Foot exercise and taping in patients with patellofemoral pain and pronated foot

Effect of adding short foot exercise to hip and knee focused exercises in treatment of patients with patellofemoral pain syndrome: a randomized controlled trial

BACKGROUND

Patellofemoral pain syndrome is considered a common cause of anterior knee pain that could disturb function and limit daily activities. The purpose of the study was to investigate the effect of adding short foot exercise on pain, function, balance, and hip abductors, and quadriceps muscles strength in the treatment of patients with patellofemoral pain syndrome.

METHODS

Twenty-eight male and female patients with patellofemoral pain syndrome with age ranged from 18 to 35 years old participated in this study. They were equally and randomly assigned into two groups; the study group which received short foot exercise in addition to hip and knee exercises (n = 14) and thecontrol group which received hip and knee exercises only (n = 14). Participants received their interventions during 6 consecutive weeks (12 sessions). Pain intensity, function, abductors quadriceps muscle strength, and balance were assessed using the Visual Analog Scale, anterior knee pain scale (AKPS), hand-held dynamometer, and the Biodex Balance System respectively. All measurements were taken before and after 6 weeks of intervention in both groups. Multivariate analysis of variance was performed to compare the within and between groups effects for measured variables.

RESULTS

The within-group comparison showed significant improvement in pain severity, function, balance, and hip abductors, and quadriceps muscles strength in both groups post-treatment compared with pre-treatment. Between groups analysis, however, showed no significant statistical difference between both groups in all variables, except in pain, function, and mediolateral stability which showed better improvement compared to the control group.

CONCLUSIONS

Adding short foot exercise to hip and knee exercises improved pain, function, and mediolateral stability in patients with patellofemoral pain syndrome.

TRIAL REGISTRATION

clinicaltrials.gov. NO: NCT05383781. Date 19/ 5/2022.

Gait retraining targeting foot pronation: A systematic review and meta-analysis

Foot pronation is a prevalent condition known to contribute to a range of lower extremity injuries. Numerous interventions have been employed to address this issue, many of which are expensive and necessitate specific facilities. Gait retraining has been suggested as a promising intervention for modifying foot pronation, offering the advantage of being accessible and independent of additional materials or specific time. We aimed to systematically review the literature on the effect of gait retraining on foot pronation. We searched four databases including PubMed, Web of Science, Scopus and Embase from their inception through 20 June 2023. The Downs and Black appraisal scale was applied to assess quality of included studies. Two reviewers screened studies to identify studies reporting the effect of different methods of gait-retraining on foot pronation. Outcomes of interest were rearfoot eversion, foot pronation, and foot arch. Two authors separately extracted data from included studies. Data of interest were study design, intervention, variable, sample size and sex, tools, age, height, weight, body mass index, running experience, and weekly distance of running. Mean differences and 95% confidence intervals (CI) were calculated with random effects model in RevMan version 5.4. Fifteen studies with a total of 295 participants were included. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. The results of the meta-analysis showed that changing step width does not have a significant effect on peak rearfoot eversion. Results of single studies indicated that reducing foot progression angle (MD 2.1, 95% CI 0.62, 3.58), lateralizing COP (MD -3.3, 95% CI -4.88, -1.72) can effectively reduce foot pronation. Overall, this study suggests that gait retraining may be a promising intervention for reducing foot pronation; Most of the included studies demonstrated significant improvements in foot pronation following gait retraining. Changing center of pressure, foot progression angle and forefoot strike training appeared to yield more favorable outcomes. However, further research is needed to fully understand its effectiveness and long-term benefits.

The effects of short foot exercises to treat flat foot deformity: A systematic review

BACKGROUND

Studies on the effects of performing short foot exercises (SFEs) on the medial longitudinal arch (MLA) have been inconclusive.

OBJECTIVE

This study aimed to conduct a systematic review of the effects of SFEs.

METHODS

'SFE' and 'intrinsic foot muscle' were keywords used to search for randomized controlled trials. One researcher screened relevant articles based on their titles and abstracts, and two independent researchers closely read the texts, accepting nine studies for inclusion. Outcomes, intervention duration, frequency, and the number of interventions were investigated.

RESULTS

Of 299 potential studies identified, the titles and abstracts of 211 studies were reviewed, and 192 were excluded. The full texts of 21 studies were obtained and evaluated according to inclusion and exclusion criteria. Nine studies met the inclusion criteria. Six studies concerning the MLA were identified, with four reporting MLA improvement. There was no consensus concerning the number and frequency of SFEs performed, and the mechanism of MLA improvement was unclear. MLA improvement was observed in participants who undertook ⩾ 5 weeks of interventions.

