Effects of selective strengthening of tibialis posterior and stretching of iliopsoas on navicular drop, dynamic balance, and lower limb muscle activity in pronated feet: A randomized clinical trial

Comparing the efficacy of exercise therapy on adult flexible flatfoot individuals through a network meta-analysis of randomized controlled trials

The aim of this study is to compare the efficacy of different exercise interventions for adult flexible flatfoot. Nine databases (PubMed, EMBASE, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), SCOPUS, PRDro, Google Scholar, China National Knowledge Infrastructure(CNKI) and Wanfang data) were systematically searched from their inception until February 2024. The search resulted in 2112 records, with 11 studies included. All networks revealed low heterogeneity and non-significant inconsistency (I2 ≤ 25.0%). Three network plots were formed for navicular drop. Firstly, compared with the control group, strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE (MD: 3.32, 95% CI: 1.78, 4.89), PNF (MD: 1.81, 95%CI: -0.05, 3.70), SFE (MD: 1.23, 95%CI: 1.02, 1.44) all showed better effects. And strengthening the posterior tibial muscle + stretching the iliopsoas muscle + TCE exercise is considered to be the most effective intervention, with SUCRA of 0.97. Secondly, compared with the control group, hip-focused neuromuscular exercise (MD: 6.22, 95% CI: -1.69, 14.12), SFE with EMG biofeedback (MD: -0.81, 95%CI: -1.59, 3.21) all showed better effects. And hip-focused neuromuscular exercise is considered to be the most effective intervention, with SUCRA of 0.92. Thirdly, the internal foot muscle training combined with gluteus muscle strengthening is significantly better than the other two groups, with SUCRA of 0.99. For the foot posture index, comprehensive reinforcement (MD: 1.95, 95% CI - 0.19, 4.03) showed better effects compared with the control group. In the probability ranking table, comprehensive reinforcement is significantly better than the other two groups, with SUCRA of 0.98. For the foot function index, orthoses wear + stretching + eccentric progressive resistive exercise of tibialis posterior is significantly better than the other two groups, with SUCRA of 0.92. In conclusion, various exercise therapies improve the arch shape and function of patients with flexible flatfoot, particularly hip muscle and lower limb overall muscle training.

Effects of physical interventions on pain and disability in chronic low back pain with pronated feet: a systematic review and meta-analysis

BACKGROUND

A link between pronated feet (PF) and chronic low back pain (CLBP) has been reported in the literature. However, physical interventions (PI) like physiotherapy and orthotics mainly target the lower back, neglecting the broader biomechanical impacts of PF that affect the feet, ankles, and overall posture. Currently, there is a lack of comprehensive meta-analyses or systematic reviews on this subject.

OBJECTIVES

This systematic review with a meta-analysis aimed to evaluate the effects of PI on pain and disability in patients having CLBP with PF.

METHODS

From inception until October 15, 2023, Medline/PubMed, Web of Science, and Scopus databases were searched using the desired keywords for randomized control trials (RCTs). The quality of the RCTs was evaluated using the PEDro scale and risk of bias tool.

RESULTS

Four studies involving 268 patients were identified, two compared custom-made foot orthoses to non-biomechanical foot insoles, while the other two used exercises. The meta-analysis included four studies for pain and three for disability. The results showed a significant change in pain [-2.43 (95% CI -2.73 to -2.13, p < .001)] and disability of -6.69 (95% CI -8.04 to -5.33, p < .001)].

CONCLUSIONS

This systematic review and meta-analysis of four RCTs elucidates that PI, specifically targeting PF, significantly alleviate pain and reduce disability in patients having CLBP with PF. These findings advocate for integrating foot-based PI within the treatment protocols for patients suffering from CLBP accompanied by PF.

Does Kinesio taping of tibialis posterior or peroneus longus have an immediate effect on improving foot posture, dynamic balance, and biomechanical variables in young women with flexible flatfoot?

BACKGROUND

Flexible flatfoot is common in young adults. One of its causes is the failure of dynamic stabilizers, which play an important role in the medial longitudinal arch support, and their appropriate function is necessary for the integrity of the lower extremity and the spine.

OBJECTIVE

The study aimed to determine Kinesio taping on which extrinsic foot muscle provides greater benefit regarding enhancement of foot posture, dynamic balance, and biomechanical parameters in functional tasks immediately.

