Short-Foot Exercise Promotes Quantitative Somatosensory Function in Ankle Instability: A Randomized Controlled Trial

Effects of Rehabilitative Exercise and Neuromuscular Electrical Stimulation on Muscle Morphology and Dynamic Balance in Individuals with Chronic Ankle Instability

Background and Objectives: Muscle atrophy caused by chronic ankle instability (CAI) can incur muscle weakness, altered movement patterns, and increased risk of injury. Previous studies have investigated the effects of rehabilitative exercises and neuromuscular electrical stimulation (NMES) on characteristics in CAI individuals, but few studies have examined their effects on foot and ankle muscle morphology. This study aimed to determine the effects of rehabilitative exercises and NMES on muscle morphology and dynamic balance in individuals with CAI. Materials and Methods: Participants with CAI (n = 47) were randomly divided into control (CG), rehabilitative exercise (REG), NMES (NG), and rehabilitative exercise and NMES combined (RNG) groups. The six-week intervention program consisting of rehabilitative exercises and NMES was applied to groups excluding CG. Muscle morphology and dynamic balance were evaluated using a portable wireless diagnostic ultrasound device and dynamic balance tests. For statistical analysis, an effect size with 95% confidence interval was calculated to assess mean differences according to intervention. Results: After six weeks, significant increases in morphology and dynamic balance were observed for all muscles except flexor hallucis longus (p > 0.05) in the intervention groups except for CG. However, no significant changes were observed in the CG (p > 0.05). Conclusions: These findings suggest that intervention programs may help prevent muscle atrophy and improve balance in CAI individuals.

Relationship between Tilt Sensation Ability and Lower Limb Injuries in Junior Athletes

The purpose of this study was to devise a tilt sensation measurement method to evaluate ankle proprioception and to examine its reliability. It was also used to determine the relationship among tilt sensation abilities, physical development, and lower limb injuries in junior athletes. In this study, a step platform created tilt angles. Participants with eye masks answered "yes" or "no" to sensing a tilt, evaluated over nine or seven trials. Experiment 1 involved 22 university students (20.6 ± 0.9 years). The minimum angle at which a tilt could be sensed while standing on both feet was determined, and measurements were taken again to examine reliability. Experiment 2 involved 40 junior athletes (12.3 ± 2.0 years), where the minimum angle for tilt sensation was obtained, and medical checks were conducted to assess injuries in the knee, lower leg, and foot. Reliability studies showed a moderately significant correlation between the first and second sessions (r = 0.504, p = 0.017), suggesting the reliability of the experimental method. The proportion capable of sensing a tilt of 1.1° and 1.6° was significantly higher in junior high school students than in elementary school students (1.1°; χ2 = 8.839, p = 0.003. 1.6°; χ2 = 4.038, p = 0.044). The group unable to sense a tilt of 1.6° and 2.1° had a significantly higher positive rate of knee injuries compared to the sensed group among junior high school students (1.6°; χ2 = 4.622, p = 0.032. 2.1°; χ2 = 4.622, p = 0.032). Our findings suggested that a reduced tilt sensation ability was associated with knee injuries in junior high school students. Utilizing our devised tilt sensation assessment could play a crucial role in preventing and detecting early injuries in junior high school students.

Effectiveness of photobiomodulation therapy in the treatment of patients with an ankle sprain: a systematic review and meta-analysis

BACKGROUND

Photobiomodulation therapy (PBMT) is widely used in the treatment of patients with musculoskeletal and sports disorders with a lack of significance in patients with sprain ankle.

PURPOSE

This review investigated the effect of PBMT on pain, oedema, and function in patients with an ankle sprain.