CONCLUSIONS

The results suggest that performing SFEs for ⩾ 5 weeks is effective in improving the MLA. Randomized controlled trials with details concerning the number and frequency of treatments are required.

Does the Foot and Ankle Alignment Impact the Patellofemoral Pain Syndrome? A Systematic Review and Meta-Analysis

Background: A convincing association between the foot and ankle alignment (FAA) and patellofemoral pain syndrome (PFPS) remains debatable in the literature. Therefore, all studies investigating the role of FAA in patients with PFPS were systematically reviewed. Methods: A systematic literature search was performed on the databases PubMed, Embase, Cochrane Library, and Web of Science. Inclusion criteria were all studies investigating static and/or dynamic FAA factors and PFPS. Studies with less than 20 patients or with patellofemoral osteoarthritis were excluded. The quality assessment was based on Cochrane study criteria, and the maximum score was set at eight. Results: Of 2246 articles, only 13 case-control studies were eligible. Considering static FAA factors, two studies found an association with rearfoot eversion and one with rearfoot inversion. While examining dynamic FAA characteristics, one study found an association with rearfoot eversion range of motion and three with gait kinematics. No further associations were reported. The quality assessment mean score was 5.5 (SD = 0.97) corresponding to moderate quality. Conclusions: In contrast to our expectations, a limited number of studies were founded supporting an association between FAA and PFPS. At present, the quality of the literature is still poor and conflicting, thus the need for further studies to determine any association between FAA and PFPS.

Long-term training on sand changes lower limb muscle activities during running in runners with over-pronated feet

BACKGROUND

Running on sand could be a promising exercise intervention for the treatment of over-pronated feet. However, there is a lack of knowledge about the effects of running on sand on muscle activities. Therefore, this study aims to evaluate the long-term effects of running on sand on the activities of selected lower limb muscles in individuals with OPF compared with healthy controls.

METHODS

Sixty recreational adult male runners with over-pronated feet (foot posture index > 10) were divided into two equal groups (intervention and control). Participants ran barefoot at a pre-defined speed (⁓3.3 m/s) over level stable ground both before and after long-term training on the sand. Muscle activities were recorded using a surface bipolar electromyography system.

RESULTS

For the intervention group, we found a reduced foot posture index (p < 0.001; d = 2.00) and significant group-by-time interactions for gluteus medius activity during the mid-stance phase (p < 0.028; d = 0.59). Significantly higher gluteus medius activity (p = 0.028, d = 0.569) was found during the post-test. We also observed significant group-by-time interactions for medial gastrocnemius activity during the push-off phase (p < 0.041; d = 0.54). Significantly larger medial gastrocnemius activity (p = 0.041; d = 0.636) was found during the post-test compared to the pre-test.

CONCLUSIONS

Long-term running on sand resulted in reduced pronation, increased medial gastrocnemius activity, and improved frontal plane pelvic stability due to higher gluteus medius activity.

TRIAL REGISTRATION

IRCT20191211045704N1. Registered 25 February 2020. Retrospectively registered.

Examining the efficacy of short foot exercises as an effective stand-alone treatment for mechanical low back pain associated with foot overpronation

BACKGROUND: Abnormal foot mechanics in foot over-pronation has an identified relationship with mechanical low back pain (MLBP). OBJECTIVE: To explore the use of short foot exercises (SFEs) as a standalone treatment for MLBP with foot over-pronation. METHODS: Forty-six patients with MLBP (PwMLBP) presenting with and foot over-pronation were analyzed. They were randomized into the SFE (short foot exercise), SFE plus traditional physical therapy treatment (SFE+TPT), and control (CG) groups. Functional disability and pain level were measured using the Oswestry Disability Index (ODI) and visual analog scale (VAS), respectively. Ultrasonography measured the cross-sectional area (CSA) of the abductor hallucis (AbdH) muscle. The foot posture and navicular drop (ND) were investigated using the foot posture index-6 (FPI) score and ND test, respectively. RESULTS: The CSA of the AbdH and VAS scores improved significantly (p< 0.001) between the groups, more in the SFE+TPT group than in the SFE group (p< 0.001). The ND, FPI, and ODI measures improved significantly among the groups (p< 0.001), with no significant difference (p> 0.002) between the SFE and SFE+TPT groups. The CG did not show significant differences in the outcome measures (p> 0.002). Based on the effect size, SFEs significantly improved all the variables of interest (d>1). CONCLUSION: SFEs, with or without TPT may offer an effective treatment for PwMLBP with foot over-pronation.

