelines. To assess completeness of reporting, each study was assessed with the Consensus on Exercise Reporting Template (CERT).

RESULTS

The search yielded 1511 documents, and 87 were included after full-text screening. Of the included studies, most were randomized controlled trials, and the most common participants were healthy adults (mean age range: 18-83 years). Across all studies, a total of 300 foot and ankle exercises were prescribed. The most common strengthening exercise category involved ankle plantar flexion (25% of 300 exercises), followed by plantar foot intrinsics (16%). The most common prescription of strengthening exercises included 3 sets (37%) of 10 repetitions (38%) performed 3 times per week (34%), often without a prescribed load (66%). Prescribed sets per muscle group met ACSM recommendations for novice lifters in 93% of studies. In contrast, load intensity (for increasing muscle strength) was prescribed at the recommended dose of 60% of 1 repetition maximum or greater in only 2% of exercises. The median score for completeness of reporting according to the CERT checklist was 31% of all items.

CONCLUSIONS

This scoping review found that the studies predominantly included ankle plantar flexion and plantar foot intrinsic muscle strengthening exercises, typically prescribed at 3 sets of 10 repetitions, 3 times per week. When compared to best practice recommendations, load intensity in exercise prescription is commonly less than recommended or is not reported. In addition, the review highlights deficiencies in the reporting of exercise programs. We propose using established best-practice exercise prescription guidelines like those from the ACSM and the adoption of CERT for reporting exercises in the scientific literature.

Efficacy of Functional Re-Education as a Treatment for Infantile Flexible Flatfoot: Systematic Review

BACKGROUND

Flexible pediatric flatfoot is an anatomical presentation of the foot that is common in children, and its functional impact raises long-term uncertainty. Functional re-education includes strengthening and stretching exercises for the intrinsic and extrinsic musculature of the foot, proposed as an effective conservative treatment. However, to date, there is no systematic review examining its effectiveness in the pediatric population. This systematic review aims to evaluate the effectiveness of functional re-education as a conservative treatment for flexible pediatric flatfoot, determining which exercises are most effective.

METHODS

A search (PROSPERO: CRD42023391030) was conducted across six databases, resulting in an initial total of 327 studies. Of these, 11 randomized controlled trials (RCTs) met the inclusion criteria, resulting in a sample of 419 children aged 6 to 14 years with a diagnosis of flexible flatfoot. The evaluated studies present variations in diagnostic criteria, types of exercises, and treatment duration.

RESULTS

The results indicate that functional re-education is effective in improving the symptomatology and functionality of the foot in children. In particular, exercises targeting the intrinsic musculature proved to be among the most effective treatments, improving the structural development of the medial longitudinal arch. The reviewed literature recommends a minimum treatment duration of eight weeks.

CONCLUSIONS

Functional re-education represents an effective conservative treatment option for flexible flatfoot in children, positioning it as the treatment of choice for this condition.

The effects of combined exercises, short foot exercises, and short foot exercises with isometric hip abduction on navicular drop, static parameters, and postural sway in women with flat foot: A randomized trial

BACKGROUND

Recent research has found that strengthening hip joint stability can considerably affect foot mechanics. The purpose of this study was to determine the effect of short foot exercises (SFEs), combined exercises (CEs), and SFEs with isometric hip abduction (IHA) on navicular drop (ND), static parameters (SP), and postural sway in women with flat foot (FF).

METHODS

This study recruited 45 women with flexible FF. The participants were divided into three groups: the CEs group, who performed a series of strengthening, stretching, and balancing exercises, the SFEs group, and the SFEs with IHA group. The groups carried out their assigned regimens daily for six weeks. ND, SP, and postural sway (center of pressure (CoP) parameters) were measured using the ND test and pedoscan device. The data was analysed using a repeated-measures ANOVA statistical test (p≤0.05).

