Does Short Foot Exercise Combined with Breathing Exercise Increase Muscular Activity in Individuals with Pes Planus?

BACKGROUND: Improvements in muscle oxygenation and exercise posture can significantly impact muscle contraction. The aim of this study was to compare the effects of combined breathing and exercise posture (sitting or standing) on the muscle activity of the foot and ankle during short foot exercises (SFE) in individuals with pes planus. METHODS: The study included 15 subjects aged 21.53 ± 1.06 years, diagnosed with pes planus. Short foot exercises were performed with and without breathing exercises (BE) in sitting and standing positions. Surface electromyography was used to measure the activity of the tibialis anterior (TA), peroneus longus (PL), and abductor hallucis longus (ABDH) muscles during four different SFE. Four-way repeated analyses of variance were used to assess the addition of BE to SFE and muscle activities of the foot and ankle. RESULTS: Muscle activity in the TA, PL, and ABDH was significantly higher in the SFE with BE than without BE in the standing position than in the sitting position. The SFE performed with BE when standing significantly increased the ABDH and ankle muscle activity compared to without BE. CONCLUSIONS: SFE with BE may represent a new strengthening program for ABDH and PL foot muscles in rehabilitation programs for individuals with pes planus.

Foot Muscle Exercise: A Novel Approach to Improve Motor Functions in Children with Down Syndrome Having Pes Planus - A Randomized Controlled Trial.

OBJECTIVE: The study aimed to determine the efficacy of foot muscle exercises in children with DS having pes planus. METHODS: Forty-seven subjects randomly assigned to foot muscle exercises (study group) or an arch support insole with one-leg balance exercises (control group), thrice weekly intervention for 12-weeks followed by a home program with residual effect assessed after 24-weeks from baseline. RESULTS: The motor functions were significantly improved in both groups (p = 0.00). A positive residual effect was found in the study group for both parameters. Whilst in the control group it failed to give a positive residual effect for GMFM-88, while PBS yielded positive outcomes. The study group showed significantly better results than the control group in comparison. CONCLUSION: The novel finding suggests that the foot muscle exercise has the potential to improve motor functions in children with Down syndrome and it can be used as an alternative therapeutic approach to the conventional method.

Effect of short foot exercise on lower-limb motor control function during single-leg standing in university students with flatfoot: A randomized controlled trial.

INTRODUCTION: Intrinsic foot muscles (IFMs) play an important role in lower-limb motor control, including biomechanics and neuromuscular control function. Short foot exercise (SFE) and toe curl exercise (TC) are methods used to train the IFMs, but their effect on lower-limb motor control has not been reported in previous studies. This study evaluated the effects of SFE and TC on lower-limb motor control function during single-leg standing (SLS). TRIAL DESIGN: Randomized control trial. METHOD: Thirty-six participants with flatfoot were randomly assigned to the SFE or TC group and performed exercise for 8 weeks. The assessment items were navicular drop test, toe grip strength (TGS), plantar sensation, and SLS. In the SLS assessment, we measured the mean center of pressure (COP) amplitude in the anteroposterior (AP) and mediolateral (ML) directions, onset time of gluteus maximus (G. max) and gluteus medius (G. med), angle of forefoot/hindfoot protonation and hip adduction, and lateral pelvic shift. Mixed-model repeated-measures analysis of variance and Bonferroni corrections were performed in statistical analysis. RESULTS: The SFE group showed significant differences between pre- and post-intervention for TGS (p < 0.001), COP ML (p = 0.039), and onset times of G. max (p = 0.015), and G. med (p < 0.001). The TC group showed no significant differences in all assessment items. CONCLUSION: Our finding suggests that SFE contributes to lower neuromuscular control function in people with flatfoot. TRIAL REGISTRATION: UMIN000049963.

Treating symptomatic flexible flatfoot deformities. a novel technique: comparison of uc berkeley laboratory foot orthosis with and without kinesio taping in juvenil athletes.