METHODS

A systematic search of the databases (MEDLINE, PubMed, EBSCO, Web of Science, Wiley Online Library, Science Direct, Physiotherapy Evidence (PEDro), and the Cochrane Databases) was performed from inception to the end of 2023 to identify any clinical study investigating the effect of PBMT on ankle sprain. PBMT parameters and measured outcomes were extracted. The primary measured outcome was pain and function, and oedema were secondary measured outcomes. Methodological quality was assessed using the PEDro scale. The level of evidence was determined by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. A random effect meta-analysis with forest plot was used to calculate standardized mean difference (SMD) at a 95% confidence interval and the overall effect size (ES).

RESULTS

Six studies (598 patients) were included in the review and five studies in the meta-analysis. There were two fair-quality and four good-quality studies, with a moderate level of evidence on pain, and a low level of evidence on oedema and function. The meta-analysis revealed a significant overall effect of PBMT on pain with high ES [SMD - 0.88 (-1.76, -0.00), p = 0.05], with a non-significant effect on oedema and function with a medium ES [SMD - 0.70 (-1.64, 0.24), p = 0.14] on oedema and low ES on function [SMD - 0.22 (-0.69, 0.24), p = 0.35]. Significant heterogeneity was observed in all measured outcomes with high heterogeneity (I2 > 75%) in pain and oedema and moderate heterogeneity in function.

CONCLUSION

PBMT is quite effective for patients with an ankle sprain. PBMT showed high effect size with a moderate level of evidence on pain intensity. The lack of significant effects of PBMT on function and edema with low level of evidence limit the confidence to the current results and recommend further large high-quality studies with higher PBMT intensity and fluency for standardisation of the irradiation parameters and treatment protocol.

REGISTRATION

PROSPERO registration number (CRD42021292930).

Effects of combination of strength and balance training on postural control and functionality in people with chronic ankle instability: a systematic review and meta analysis

AIM

To identify the effects of strength and balance training on dynamic balance and patient reported outcomes in people with chronic ankle instability(CAI).

METHOD

Five databases(CNKI, WanFang, Web of Science, EBSCO-SPORTD and PubMed were searched in September 2022. The search was conducted on randomized controlled trials(RCTs) that the effects of strength training, balance training and combination of strength and balance training in people with chronic ankle instability compared to a control group. Using Review Manager 5.3 and Stata-SE 15 to conduct Meta-analysis on the included literature. methodological quality and risk of bias were assessed by using the PEDro scale.

RESULTS

A total of 33 Chinese and English RCTs document were screened and 1154 patients with CAI were included in the study. Compared with control group, strength training, balance training and combination of strength and balance training demonstrated to be more effective in terms of improving patient reported outcomes(strength training: SMD = 0.80, 95%CI = 0.39-1.22; balance training: SMD = 0.79, 95%CI = 0.41-1.17; combination of strength and balance training: SMD = 1.28, 95%CI = 0.57, 1.99). Subgroup analysis: Intervention for 6 weeks, more than 3 times a week and more than 30 min each time were the best rehabilitation programs to improve CAI patientreported outcomes. Compared with control group, balance training demonstrated to be more effective in terms of improving Star Excursion Balance Test (SEBT)((anterior: SMD = 0.71, 95%CI = 0.03-1.40; posterolateral: SMD = 0.84, 95%CI = 0.22-1.46; posteromedial: SMD = 0.88, 95%CI = 0.45-1.32). However, strength training and combination of strength and balance training had no improvement effects on SEBT.

CONCLUSIONS

Available evidence showed that, results of the comparison between balance training versus strength training suggest that the combination of strength and balance training achieves greater benefits for patient reported outcomes and balance training could bring greater benefits to dynamic balance. Strength training should be used cautiously in clinic to improve the dynamic balance in individuals with CAI.

TRIAL REGISTRATION

( http://www.crd.york.ac.uk/PROSPERO , Registration No. CRD42022371396).

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.