RESULTS

The results showed that all three groups decreased in ND, surface, and foot rotation in the post-test compared to the pre-test (P < 0.05). No difference was observed in the maximum pressure (P = 0.616) and anteroposterior fluctuations (P = 0.065) of the CEs group. Both SFEs and SFEs with IHA groups showed a reduction in all CoP parameters. When comparing the ND (P = 0.22) and mediolateral sway (P = 0.035) of the SFEs with IHA group, a significant difference was observed compared to the CEs group. Additionally, the SFEs with IHA group had a higher percentage of changes in all variables compared to the other two groups.

CONCLUSIONS

SFEs with IHA appear more effective than other training methods in reducing ND and decreasing CoP oscillations and stance parameters. Future studies should investigate the long-term effect of this exercise protocol.

TRIAL REGISTRATION

Name of the registry: Iranian Registry of Clinical Trials.

TRIAL REGISTRATION NUMBER

IRCT20220409054456N.

DATE OF REGISTRATION

28/09/2022. URL OF TRIAL REGISTRY RECORD: https://fa.irct.ir/trial/63065 .

Flatfoot Deformity; Exercise to Therapeutic Interventions: A Systematic Review

Background

Deviation of the foot from the normal posture affects the function of the foot and lower limb and causes lower limb injuries in normal people and athletes. Flat feet or flatfoot deformity are usually associated with pain in the foot area and a decrease in the normal function of the foot, which can negatively affect the sports ability of athletes. Therefore, we aimed to investigate the abnormality of flat feet from training, exercise to therapeutic interventions.

Methods

Articles were identified by searching five databases: PubMed, Scopus, Google Scholar, Science Direct, and Gate & Pasteur from 2000 to 2022. The keywords were selected specifically and correctly and all the researches and articles related to the title of the article were searched and found. This research was also searched in Persian databases that this database, included: Irandoc, Mag Iran and Noormagz.

Results

Finally, 30 studies met the criteria for entering this study, selected and used to conduct this study.

Conclusion

By using the results obtained in the research, which include corrective exercises and therapeutic interventions, especially the use of orthoses and various medical insoles, it is possible to help in the treatment and improvement of this anomaly.

Effects of short foot training on foot posture in patients with flatfeet: A systematic review and meta-analysis

BACKGROUND

With lifestyle changes, the prevalence of flatfoot is increasing year by year, with a prevalence of 29%. Flatfoot will lead to an inevitable injury and reduce the quality of life. Short foot exercises can enhance the strength of the intrinsic muscles of the foot and improve the symptoms of flatfoot. However, there is controversy regarding its specific efficacy.

OBJECTIVE

This meta-analysis quantitatively evaluates the effect of short foot training on patients with flatfeet and provides evidence to inform the clinical approach to short foot training in patients with flat feet.

METHODS

A total of eight databases were searched, including CNKI, WANFANG, VIP, and CBM in Chinese and PubMed, Cochrane, Web of Science, and Embase in English. The timeframe for searching the literature was March 2023 for each database build. English database search terms and search formulas were: (flat foot OR talipes valgus OR talipes calcaneovalgus) AND (short foot exercises OR physical therapy OR neurophysiotherapy).

RESULTS

The current pooled results show no significant difference in the improvement of the navicular drop test and foot posture index with short foot exercises compared to controls; only short foot exercises greater than 6 w showed a significant improvement in the navicular drop test, and sensitivity analysis showed a significant improvement in the foot posture index with short foot exercises.

CONCLUSION

This systematic review and meta-analysis showed that short foot exercises need a larger sample size to find their effect on improving flat feet; the duration of the intervention is a factor. As most studies are currently unclear whether the participants were patients with flat feet or asymptomatic individuals with flat feet the disease syndrome in patients with flatfoot may also be a factor.

Efficacy of Faradic Foot Baths and Short Foot Exercises in Symptomatic Flatfoot: A Review

Flatfoot is a common condition among adults, according to orthopedic experts. Flatfoot is defined in this document as a foot condition that occurs after the completion of skeletal growth and is characterized by either partial or complete reduction of the medial longitudinal arch (MLA). The purpose of this study was to evaluate the effects of short foot exercise (SFE) and faradic foot baths on people who have flat feet. This review focused on comprehensive original primary articles written in English. Numerous studies have been conducted in order to determine the effects of both interventions. The search yielded a wide range of papers, including editorials, review articles, freely available full texts, and abstracts. The results showed that both SFE and faradic foot baths effectively improved flat feet.