PURPOSE: Symptomatic flexible pes planus (SFPP) can cause pain and discomfort when walking or engaging in sportive activities in children and adolescents. SFPP can be treated conservatively with foot orthoses, such as the University of California Berkeley Laboratory (UCBL) foot orthosis, which can improve foot function and reduce pain. Kinesio Tape (KT) has also been used as an adjunct to foot orthoses in the treatment of pes planus. This study aims to compare the effectiveness of the UCBL foot orthosis with and without KT in the treatment of SFPP among amateur juvenile and adolescent athletes. METHODS: Fifty patients with SFPP were included in the study. In 27 patients UCBL foot orthosis with KT (group 1) was used whereas in 23 UCBL (group 2) was preferred only. The patients were evaluated with AOFAS and radiological measurements. RESULTS: The mean follow-up period was 28.6 ± 4.3(26) months. At the final follow-up AOFAS of group 1 was significantly higher than group 2. In group 2, 12 patients (%52,17) had pressure sores that caused superficial dermabrasion. Lateral TFMAs and talocalcaneal angle in group 1 was significantly better than group 2. CONCLUSIONS: This study attempted to determine if using KT with the UCBL foot orthosis was beneficial to the treatment of SFPP compared to simply wearing the orthosis. Our results suggest that KT is effective in reducing pronation and improving the AOFAS score. The use of UCBL with KT seems to be preferable in children and adolescents with SFPP since it is associated with a lower rate of complication, a higher degree of patient compliance and faster improvement in the radiological and clinical findings, compared to the use of the UCBL orthosis alone.

[Flatfoot in children]. / Kindlicher Knick-Senk-Fuß.

The diagnosis of flatfoot in children is made clinically. In most cases it is an age-appropriate benign physiological variant, as long as it can be passively and actively redressed and the child does not show any neurological abnormalities, especially under the age of 6 years. Treatment is only indicated for symptomatic variants. In the case of rigid flatfeet, further diagnostics are necessary to exclude neurological or structural causes. Subtalar arthroereisis has become established and is an effective but slightly invasive procedure. Further options include the lengthening and medial translational osteotomy of the calcaneus or the Cotton operation; however, the indications must always be critically questioned, especially for surgical but also for conservative treatment, even if it is the wish of the family.

Effect of foot orthoses on balance among individuals with flatfoot: A systematic review and meta-analysis.

Individuals with flatfoot have impaired proprioception owing to ligament laxity and impaired tendons, which can result in poor balance. Foot orthoses (FOs) have been reported to stimulate plantar mechanical receptors and are used to manage foot overpronation in individuals with flatfoot. However, the results of the use of FOs to improve balance are inconsistent. In this systematic review and meta-analysis, we aimed to identify and investigate the effects of FOs on balance in individuals with flatfoot. Electronic databases were searched for articles published before March 2023. Peer-reviewed journal studies that included adult participants with flexible flatfoot and reported the effects of FOs on balance were included and classified based on the study design: randomized control trials (RCT) and non-RCTs. Four RCT studies were retained, and their methodological quality was assessed (mean, 63.2%; range 47.3%-73.1%: high), as were three non-RCT studies (mean, 54.1%; range, 42.1%-68.4%: high). Meta-analysis was performed by calculating the effect size using the standardized mean differences between the control and FO conditions. Transverse-arch insoles immediately improved static balance after use. However, no immediate significant effect was found for medial archsupport FOs, cuboid-posting FOs, or University of California Berkeley Laboratory FOs during the study period (2-5 weeks) when compared with the controls. The transverse-arch insole is the most effective FO feature for improving static balance. However, the high heterogeneity between study protocols contributes to the lack of evidence for the effects of FO on balance in people with flatfoot.

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.

Flatfoot arch correction with generic 3D-printed orthoses at different body weight percentages.

BACKGROUND: Flatfoot can be associated with foot pathologies and treated conservatively with foot orthoses to correct arch collapse and alleviate painful symptoms. Recently, 3D printing has become more popular and is widely used for medical device manufacturing, such as orthoses. This study aims at quantifying the effect of generic 3D-printed foot orthoses on flatfoot arch correction under different static loading conditions. METHODS: Participants with normal and flatfeet were recruited for this cross-sectional study. Clinical evaluation included arch height, foot posture index, and Beighton flexibility score. Surface imaging was performed in different loading conditions: 1) 0% when sitting, 2) 50% when standing on both feet, and 3) 125% when standing on one foot with a weighted vest. For flatfoot participants, three configurations were tested: without an orthosis, with a soft generic 3D printed orthosis, and with a rigid 3D printed orthosis. Arch heights and medial arch angles were calculated and compared for the different loading conditions and with or without orthoses. The differences between groups, with and without orthoses, were analyzed with Kruskal-Wallis tests, and a p < 0.05 was considered significant. RESULTS: A total of 10 normal feet and 10 flatfeet were analyzed. The 3D printed orthosis significantly increased arch height in all loading conditions, compared to flatfeet without orthosis. Wearing an orthosis reduced the medial arch angle, although not significantly. Our technique was found to have good to excellent intra and interclass correlation coefficients. CONCLUSIONS: Generic 3D printed orthoses corrected arch collapse in static loading conditions, including 125% body weight to simulate functional tasks like walking. Our protocol was found to be reliable and easier to implement in a clinical setting compared to previously reported methods. LEVEL OF EVIDENCE: II.