Moderate-to-Vigorous Physical Activity and Response Inhibition Predict Balance in Adults with Attention Deficit/Hyperactivity Disorder

Background: Some evidence indicates that adults with attention deficit hyperactivity disorder (ADHD) may have balance impairments. This study examined the associations between moderate-to-vigorous physical activity (MVPA), response inhibition (RI), and static balance in this population while off and on psychostimulant medication (PS). Methods: Participants (n = 40; 30 females; M age = 29.0; SD = 6.3 years) wore an ActiGraph GT9X-link around their waist to estimate MVPA levels (minutes/day). To assess RI, participants completed the Delis-Kaplan Executive Function System (D-KEFS) subtests Trail-Making Test (TMT) and Color-Word Interference Test (CWIT). To evaluate static balance, participants completed postural sway area (cm2) assessments in four conditions: feet-apart eyes-open (FAEO), feet-apart eyes-closed (FAEC), feet-together eyes-open (FTEO), and feet-together eyes-closed (FTEC). Participants also completed the single-leg standing tests (seconds) with eyes open (SLEO) and with eyes closed (SLEC). Results: When off medication, MVPA significantly predicted SLEC (β = 0.30; p = 0.017). MVPA and TMT significantly predicted FTEO, explaining ~19% of the variance in FTEO; both MVPA and TMT were significant predictors (β = -0.33, p = 0.027 and β = -0.31, p = 0.039, respectively). When on medication, TMT significantly predicted FAEC (β = 0.17; p = 0.047). Conclusions: MVPA and RI may be effective parameters in predicting static balance in adults with ADHD when off medication only.

Comparison by ultrasound shear wave elastography of toe flexor muscle contraction during MTP flexion exercise and short-foot exercise

BACKGROUND

The intrinsic foot muscles play an important role in medial longitudinal arch support, as well as several extrinsic foot muscles. While various strength training methods specific to intrinsic foot muscles have been conducted, these exercises are associated with certain concerns regarding their effectiveness and difficulty. We developed a new exercise for the intrinsic muscles (MTP flexion exercise).

OBJECTIVE

The aim was to compare the shear modulus of the toe flexors as the muscle contraction activity during MTP flexion and short-foot exercises using ultrasound shear wave elastography.

METHODS

Eleven healthy participants were included in this study. The shear modulus of the toe flexor muscles was measured during MTP flexion and short-foot exercises using ultrasound shear wave elastography. The muscle shear modulus was statistically compared between the resting phase, and during the two exercises.

RESULTS

The shear modulus during MTP flexion exercise was significantly greater than in the resting phase in the abductor hallucis, flexor hallucis brevis, flexor digitorum brevis, quadratus plantae, and flexor digitorum longus. The flexor digitorum longus showed greater shear modulus during MTP flexion exercise than during short-foot exercise.

CONCLUSION

MTP flexion exercise showed equivalent or greater contraction activity in certain intrinsic and extrinsic foot muscles when compared with short-foot exercise. This exercise is considered one of the training options for strengthening the intrinsic muscles of the foot.

A Home-Based Exercise Program With Active Video Games for Balance, Motor Proficiency, Foot and Ankle Ability, and Intrinsic Motivation in Children With Chronic Ankle Instability: Feasibility Randomized Controlled Trial

Background

Children with chronic ankle instability (CAI) frequently experience ankle unsteadiness, causing trips, falls, and ankle sprain injuries resulting in poor quality of life. A specific exercise program focused on physical and psychological purposes in children with CAI is needed.

Objective

The purpose of this study was to investigate the feasibility of a 4-week home-based exercise training program using active video games (AVGs) for balance, motor proficiency, foot and ankle ability, and intrinsic motivation in children with CAI.

Methods

Sixty children with CAI (mean age 10, SD 2 years) were randomly assigned to an experimental group (AVG group; n=30) or a control group (CG; n=30). The AVG group played 2 selected video games, Catching Fish and Russian Block, while the CG received the traditional exercise program for CAI. Both programs were scheduled for 30 minutes per day, 3 times per week, for 4 weeks at home. The single-leg stance test was used to assess static balance. The walking forward on a line and standing long jump tests were used to assess motor proficiency. The Foot and Ankle Ability Measure (FAAM) and the Intrinsic Motivation Inventory questionnaire were used to assess foot and ankle ability and intrinsic motivation, respectively. Assessments were conducted at baseline and after 4 weeks.