A deep learning method for foot-type classification using plantar pressure images

Background: Flat foot deformity is a prevalent and challenging condition often leading to various clinical complications. Accurate identification of abnormal foot types is essential for appropriate interventions. Method: A dataset consisting of 1573 plantar pressure images from 125 individuals was collected. The performance of the You Only Look Once v5 (YOLO-v5) model, improved YOLO-v5 model, and multi-label classification model was evaluated for foot type identification using the collected images. A new dataset was also collected to verify and compare the models. Results: The multi-label classification algorithm based on ResNet-50 outperformed other algorithms. The improved YOLO-v5 model with Squeeze-and-Excitation (SE), the improved YOLO-v5 model with Convolutional Block Attention Module (CBAM), and the multilabel classification model based on ResNet-50 achieved an accuracy of 0.652, 0.717, and 0.826, respectively, which is significantly higher than those obtained using the ordinary plantar-pressure system and the standard YOLO-v5 model. Conclusion: These results indicate that the proposed DL-based multilabel classification model based on ResNet-50 is superior in flat foot type detection and can be used to evaluate the clinical rehabilitation status of patients with abnormal foot types and various foot pathologies when more data on patients with various diseases are available for training.

Effect of foot orthoses on dynamic balance in taekwondo athletes with flexible flatfoot: A randomized controlled trial

BACKGROUND

Flexible flatfoot (FFF) cause biomechanical and sensorimotor disorders of the foot and ankle complex and reduce of postural stability. Postural stability is an important movement skill that affects the performance of taekwondo (TKD) athletes and can lead to fall injuries. The purpose of this study is the effect 12-week application of foot orthosis (FOs) on dynamic balance in TKD athletes with FFF.

METHOD

In this trial, 30 girls of the TKD athletes with FFF were recruited. They were randomly assigned to experimental and control groups (15 subjects in each group). The experimental group used FOs with medial longitudinal arch support for 12 weeks, and the control group did not have any intervention. The outcome measures include navicular drop and balance in three directions: anterior-posterior, medial-lateral and overall stability. Covariance analysis was used to compare the results between two groups.

RESULTS

The covariance results showed that the experimental group compared to the control group with a high effect size had a significant difference in reducing of navicular drop (P = 0.000, ηp2 =0.512), anterior-posterior sway (P = 0.000, (ηp2 =0.397) medial-lateral sway (P = 0.019, ηp2 = 0.186) and overall stability sway (P = 0.008, ηp2 = 0.232).

CONCLUSIONS

The FOs with medial longitudinal arch support leads to FFF correction and provides mechanical stability of the foot and ankle complex. Also, the impulses sent from plantar receptors are increased and a better understanding of postural sway is transmitted to the central nervous system and balance strategies are improved.

Comparison of toe pressure strength in the standing position and toe grip strength in association with the presence of assistance in standing up: a cross-sectional study in community-dwelling older adults

PURPOSE

We believe that toe pressure strength in the standing position, which is closer to the actual movement, is more associated with standing up in the older adults than the conventional toe grip strength. Therefore, the purpose of this study is to examine the association between toe pressure strength in the standing position and the presence of assistance in standing up in the older adults.

METHODS

Ninety-five community-dwelling older adults (82 ± 8 years old, 72% female) were included in this study. The patients were evaluated based on their need for assistance in standing up. Physical functions, including toe pressure strength in the standing position, toe grip strength, hand grip strength, knee extension strength, one-leg standing time with eyes open, and maximal walking speed, were measured.

RESULTS

When compared with and without assistance to stand up, the group requiring assistance had weaker toe pressure strength in the standing position than the group without assistance (p = 0.015, ES = 0.53). After adjusting for confounding factors, the final model revealed that toe pressure strength in the standing position was associated with the use of assistance in standing up (odds ratio 0.94 [0.88-0.99, p = 0.025]).