Acute effects of athletic taping on arch deformity and plantar pressure in young female adults with flexible flatfoot.

OBJECTIVE: This work aimed to explore the acute effects of athletic taping techniques on foot arch deformity and plantar pressure in young female adults with flexible flatfoot (FFT). METHODS: Twenty young female adults with FFT were recruited in the current study. Each participant was randomly divided into two taping groups, namely, augmented low-dye (ALD) and modified low-dye (MLD). The foot arch deformity and plantar pressure were measured at baseline, after taping and after 20 min of walking. The foot arch deformity was determined based on navicular drop distance (NDD) and resting calcaneal stance position (RCSP). RESULTS: Compared with baseline, the NDD values were significantly lower after taping. After 20 min of walking, ALD taping resulted in a lower NDD value than MLD (p < 0.001). ALD maintained a higher RCSP than baseline after 20 min of walking (p = 0.004). Furthermore, compared with baseline, medial midfoot force-time integration (p = 0.013) and contact area (p = 0.022) increased after taping with MLD, and peak pressure in the medial midfoot increased after walking for 20 min with MLD (p = 0.026). Peak pressure in the second to fifth toes significantly decreased after 20 min of walking with ALD compared with that after taping immediately (p = 0.002). CONCLUSIONS: ALD and MLD taping could improve FFT arch deformity and plantar pressure distribution, prospectively changing peak pressure of the second to fifth toe area and medial midfoot after 20 min of walking, integrated contact area and force-time integration medial midfoot during walking in young female adults. Furthermore, ALD taping could improve FFT deformity more than using MLD after 20 min of walking. Thus, when treating FFT in young female adults, ALD taping should be considered adaptively to guide arch support production and correct midfoot pronation.

Orthotic Devices for the Foot and Ankle.

Millions of Americans wear ankle-foot orthotic devices for protection, pain relief, and deformity correction. Inquiries about off-the-shelf and custom devices are a common reason for evaluation with a foot and ankle surgeon or general orthopaedic surgeon. Despite limited high-quality evidence for their use, these devices can have a notable clinical impact on physical function. An up-to-date understanding of orthotic device options and their appropriate use in managing musculoskeletal pathologies applies to all orthopaedic providers. This review aims to categorize orthosis types and provide specific device recommendations for common adult conditions such as flatfoot, cavovarus foot, and ankle instability. Collaboration with a certified orthotist can help patients achieve functional and recreational goals with the use of appropriately designed and applied orthoses.

Eficacia del tratamiento ortopédico en pie plano flexible pediátrico: revisión sistemática / Eficacy of orthopediac treatment of flexible flatfoot in pediatrics: A systematic review

Introducción: El pie plano flexible es una de las entidades ortopédicas más frecuentes en Pediatría. Algunos autores lo consideran una variante anatómica. La incertidumbre en cuanto a su evolución y pronóstico, sumado a la preocupación y demanda por parte de los padres, hace que en muchas ocasiones se indique tratamiento ortésico. Metodología: se realizó una búsqueda sistemática en Medline, Lilacs, Cochrane y Google académico, usando los términos therapy, flatfoot, flatfeet, pie plano y pes planus; población hasta los 18 años, publicaciones hasta abril 2017 y restringiendo por idiomas español e inglés. Para el aná- lisis de los artículos se utilizaron la guía de lectura crítica del Hospital Garrahan y la escala de calidad metodológica JADAD. Resultados: de 778 artículos encontrados, 421 correspondían a pacientes con enfermedad de base, 194 evaluaban corrección quirúrgica, 144 eran descriptivos, 7 comparaban diferentes ortesis entre sí y 7 eran revisiones de trabajos. Finalmente fueron analizados 5 trabajos (cuatro ECCAs y un estudio de cohorte). De los 5 artículos, 2 poseían aceptable y muy buena calidad metodológica según la escala JADAD, ninguno demostrando diferencias significativas con el tratamiento ortésico. De los 3 restantes, sólo uno halló mejores resultados en cuanto al alivio del dolor y de la marcha combinando ortesis con ejercicios (RR 0.33 y 0.29 respectivamente). Conclusión: en base a esta revisión no hay evidencia científica que demuestre la eficacia del uso de ortesis para la corrección del pie plano flexible en la población pediátrica sana.(AU)