METHODS

Thirty women were recruited for the study. They were randomly divided into groups (A = 15, B = 15). In group A, Kinesio taping was applied on the tibialis posterior (TP), and in group B, Kinesio taping was applied on the peroneus longus (PL) and remained for 30 min. Outcome measures were the navicular drop test (NDT), foot posture index (FPI), Y-balance test, and biomechanical parameters in functional tasks. Before/After within-group and between-group comparisons of outcome measures were performed.

RESULTS

NDT and FPI decreased in both groups (p < 0.05) with no significant difference between groups. In group A, maximum total force of the stance phase (MaxTFSP) during running increased, and some temporal parameters were changed. (p < 0.05). In group B, Y-balance test improved in all directions, and the width of the gait line during walking increased. There were no significant differences in the postural stability parameters in the within-group comparison, except for mean center of pressure displacement in group B (p = 0.04).

CONCLUSION

Kinesio taping of both muscles could improve foot posture. TP Kinesio taping can increase the MaxTFSP during running and alter some temporal parameters during walking and running tasks. PL Kinesio taping could lead to better dynamic stability and coordination during dynamic tasks. Each muscle can be considered a therapeutic target for a specific purpose.

Analysis of technical characteristics of typical lower limb balance movements in Tai Chi: a cross-sectional study based on AnyBody bone muscle modeling

BACKGROUND

Tai Chi is an excellent traditional Chinese physical fitness exercise, and its unique balancing movements are very important for improving human balance. In this study, the two most representative Tai Chi balance movements, "knee lift balance" and "leg stirrup balance", were selected to establish the lower limb bone muscle model of Tai Chi balance movements by using computer simulation modeling technology, aiming to analyze the characteristics of the lower limb movement mechanisms of typical balance movements, to provide a quantitative theoretical basis for improving the scientific level of Tai Chi.

METHOD

A total of 16 subjects were recruited for this study. the BTS three-dimensional motion capture system and three-dimensional force platform were used for motion data acquisition, the physiological electromyographic signals were collected using BTS surface electromyography, and the lower limb bone muscle model of Tai Chi balance movements was established by AnyBody human simulation.

RESULT

In the knee lift balancing movement, the balance leg hip abduction/adduction angle, hip flexion/extension moment, and the strength of the rectus femoris muscle, biceps femoris short capitis, and iliacus muscle of the amateur group was significantly smaller than that of the professional group (P < 0.01). In the leg stirrup balance movement, the knee flexion/extension angle of the balancing leg in the amateur group was significantly greater than that in the professional group (P < 0.01), and the hip flexion/extension angle, hip inversion/abduction angle, knee flexion/extension moment, hip flexion/extension moment, the strength iliacus, gluteus maximus, and obturator internus were significantly smaller than those in the professional group (P < 0.01). The integral EMG of the biceps femoris of the support leg in the amateur group was significantly smaller than that of the professional group (P < 0.01). The integral EMG of the lateral femoral muscle of the balance leg was significantly smaller than that of the professional group (P < 0.01).

CONCLUSION

In this study, we found that the balancing leg of the balancing movement has a larger hip joint angle, the stirrup balancing knee joint angle is smaller, and the hip and knee joint moments are larger. This is related to joint activity and muscle activation, and amateurs should pay attention to increasing the range of motion of the hip joint and decreasing the range of motion of the knee joint when practicing to better stimulate exercise of the lower limb joints. In addition, the practice of balancing movements should strengthen the iliacus muscle, which plays an important role in maintaining the stable balance of the lower limbs, and strengthen the knee flexor and extensor muscles and hip adductor/abductor muscles of the balancing leg, thus promoting the stability of the balancing leg movements.

Newly compiled Tai Chi (Bafa Wubu) promotes lower extremity exercise: a preliminary cross sectional study

Background

Tai Chi (Bafa Wubu) is a new type of simplified Tai Chi widely practiced by Tai Chi enthusiasts that has developed and perfected simplified Tai Chi movement and enriched Tai Chi practice methods. When practicing, Tai Chi athletes and enthusiasts can choose the Bafa Wubu movements to practice according to their physical conditions. The purpose of this article is to discuss the mechanism by which Bafa Wubu promotes lower extremity exercise from the perspective of exercise biomechanics.