Results

In the AVG group, the single-leg stand test (eyes open; on floor and on foam conditions), the FAAM (activities of daily living subscale), and intrinsic motivation (interest/enjoyment, pressure/tension, and value/usefulness dimensions) were improved compared with the CG (all P<.05). Motor proficiency did not differ between the 2 groups at the end of the 4-week program (P=.31 for the walking forward on a line, P=.34 for the standing long jump test).

Conclusions

A 4-week home-based exercise training program using AVGs can be beneficial and may be an effective approach for improving balance, foot and ankle ability, and enhancing positive motivation by increasing the interest/enjoyment and value/usefulness dimensions and lowering the pressure/tension dimension in children with CAI that require long-term rehabilitation sessions.

Adolescent exercise-related lower leg pain musculotendinous characteristics

BACKGROUND

Exercise-related lower leg pain (ERLLP) is one of the most common injuries among adolescent runners; however, there is limited information available on lower extremity musculotendinous characteristics in relationship to injury. Ultrasound imaging has previously been used to evaluate musculotendinous structures among adults with chronic lower limb injuries. Similar measurement approaches may be adopted to assess young runners with ERLLP.

OBJECTIVE

To compare ultrasound-derived lower extremity musculotendinous thickness, echogenicity, and muscle fiber pennation angles between adolescent runners with and without ERLLP.

DESIGN

Cross-sectional design.

SETTING

Hospital-affiliated sports injury prevention center.

PARTICIPANTS

Twenty-eight adolescent runners with (N = 14) and without ERLLP (N = 14).

INTERVENTIONS

Runners' patellar and Achilles tendons, and tibialis anterior, medial gastrocnemius, abductor hallicus, and flexor digitorum brevis muscles were assessed with ultrasound imaging using standardized procedures.

MAIN OUTCOME MEASURES

Separate repeated measures multivariate analyses of covariance (covariate: gender) were used to compare groups and limbs for mass-normalized musculotendinous thickness, musculotendinous echogenicity, and extrinsic ankle muscle fiber pennation angles.

RESULTS

The adolescent ERLLP group had reduced average muscle size for all structures except the tibialis anterior compared to the uninjured group (mean difference [MD] range: -0.12-0.49 mm/kg; p range: .002-.05), and reduced average medial gastrocnemius pennation angles on their case limb compared to their contralateral limb and the uninjured group (MD range: -3.7-6.4°; p < .001). The ERLLP group additionally had reduced average patellar and Achilles tendon size (MD range: -0.14--0.15 mm/kg; p range: .02-.03), and lower Achilles tendon echogenicity compared to uninjured counterparts (MD: -18; p = .02).

CONCLUSIONS

Adolescent runners with ERLLP exhibited morphological musculotendinous changes that may occur either as a result of or as a contributing factor to pain and persistent dysfunction. The findings highlight key targets for rehabilitation for young, injured runners, particularly intrinsic foot muscle strengthening.

Evidence for Intrinsic Foot Muscle Training in Improving Foot Function: A Systematic Review and Meta-Analysis

OBJECTIVE

To critically assess the literature focused on strength training of the intrinsic foot muscles (IFMs) and resulting improvements in foot function.

DATA SOURCES

A search of electronic databases (PubMed, CINAHL, Scopus, and SPORTDiscus) was completed between January 2000 and March 2022.

STUDY SELECTION

Randomized control trials with an outcome of interest and at least 2 weeks of IFM exercise intervention were included. Outcomes of interest were broadly divided into 5 categories of foot posture (navicular drop and Foot Posture Index), namely: balance, strength, patient-reported outcomes, sensory function, and motor performance. The PEDro scale was used to assess the methodologic quality of the included studies with 2 independent reviewers rating each study. Studies with a PEDro score greater than 4/10 were included.