CONCLUSION

Toe pressure strength in the standing position was associated with the use of assistance in standing up in older adults. Improving toe pressure strength in the standing position may facilitate the ability of older adults to stand up.

The influence of curricular physical activities on the values of body balance indices in university students

The investigation analyzes the effect of specific motor structures on the indicators of the static and dynamic balance of the students of Dunărea de Jos University in Galați (99 boys aged = 20.29 years, body weight = 84.17 kg, height = 180.08 cm, respectively 96 girls aged = 20.09 years, mass bodyweight = 60.88 kg, height = 164.73 cm. The members of the tested group have no concerns related to performance sports or physical activities as a lifestyle. The application of the experi-mental program was made during the 28 weeks of the academic year 2018-2019, with 3 distinct moments: T1 / initial at the beginning of the 1st semester, T2 / intermediate before the winter break, T3 / final at the end of the academic year. The battery of tests included 7 tests: One leg standing test with eyes closed (sec), Stork test (sec), Flamingo test (number of attempts), Bass test (points), Functional reach test (cm), Walk and turn field sobriety test (errors) and Fukuda test (degrees). The results of the Anova parametric test with repeated measurements revealed statis-tically significant values of F associated with critical thresholds (p <0.05), and the values of Parti-al eta squared (Ƞ2p) indicate strong influences of the proposed program on test performance in most cases, both at the level of the whole group and also for each gender. It should be noted that the performance improvements are greater in the first part of the study (differences between ini-tial and intermediate tests, with p <0.05), compared to those in semester 2 (differences between intermediate and final tests), which can be explained by the adaptation to the planned and ap-plied stimuli, so modifying or changing their dosage is necessary in order to have a better chan-ce of improving the results. Significant differences are confirmed for most tests of both genders (p <0.05), with exceptions being the Walk and turn field sobriety test for boys (at the level of the difference between intermediate and final testing) and the Fukuda test for both genders (for dif-ferences between initial and intermediate testing). However, the results should be viewed with caution, the low level of physical training and sedentary behavior of most students providing the premises for such progress, even with a single weekly physical activity. Keywords: students, balance, postural stability, physical exercise, progress, motor skills

Monitoring the Role of Physical Activity in Children with Flat Feet by Assessing Subtalar Flexibility and Plantar Arch Index

Flat foot is a common pediatric foot deformity which involves subtalar flexibility; it can affect the plantar arch. This study analyzes the evolution of two parameters, i.e., plantar index arch and subtalar flexibility, before and after physiotherapy and orthoses interventions, and examines the correlation between these two parameters. Methods: The study included 30 participants (17 boys, 12 girls, average age 9.37 ± 1.42 years) with bilateral flat foot. We made two groups, each with 15 subjects. Assessments of the subtalar flexibility and plantar arch index used RSScan the platform, and were undertaken at two time points. Therapeutic interventions: Group 1—short foot exercises (SFE); Group 2—SFE and insoles. Statistical analyses included Student’s t-test, Cohen’s D coefficient, Pearson and Sperman correlation. Results: Group 1—subtalar flexibility decreased for the left and right feet by 28.6% and 15.9% respectively, indicating good evolution for the left foot. For both feet, a decrease of the plantar index arch was observed. Group 2—subtalar flexibility decreased for the right and left feet by 43.4% and 37.7% respectively, indicating a good evolution for the right foot. For both feet, a decrease of plantar index arch was observed. Between groups, subtalar flexibility evolved well for Group 2; this was attributed to mixt intervention, physical therapy and orthosis. For plantar arch index, differences were not significant between the two groups. We observed an inverse correlation between subtalar flexibility and plantar arch index. Conclusions: Improvement of plantar index arch in static and dynamic situations creates the premise of a good therapeutic intervention and increases foot balance and postural control. The parameter which showed the most beneficial influence was the evolution is subtalar flexibility.