Objectives

This article aims to explore the scientific training methods and technical characteristics of Bafa Wubu, and its contribution to comprehensive exercise of the lower extremities, by analyzing the biomechanical characteristics of the lower extremities of participants who practice Bafa Wubu at different levels and by comparing their ground reaction force, lower limb joints, and muscles during Bafa Wubu.

Methods

A total of 16 male participants were recruited and divided into an amateur group (N = 8) and a professional group (N = 8). The data were collected by a BTS 3D infrared-based motion capture system, and Kistler 3D force plate. The lower extremity joint forces and muscle strength were calculated by anybody simulation software with inverse dynamics.

Results

During elbowing and leaning sideways with steps sideways (ELS), the ground reaction force of the professional group was significantly higher than that of the amateur group in the sagittal, vertical, and frontal axes (P < 0.01). While stepping forward, backward, and sideways, the professional group's joints loading at the hip, knee, and ankle was always higher in the vertical direction (P < 0.01). Furthermore, during warding off with steps forward (WOF), laying with steps forward (LF), and rolling back with steps backward (RBB), hip joint loading increased in the med-lat direction. During actions with steps backward and sideways, the professional group's ankle flexion/extension torque and hip abduction/rotation torque were significantly larger than those of the amateur group (P < 0.01). Different actions in Bafa Wubu activate muscles to different degrees, whereas the iliacus is mainly responsible for stabilizing postures when practitioners perform standing knee lifting motions.

Conclusions

Professional groups who have been practicing Tai Chi (Bafa Wubu) for a long time have higher ground reaction force, and the force on the three joints of the lower extremities is different for various movements, which has positive significance for exercising the joints of the lower extremities. In addition, various motions activate muscles of different types at different levels. For amateurs to practice different movements to stimulate the muscles, targeted areas of practice promote the lower extremity muscles' synergistic force. In summary, the muscles and joints of the lower extremity can obtain comprehensive and balanced exercise through Bafa Wubu.

Gluteus medius muscle strengthening exercise effects on medial longitudinal arch height in individuals with flexible flatfoot: a randomized controlled trial

This study aimed to compare the effects of 8 weeks of foot plus hip exercise to foot exercise alone on medial longitudinal arch (MLA) parameters; navicular drop (ND), arch height index (AHI), plantar pressure, static balance, and dynamic balance were measured at baseline, 4 weeks, and 8 weeks. A total of 52 healthy participants with bilateral flatfoot were randomly assigned into foot exercise (n=26) and foot plus hip exercise (n=26) group. At 4 weeks, the foot plus hip exercise group showed significantly less ND (P=0.002), plantar pressure at the medial forefoot (P=0.002), and mediolateral displacement (P=0.001) while showing a greater AHI (P=0.019) than the foot exercise group. At 8 weeks, there was also significantly less plantar pressure at the medial hindfoot (P=0.017) and less anteroposterior displacement (P=0.002) in the foot plus hip exercise group than in the foot exercise group. No significant differences between groups were found in dynamic balance. The addition of gluteus medius muscle strengthening exercise to foot exercise was more effective in supporting the MLA than performing foot exercise alone.

Comparison between the effects of tibialis posterior versus fibularis longus Kinesio taping on foot posture, physical performance, and dynamic balance in young women with flexible flatfoot

Purpose

The purpose of the study is to compare the effectiveness of the tibialis posterior Kinesio taping and fibularis longus Kinesio taping on the foot posture, physical performance, and dynamic balance in young women with flexible flatfoot.

Methods

Twenty-four subjects were recruited for the study. They were randomly divided into groups (A = 12, B = 12). In group A, Kinesio taping was applied on the tibialis posterior, and in group B, Kinesio taping was applied on the fibularis longus and remained for 30 min. Outcome measures were the navicular drop test (NDT), foot posture index (FPI), timed up and go (TUG) test, and Y-balance test. The pre- and post-treatment results were compared for each group; between-group differences were determined as well.

Results

For group A, NDT, FPI, and TUG test changed significantly (P = 0.01, P = 0.001, P = 0.006, respectively). For group B, the FPI score decreased (P = 0.03), and the Y-balance test in the anterior direction improved significantly (P = 0.01). Any variables have not shown a significant difference between groups (P > 0.05).