DATA EXTRACTION

Data extracted by 2 independent reviewers were design, participant characteristics, inclusion and exclusion criteria, type of intervention, outcomes, and primary results. We performed a random-effects meta-analysis to analyze the difference between intervention and control groups for each outcome when at least 2 studies were available. Standardized mean differences (SMDs) describe effect sizes with 95% CIs (SMD ranges). When the CI crossed zero, the effect was not significant.

DATA SYNTHESIS

Thirteen studies were included, and IFM exercise interventions were associated with decreasing navicular drop (SMD range = 0.37, 1.83) and Foot Posture Index (SMD range = 1.03, 1.69) and improving balance (SMD range = 0.18, 1.86), strength (SMD range = 0.06, 1.52), and patient-reported outcomes for disability (SMD range = 0.12, 1.00), with pooled effect sizes favoring the IFM intervention over the control. The IFM exercises were not superior (SMD range = -0.15, 0.66) for reducing pain. We could not perform a meta-analysis for sensory function and motor performance, as only 1 study was available for each outcome; however, these results supported the use of IFM strength training.

CONCLUSIONS

Strength training of the IFMs was helpful for patients in improving foot and ankle outcomes.

Efficacy of resistance training with elastic bands compared to proprioceptive training on balance and self-report measures in patients with chronic ankle instability: A systematic review and meta-analysis

BACKGROUND

Proprioceptive training and resistance training are physiotherapy treatment methods for Chronic Ankle Instability (CAI).

OBJECTIVE

To compare the efficacy of proprioceptive training to resistance training with elastic bands for treating CAI as measured by the Star Excursion Balance Test (SEBT), the Foot and Ankle Ability Measure (FAAM), and the Cumberland Ankle Instability Tool (CAIT).

METHOD

Our systematic study and meta-analysis was based on the PICOS and PRISMA protocols. The PubMed, PEDro, and ScienceDirect databases were searched for randomized clinical trials on proprioceptive and resistance training. Risk of bias was assessed according to Cochrane guidelines and quality of evidence was reported using the Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE).

RESULTS

Five studies involving 259 patients were included in the review. According to the findings of the meta-analysis, proprioceptive training was similarly effective with resistance training in SEBT and FAAM measures. Compared with resistance exercise, proprioceptive training demonstrated some benefits in CAIT scores (weighted mean difference [WMD] = -2.21, 95% CI = -4.05-0.36), but these intervention results were not clinically significant (MDC, MCID score >3 points).

CONCLUSION

Low-quality evidence from studies showed that neither of the interventions was superior on the SEBT or the FAAM scores in individuals with CAI because no clinically significant differences were found. More high-quality studies comparing the two interventions are needed to draw firm conclusions.

Effects of foot intensive rehabilitation (FIRE) on clinical outcomes for patients with chronic ankle instability: a randomized controlled trial protocol

BACKGROUND

Lateral ankle sprains account for a large proportion of musculoskeletal injuries among civilians and military service members, with up to 40% of patients developing chronic ankle instability (CAI). Although foot function is compromised in patients with CAI, these impairments are not routinely addressed by current standard of care (SOC) rehabilitation protocols, potentially limiting their effectiveness. The purpose of this randomized controlled trial is to determine if a Foot Intensive REhabilitation (FIRE) protocol is more effective compared to SOC rehabilitation for patients with CAI.

METHODS

This study will use a three-site, single-blind, randomized controlled trial design with data collected over four data collection points (baseline and post-intervention with 6-, 12-, and 24-month follow-ups) to assess variables related to recurrent injury, sensorimotor function, and self-reported function. A total of 150 CAI patients (50 per site) will be randomly assigned to one of two rehabilitation groups (FIRE or SOC). Rehabilitation will consist of a 6-week intervention composed of supervised and home exercises. Patients assigned to SOC will complete exercises focused on ankle strengthening, balance training, and range of motion, while patients assigned to FIRE will complete a modified SOC program along with additional exercises focused on intrinsic foot muscle activation, dynamic foot stability, and plantar cutaneous stimulation.