Introduction: Flexible flatfoot is one of the most common orthopedic findings in children. Some authors consider the entity to be a normal anatomical variant. Uncertainty regarding outcome and prognosis added to the worries and demands of the parents often results in the indication of orthotic treatment. Methods: A systematic search was conducted in Medline, Lilacs, Cochrane, and Google academics using the terms therapy, flatfoot, flatfeet, and pes planus; population up to 18 years of age, publications until April 2017, in Spanish and English. For the analysis of the articles the critical reading guidelines of Hospital Garrahan and the JADAD scale for methodological quality were used. Results: Of 778 articles found, 421 were related to patients with an underlying disease, 194 evaluated surgical correction, 144 were descriptive studies, 7 compared different orthosis, and 7 were review studies. Finally, 5 studies were analyzed (four randomized controlled trials (RCT) and one cohort study). Of the five studies, two were considered acceptable and of good quality on the JADAD scale. None of the studies showed significant differences with orthotic treatment. Of the three remaining studies, only one found better results regarding pain relief and gait improvement with orthosis combined with exercise (RR 0.33 and 0.29, respectively). Conclusion: Based on this review, there is no scientific evidence that shows efficacy of the use of orthosis for the correction of flatfoot in healthy children. (AU)

Manejo del retropié plano valgo flexible con la férula tipo UCBL en pacientes pedátricos: [revisión] / Management of the flexible flat hindfoot valvus with orthesis type UCBL in pediatric patients: [review]

El tratamiento de las diversas deformidades del pie varia según las patologías y es precisamente en el niño por su gran plasticidad biológica, en quien se pueden aplicar los diferentes resursos que se poseen para el tratamiento ortopédico conservador. En el presente trabajo se plantea una alternativa para el tratamiento del retropié valgo, con la férula termo formada tipo UCBL (University of California Biomechanics Laboratory. Demostrar la utilidad de la férula tipo UCBL en el tratamiento conservador del retropié valgo para postegar y/o evitar tratamientos quirúrgicos por deformidades severas. La muestra utilizada fue de 15 pacientes (6 niñas, 9 niños, con edades entre 2 años 6 meses y 10 años) con disfunción del brazo de palanca por pérdida de la rigidez ósea, debido a la subluxación de la articulación sub-astragalina (retropié valgo flexible), en quienes se utilizó la férula termoformada tipo UCBL con seguimiento promedio de 12 a 36 meses. Se evaluó clínicamente la flexibilidad del pié y la maniobra de Silverskiold y radiologicamente en bípeda estación estática, el ángulo Costa-Bertani, Astrágalo calcáneo y astrágalo-1er metatarsiano. 10 pacientes presentaron mejoría clínica y radiológica, 5 de los casos no evidenciaron cambios, sin embargo, mantuvieron su flexibilidad. La férula resultó útil, inclusive en los casos donde no se demostró corrección radiológica, ya que evitó estructuración de la deformidad.

The adequate treatment for foot deformities varies depending on the pathology, and because of the high plasticity found in children, it is in this age group where the available conservative treatment resources can be applied. An alternative for the valgus hindfoot treatment is presented in this paper, using the UCBL (University of California Biomechanies Laboratory) thermoshaped orthesis. To prove utility of the thermoformed UCBL type orthesis in the treatment of flexible pes valgus in orden to avoid fuseverity deformities. The study included 15 patients (6 female, 9 male, ages between 2 years 6 months and 10 years) with lever-arm dysfunction due to loss of bony rigidity with sub-astragaline joint subluxation (flexible valgus hindfoot), in whom UCBL thermoshaped orthesis was indicated with an average follow up between 12 to 36 monts. Foot flexibility was clinical evaluated; also Silverskiold maneuver and static bipedestation x-rays angles were measured. Ten patients showed clinical and radiological improvement, 5 patients showed no change, although flexibility was maintained. The UCBL orthesis was useful, even in cases were no radiological change was observed, because it avoided structuration of bony deformity.

Tratamiento de pie plano valgo neuropático con artrorrisis subastragalina / Treatment of flatfoot with neuropathic worth artrorrisis subastragalar

Presentamos nuestra experiencia quirúrgica para el tratamiento de Pie Plano Neuropático, con la técnica descrita por Crawford, Artrorisis Subtalar con Grapa, en 35 pacientes (55 pies) cuya edad promedio al momento de la intervención era de 6 años. Fueron tratados en el Hospital Pediátrico San Juan de Dios durante un periodo promedio de 10 años (1995-2005). En todos los casos se obtuvo resultados satisfactorios. Nosostros consideramos que la intervención es un procedimiento sencillo y efectivo para la correción del pie plano neuropático.