Conclusion

Kinesio taping of the tibialis posterior and fibularis longus can improve foot posture in young women with flexible flatfoot. Also, physical performance and dynamic balance improved by Kinesio taping of the tibialis posterior and the fibularis longus, respectively. In addition to the tibialis posterior, we found that the fibularis longus muscle can be considered a therapeutic target for managing flexible flatfoot in healthy young women.

Pie plano y tratamientos conservadores en adultos físicamente activos. Una revisión sistemática

El término pie plano es utilizado para describir cualquier anormalidad que causa el colapso del arco longitudinal medial del pie, cuando es sintomático condiciona el grado, tipo y calidad de actividad física que practique un adulto. Como objetivo nos planteamos revisar los tratamientos conservadores existentes para el pie plano en adultos jóvenes y de mediana edad. Siguiendo las directrices de la declaración PRISMA, se realizó una revisión sistemática de la literatura científica publicada sobre el pie plano y tratamientos conservadores. Los tratamientos conservadores para el pie plano son aplicados de manera aislada o en combinación, estos incluyen ejercicios de fortalecimiento, de estiramientos, uso de ortesis, aplicación de vendaje, modificación del calzado y estimulación eléctrica. Son requeridos estudios de tratamientos conservadores en adultos de mediana edad con pie plano sintomático que evalúen el efecto a corto y largo plazo de los actuales protocolos en poblaciones con diferente nivel de condición física. 

Isokinetic Analysis of Flexible Flatfoot: Is It a Weakness of Proprioception and Muscle Strength?

BACKGROUND

Although flexible flatfoot (FF) in children is a foot deformity that is frequently encountered in daily orthopedics practice, its etiology is still controversial. The aim of this study was to determine whether there is a weakness in muscle strength and proprioception in patients with FF.

METHODS

The study group consisted of 16 cases with FF, and the control group consisted of 25 volunteers with normal feet. An isokinetic dynamometer was used to assess muscle strength and proprioception of movement directions of plantarflexion, dorsiflexion, eversion (EV), and inversion (INV) in both groups.

RESULTS

There was no statistically significant difference between the groups in strength of plantarflexion and dorsiflexion muscles, whereas in the control group, proprioception of all four movement directions and strengths of the EV and INV muscles were found to be statistically significantly higher (P < .05).

CONCLUSIONS

There is weakness in EV and INV muscle strength and proprioception disorder in patients with FF. We recommend conducting further studies that validate muscle weakness and proprioception disorders with different study designs and evaluate the effectiveness of improving muscle strength and proprioception weakness in FF.

Differences in trunk and lower extremity muscle activity during squatting exercise with and without hammer swing

Perturbation exercises enhance lower limb and trunk muscles, and adding swing perturbation while loading during exercise might improve muscle activation or strength. This study aimed to check variations in trunk and lower limb muscle activity during conventional isometric squats, and whether it will change with or without swing using the Hammerobics-synchronized squat method. Twelve healthy men participated in this study. Activities for the abductor hallucis, tibialis anterior, tibialis posterior, peroneus longus, rectus femoris, biceps femoris long head, semitendinosus, gluteus maximus, multifidus, and internal oblique muscles were measured using surface electromyography during a Hammerobics-synchronized squat and conventional isometric squat. Muscle activities were statistically compared between squat methods. Hammerobics-synchronized squats significantly activated the abductor hallucis, tibialis anterior, tibialis posterior, peroneus longus, semitendinosus, and multifidus muscles, in both phases, compared with the conventional isometric squats. The Hammerobics-synchronized squat exercise can be considered for trunk and foot stability exercise.

Evaluation of the Correlation Between Flamenco Dance and Ankle and Foot Posture

BACKGROUND

The practice of flamenco dance involves great biomechanical demands, comparable with a high-performance sport. The technical movements of the footwork tap, the jumps, and the turns increase the prevalence of injuries and pathologic disorders of the foot and lower limb. Limited research has examined adaptation of the foot posture and dorsiflexion of the ankle in flamenco dancing. Therefore, the aim of this study was to evaluate whether the practice of flamenco dancing produces modifications in the ankle's dorsiflexion range of motion, Foot Posture Index, or pronation.

METHODS

A cross-sectional observational study with intentional sampling was performed with 26 individuals (52 feet) in two groups: professional female flamenco dancers (n = 13) and nondancers (n = 13). The participants were assessed in a single session for ankle dorsiflexion, foot pronation (navicular drop test), and foot posture (Foot Posture Index).