DISCUSSION

The overall goal of this trial is to compare the effectiveness of a FIRE program versus a SOC program on near- and long-term functional outcomes in patients with CAI. We hypothesize the FIRE program will reduce the occurrence of future ankle sprains and ankle giving way episodes while creating clinically relevant improvements in sensorimotor function and self-reported disability beyond the SOC program alone. This study will also provide longitudinal outcome findings for both FIRE and SOC for up to two years. Enhancing the current SOC for CAI will improve the ability of rehabilitation to reduce subsequent ankle injuries, diminish CAI-related impairments, and improve patient-oriented measures of health, which are critical for the immediate and long-term health of civilians and service members with this condition. Trial Registration Clinicaltrials.gov Registry: NCT #NCT04493645 (7/29/20).

Intrinsic muscles of the foot: Anatomy, function, rehabilitation

The intrinsic muscles of the foot are underappreciated structures in evaluating and treating lower extremity dysfunction. These muscles play a crucial role in the proper function of the foot during sport activities. The functions of these muscles are not generally well understood. Intrinsic dysfunction can lead to a variety of problems. Therefore, it is important for clinicians to have a good understanding of the anatomy and function of the intrinsic foot muscles in order to properly diagnose and treat foot injuries in patients. Published research on the rehabilitation of the intrinsic muscles provides insight into the function as well as benefits of treatment. The purpose of this review is to summarize the published research on the anatomy, function, contribution to pathology, as well as rehabilitation options for the intrinsic muscles of the foot.

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.

Auswirkungen des Trainings der intrinsischen Fußmuskulatur bei Patienten*innen mit Sprunggelenkinstabilität – ein narrativer Review

Hintergrund Sprunggelenkdistorsionen stellen eine der häufigsten Verletzungen im Sport dar und können sich als chronische Sprunggelenkinstabilität manifestieren. In der Therapie und Prävention hat sich ein sensomotorischer Trainingsansatz der sprunggelenkumgebenden Strukturen als wirksam erwiesen. Es gibt Hinweise, dass auch ein Training der intrinsischen Fußmuskulatur beispielsweise die Balance verbessern kann.

Ziel Ziel dieses narrativen Reviews ist die Darstellung der Evidenz eines Trainings der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität.

Methode Im Januar 2022 wurde in den Datenbanken PubMed, Cochrane Library, EBSCOhost, PEDro, SPONET und BISp-Surf eine systematische Literaturrecherche durchgeführt, die durch eine Freihandsuche ergänzt wurde. Dabei sollten Metaanalysen, Systematic Reviews und Interventionsstudien inkludiert werden, die Effekte einer Trainingsform der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität untersuchten. Die qualitative Bewertung der Literatur und Evidenz erfolgte anhand des Risk-of-Bias-Tools (RoB-Tool) des Cochrane Handbook sowie angelehnt an das GRADE-System.

Ergebnisse Fünf randomisierte kontrollierte Studien mit insgesamt 150 Proband*innen wurden inkludiert. Vier Studien nutzten die Short-Foot Exercise (SFE), eine Studie die Towel-Curl Exercise (TCE) und eine wandte ein Training der Zehen an. Drei Studien wiesen einen großen, signifikant positiven Effekt (p<0,05) der SFE auf die subjektive Instabilität auf. Die SFE und das Zehentrainingsprogramm hatten signifikant positive Effekte (p<0,05) auf die Balance, wobei die Einbeziehung der SFE in ein Trainingsprogramm zu keinem Vorteil führte. Eine Studie stellte signifikant positive Auswirkungen (p<0,05) der SFE auf die Somatosensibilität fest. Alle 3 Trainingsformen führten zu deutlichen, signifikanten (p<0,05) Verbesserungen funktioneller Aspekte.