The effect of changing foot progression angle using real-time visual feedback on rearfoot eversion during running

Atypical rearfoot in/eversion may be an important risk factor for running-related injuries. Prominent interventions for atypical rearfoot eversion include foot orthoses, footwear, and taping but a modification derived from gait retraining to correct atypical rearfoot in/eversion is lacking. We aimed to investigate changes in rearfoot in/eversion, subtalar pronation, medial longitudinal arch angle, and selected lower limb joint biomechanics while performing toe-in/toe-out running using real-time visual feedback. Fifteen female runners participated in this study. Subjects performed toe-in/toe-out running using real-time visual feedback on foot progression angle, which was set ±5° from habitual foot progression angle. 3D kinematics of rearfoot in/eversion, subtalar supination/pronation, medial longitudinal arch angle, foot progression angle, hip flexion, ab/adduction and internal/external rotation, knee flexion, ankle dorsiflexion, and ankle power were analyzed. A repeated-measures ANOVA followed by pairwise comparisons was used to analyze changes between three conditions. Toe-in running compared to normal and toe-out running reduced peak rearfoot eversion (mean difference (MD) with normal = 2.1°; p<0.001, MD with toe-out = 3.5°; p<0.001), peak pronation (MD with normal = -2.0°; p<0.001, MD with toe-out = -3.4; p = <0.001), and peak medial longitudinal arch angle (MD with normal = -0.7°; p = 0.022, MD with toe-out = -0.9; p = 0.005). Toe-out running significantly increased these kinematic factors compared to normal and toe-in running. Toe-in running compared to normal running increased peak hip internal rotation (MD = 2.3; p<0.001), and reduced peak knee flexion (MD = 1.3; p = 0.014). Toe-out running compared to normal running reduced peak hip internal rotation (MD = 2.5; p<0.001), peak hip ab/adduction (MD = 2.5; p<0.001), peak knee flexion (MD = 1.5; p = 0.003), peak ankle dorsiflexion (MD = 1.6; p<0.001), and peak ankle power (MD = 1.3; p = 0.001). Runners were able to change their foot progression angle when receiving real-time visual feedback for foot progression angle. Toe-in/toe-out running altered rearfoot kinematics and medial longitudinal arch angle, therefore supporting the potential value of gait retraining focused on foot progression angle using real-time visual feedback when atypical rearfoot in/eversion needs to be modified. It should be considered that changes in foot progression angle when running is accompanied by changes in lower limb joint biomechanics.

Modification of Pronated Foot Posture after a Program of Therapeutic Exercises

Working on the intrinsic musculature of the foot has been shown to be effective in controlling pronation. However, the potential coadjuvant effect that involving other muscle groups might have on foot posture remains unknown. The aim was, therefore, to assess whether a 9-week intrinsic and extrinsic foot and core muscle strength program influenced foot posture in pronated subjects. The participants were 36 healthy adults with pronated feet that were randomly assigned to two groups. The experimental group (n = 18) performed a strengthening exercise protocol for 9 weeks (two sessions of 40 min per week), while the control group (n = 18) did not do these exercises. After 9 weeks, the foot posture index (FPI) scores of the two groups were analyzed to detect possible changes. The FPI at the baseline was 8.0 ± 1.5. After the 9 weeks, the experimental group showed significantly reduced FPI from 8.1 ± 1.7 to 6.4 ± 2.1 (p = 0.001), while the control group had the same score as pre-intervention (FPI 8 ± 1.2, p = 1.0). The FPI scores showed no significant differences by sex. Strengthening of the intrinsic and extrinsic foot and core muscles contributed to improving foot posture in adults, reducing their FPI by 1.66 points.

Effects of the infrared laser on classical ballerinas' feet: Analysis of plantar foot and static balance

BACKGROUND AND PURPOSE

Overuse injuries and painful symptoms in athletes and dancers (especially classical ballerinas) may lead to reduced functional performance. However, laser application may reduce pain and increase physical conditioning. The aim of the current study was to evaluate the immediate and long-term effects of infrared laser on classical ballerinas' feet.

METHODS

Eight female adults who perform classical ballet training and feel pain in their foot, but report no injuries in the last 6 months participated in the study. Infrared laser (808 nm) was applied on ballerina's feet twice a week during three months. The laser parameters utilized were 100 mW average optical power and spot size of 0.04 cm² applied during 1 min, leading to 6 J and 125 J/cm² per point. Thermography, algometry and unipodal static standing balance test were performed.

RESULTS

There was a significant increase in plantar arch temperature (1.6 °C for center and 2.3 °C for border, p < 0.05) immediately after laser treatment for all ballerinas. The pressure pain thresholds (PPT) were significantly increased for 5 of 7 analyzed sites (p < 0.05). Regarding to the static standing balance, the time on one-foot showed a significant increases (from 23 ± 12 s to 34 ± 13 s, p < 0.05) only when the test was performed on the left foot (support foot).