RESULTS

Significant differences were found between the two groups for left foot Foot Posture Index (P = .007) and right foot navicular drop test (P = .006).

CONCLUSIONS

The results of this study indicate that flamenco dancing can produce modifications in the Foot Posture Index and foot pronation versus nondancers. Further research is required.

Plantar Venous Pump Activity, Generalized Joint Hypermobility, and Foot Mobility in Ballerinas: A Case-Control Study

CONTEXT

The plantar venous pump (PVP) is a vascular network located between the muscles of the foot arch. It has been suggested foot mobility is critical for PVP activation.

OBJECTIVE

This study investigates the effect of generalized joint hypermobility (GJH) on foot mobility and PVP activity in ballerinas and to determine how a short-term warm-up exercise impacts these parameters in the presence of GJH.

DESIGN

Prospective study.

METHODS

Twelve ballerinas (age = 16.73 [1.8] y) and 15 non-dancer-matched controls (age = 16.31 [2.1] y) were included. When performing weight-bearing activities, venous return parameters (diameter, velocity, and flow volume) from the posterior tibial vein were measured using color and spectral Doppler ultrasonography. Foot mobility was determined using navicular drop test. The participants performed a 10-minute cycling exercise to reveal its effect on reducing tissue stiffness. All measurements were performed synchronously and twice-before and after the cycling exercise.

RESULTS

The results showed the navicular height obtained before and after exercise in the ballerinas was significantly different compared with that obtained in the sitting position, and the values obtained in the 3 measurement positions in the nondancer group were significantly different from each other (P < .05). The difference between the venous diameter values measured before and after exercise and the reference value was significant in both groups (P < .001). There was a significant decrease in venous velocity following exercise in the nondancer group (P = .044). The venous volume values obtained after exercise were significantly different between the groups (P = .039).

CONCLUSIONS

The GJH has no distinctive effect on foot mobility and PVP activity in ballerinas. The presence of GJH did not influence the effect of short-term warm-up exercise on foot mobility and PVP activity. We believe that measuring the navicular drop and venous return with a more precise synchronization may provide additional information regarding the link between arch tension and venous return.

Progressive Collapsing Foot Deformity. Is There Really a Johnson and Strom Stage I?

Johnson and Strom stage I posterior tibialis tendon dysfunction presents with pain and swelling but preserved function and no deformity. Diagnosis is clinical. Pathomechanics explains the overloading of the tendon that may be worsened by a tight gastrocnemius, but systemic inflammatory disease may also be responsible for a stage I condition. Medial heel wedged orthoses are effective in most patients. Surgery usually consists of an open/endoscopic tenosynovectomy. In cases of complete tendon rupture, flexor digitorum longus tendon transfer may be considered. Stage I patients with a higher risk of progression-inflammatory conditions, excessive laxity, obese-may benefit from a "prophylactic" medializing calcaneal osteotomy.

Effects of taping techniques on arch deformation in adults with pes planus: A meta-analysis

Objective

To investigate effects of taping techniques on arch deformation in adults with pes planus.

Methods

The following databases were searched up to March 2020, including Web of Science, Pubmed, EBSCO, CNKI and Cochrane Library. Heterogeneity and publication bias were assessed by I² index and funnel plots, respectively. In addition, Cochrane scale was used to evaluate the quality of research.

Results

Navicular height for three antipronation taping techniques significantly increased immediately post tape compared with baseline (mean difference = 4.86 mm, 95% CI = 2.86–6.87 mm, Z = 4.75, p < 0.001). The highest increase was observed in Augmented low-Dye (ALD). Modified low-Dye (MLD) was second only to ALD (p<0.001). Navicular height after walking for 10 min was much higher than baseline (p<0.001), with MLD decreased smaller than ALD.

Conclusions

ALD was the most effective taping technique for controlling foot arch collapse immediately post tape compared with baseline, followed by MLD. By contrast, MLD could possibly performed better than ALD in maintaining immediate navicular height after walking for 10 min. Low-Dye could make resting calcaneal stance position closer to neutral position. Although positive effects of Navicular sling, low-Dye and Double X taping interventions were observed, they could not maintain this immediate navicular height effect after a period of higher intensity weight-bearing exercise.