Evaluación del tratamiento de las patologías ortopédicas más frecuentes de la consulta del Servicio de Tarumatología y Ortopedia del Centro Policlínico Valencia: 1999-2001 / Evaluation of treatment of the diseases most common orthopedic consultation Service of Orthopedics and Traumatology Centro Policlínico Valencia: 1999-2001

Evaluamos el tratamiento de los motivos de consulta: pie plano, genus valgus y marcha intrarrotada de 154 pacientes en control ortopédico. El 100 por ciento de los pacientes con pie plano fue tratado con calzado, ortesis y ejercicios. Iniciaron 89 pacientes (57,79 por ciento) con los niveles más severos de pie plano, cifra que disminuyó a 12,98 por ciento. Al final de la evaluación del tratamiento se obtuvieron 28 pacientes normales y 50 (32,46 por ciento) pie plano grado I. Con genus valgus 91,37 por ciento pacientes usaron calzado ortopédico. Para el primer control 74,14 por ciento mejoraron y al final del trabajo 93,10 por ciento mejoraron y curaron. En la marcha intrarotada 16,67 por ciento ameritó aparato ortopédico en algún momento, el resto uso calzado y fisioterapia. Permanecieron iguales un 46,30 por cientoy sólo curaron 4 pacientes. Los signos clínicos apuntados hacia una mejoría. Recomendamos nuestro método diagnóstico y terapéutico.

Pie plano en el niño y acortamiento de sóleo y gemelos / Flat foot and Achiles-tendon shortening in children

De una revisión de 637 expedientes de niños con diagnóstico de pie plano, recolectados durante cuatro años, se detectaron 16 pacientes con acortamiento de soleo y gemelos y valgo del retropié estructurado. Todos compartieron el dolor vespertino o nocturno en la planta y pantorrilla, además de prueba de Jack positiva. Radiológicamente hubo repercusión en la articulación astrágalo-escafoidea. El tratamiento consistió en soportes de polipropileno, ejercicios de estiramiento de los músculos mencionados y en tres niños fue necesario efectuar artrodesis subastragalina tipo Grice y elongación del tendón de Aquiles, en el postoperatorio se manejó con yeso y rehabilitación. Los resultados son satisfactorios por la desaparición del dolor, se evitó la deformidad del zapato, y se obtuvo la alineación del retropié, tanto en los casos manejados conservadora como quirúrgicamente

Corección del pie plano valgo en niños con enfermedades neuromusculares con artrorisis externa con grapa / Correction of the plane foot is worth in children with illnesses neuromusculares with external arthoereisis with staple

Presentamos nuestra experiencia quirúrgica para el tratamiento de pie plano neuromuscular, con la técnica descrita por Crawford, Artrorisis Subtalar con Grapa. Un total de 7 pacientes, 13 pies, cuya edad promedio al momento de la intervención fue de 6 años. Tratados en el Hospital San Juan de Dios de Caracas, con seguimiento promedio de 2 años. En el total de los casos obtuvimos resultados satisfactorios, por lo que consideramos esta técnica como una buena alternativa para el tratamiento de pie plano neuromuscular en niños

Cirugía estático-activa para el pie plano flácido en niños y adolescentes de 10 a 14 años / Static active surgery for flaccid flat foot in children and adolescent from 10 to 14 years

El pie plano flácido en el niño, también llamado aplanamiento de la bóveda plantar persiste muchas veces después de los 10 años y en ocasiones se hace permanente. La respuesta al tratamiento conservador a base de soporte y zapato adecuado no es la que esperamos, tenemos fracasos a pesar que iniciamos tratamiento a edad temprana. Los padres preocupados, no únicamente por la apariencia plana del pie, sino por el dolor, cansancio, dificultad para la marcha, alteraciones en su postura y desgaste anormal del calzado, ante está situación, buscarán otras opciones, y nosotros por nuestra parte, tenemos la necesidad de ofrecer resultados que garanticen el bienestar del paciente. Por otra parte, si insistimos en que continúe usando arreglos ortopédicos se puede perder al paciente, ya que otro médico le ofrecerá otra alternativa como la quirúrgica, quizá con los resultados que el padre desea