CONCLUSION

Then, there were pain relief and improvement of functional performance in ballerinas. The possible mechanism of laser action in reducing pain and thus enhancing performance, like higher blood flow of foot due to an increase of cutaneous temperature, will be discussed.

Effect of Isometric Hip Abduction on Foot and Ankle Muscle Activity and Medial Longitudinal Arch During Short-Foot Exercise in Individuals With Pes Planus

CONTEXT

The improvement of hip joint stability can significantly impact knee and rearfoot mechanics. Individuals with pes planus have a weak abductor hallucis (AbdH), and the tibialis anterior (TA) may activate to compensate for this. As yet, no studies have applied isometric hip abduction (IHA) for hip stability during short-foot exercise (SFE).

OBJECTIVE

To compare the effects of IHA on the muscle activity of the AbdH, TA, peroneus longus (PL), and gluteus medius (Gmed), as well as the medial longitudinal arch (MLA) angle during sitting and standing SFE.

DESIGN

Two-way repeated analyses of variance were used to determine the statistical significance of AbdH, TA, PL, and Gmed electromyography activity, as well as the change in MLA angle.

SETTING

University research laboratory.

PARTICIPANTS

Thirty-two participants with pes planus.

INTERVENTION(S)

The participants performed SFE with and without isometric hip abduction in sitting and standing positions.

MAIN OUTCOME MEASURES

Surface electromyography was used to measure the activity of the AbdH, TA, PL, and Gmed muscles, and Image J was used to measure the MLA angle.

RESULTS

Significant interactions between exercise type and position were observed in terms of the PL muscle activity and in the change in MLA angle only, while other muscles showed significant main effects. The IHA during SFE significantly increased the AbdH muscle activity, while the TA muscle activity was significantly lower. The muscle activity of Gmed and PL was significantly increased in the standing position compared with sitting, but there was no significant difference with or without IHA. The change in the MLA angle was significantly greater in SFE with IHA in a standing position than in the other SFE conditions.

CONCLUSIONS

IHA may be an effective method for reducing compensatory TA activity and increasing AbdH muscle activity during SFE for individuals with pes planus.

Randomized Clinical Trial: The Effect of Exercise of the Intrinsic Muscle on Foot Pronation

Background: There is little scientific evidence regarding the effectiveness of strengthening exercises on the foot's intrinsic musculature in improving the lower limb on the statics and dynamics in healthy individuals. Method: To evaluate the effect on foot posture with regard to the reinforcement of the short foot exercise (SFE) compared to another without a recognized biomechanical action, which we called the "non-biomechanical function" (NBF) exercise. A randomized clinical trial was carried out with 85 asymptomatic participants with a bilateral Foot Posture Index (FPI) greater than 6 points. An experimental group (n = 42) did SFE training and a control group (n = 43) carried out NBF exercises. The foot posture was evaluated twice via the navicular drop (ND) test, and the FPI was assessed on the day of inclusion in the study (pre-intervention) and after four weeks of training (post-intervention). Results: Statistically significant values were not found in foot posture between the experimental and the control groups when comparing before and after the training. However, the foot posture was modified in both groups with respect to its initial state, and the ND value decreased. Conclusions: SFE could be considered a useful tool to deal with pathologies whose etiology includes excessive pronation of the foot.

Acute effect of elastic bandage technique on middle deltoid muscle force and activation in healthy men

Abstract Introduction: Elastic bandages (EB), such as Kinesio taping, have been widely used in sports or daily life activities with the aim of preventing or reducing musculoskeletal injuries. It has been suggested that Kinesio Taping is capable of altering muscle activation through neurophysiological mechanisms, but the evidences about this are controversial. Objective: To verify the acute effect of EB on maximum voluntary isometric force (MVIF) and muscle activation of the middle deltoid muscle during muscle contraction. Method: Twenty-four healthy male (24 ± 4 years, 73.2 ± 13.9kg, 1.80 ± 0.10m) were randomly assigned to a group with elastic bandage activated at 100% (AEB n = 8); with tensionless elastic bandage (NEB n = 8), and the control group (CG n = 9). The volunteers were instructed to perform 5s of maximal isometric contraction at 90° of shoulder abduction while the MIVF and EMGrms records were registered. Results: One-way ANOVA was unable to identify significant difference (α = 0.05) in MIVF and EMGrms of the middle deltoid at 90° of shoulder abduction. Conclusion: The application of elastic bandage was not able to alter the production of maximal isometric voluntary contraction and activation of the middle deltoid muscle of healthy individuals and, therefore, its use is not justified for these purposes.