Schlussfolgerung Es zeigen sich positive Effekte durch das Training der intrinsischen Fußmuskulatur bei Patient*innen mit Sprunggelenkinstabilität auf die subjektive Instabilität, Balance, Somatosensibilität sowie auf funktionelle Aspekte. Effektive Trainingsformen scheinen die SFE und ein Zehentraining zu sein, diese könnten eine sinnvolle Ergänzung zur konventionellen Therapie darstellen. Die Qualität der Evidenz ist jedoch zu gering, um eine klare Empfehlung aussprechen zu können.

The effects of intrinsic foot muscles strengthening exercises on foot kinetic parameters in pronated foot subjects during forward jump landing

Background

Pronated foot is one of the most important factors that may lead to musculoskeletal injuries of the lower extremities. Among all treatments for this disorder, intrinsic foot muscles strengthening exercises (IFMSE) have an important role in management of the individuals with pronated foot. Although the effect of the IFMSE is well accepted in this population; however, their impacts on foot kinetic are yet to be clarified. The present study aims to identify the effects of the IFMSE on foot kinetic parameters in pronated foot individuals during forward jump landing.

Materials and Methods

In this quasi-experimental study, 20 asymptomatic male and female subjects (mean age of 22.65 ± 2.51 years) with pronated foot structures were selected by using a simple non-random sampling method. The ground reaction force (GRF), rate of loading (ROL), and the resultant vector of time to stabilization (RVTTS) were examined during a forward jump landing task by using a force plate before and after six weeks of the IFMSE.

Result

The findings showed that the following parameters were not significantly change before and after of the IFMSE: GRF (1.97 ± 0.49 vs. 2.03 ± 0.54, P =0.667), ROL (.09 ±0.12 vs. 08 ±.12, P =.632), and RVTTS (2836.60 ± 1144.62 vs. 2644.35 ± 704.71, P =.479).

Conclusion

In the pronated feet subjects, the IFMSE alone was not capable of changing the kinetic parameters of the foot, or the duration of using these exercises. In this study, six weeks may not be enough to make changes the foot kinetic parameters and therefore these exercises should be used for a longer period of time.

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.

Combined Use of Transcutaneous Electrical Nerve Stimulation and Short Foot Exercise Improves Navicular Height, Muscle Size, Function Mobility, and Risk of Falls in Healthy Older Adults

Electrical stimulation is an established method that is used to improve muscle strength. The present study compared changes in the navicular drop test (NDT), muscle size, the five times sit to stand (5TSTS) test, the timed up and go (TUG) test, and the risk of falls in response to transcutaneous electrical nerve stimulation (TENS) plus short foot exercise (SFE) and SFE alone in 68 healthy elderly participants aged 65−75 years. Participants were randomly assigned to two groups: TENS plus SFE and SFE alone (with sham TENS). Measurements of NDT, muscle size, 5TSTS, TUG, and risk of falls were made before and after 4 weeks of training. The NDT was significantly improved by a median of 0.31 mm in the TENS plus SFE group and 0.64 mm in the SFE alone group (p < 0.001). Similarly, there was a significant improvement in Falls Efficacy Scale International (FES-I), 5TSTS, and TUG for both groups (p < 0.001). The abductor hallucis muscle size increased by 0.23 cm2 in the TENS plus SFE group and 0.26 cm2 in the SFE alone group (p < 0.001). There were no significant differences between the two groups for any variables (p > 0.05) except TUG, which showed a greater improvement in the TENS plus SFE group (p = 0.008). Our findings demonstrated that TENS plus SFE and SFE alone improved intrinsic foot muscle size. However, TENS plus SFE tended to improve NDT more than SFE alone, particularly in cases of severe muscle weakness. Thus, the combined use of TENS plus SFE could be recommended for muscle strengthening and balance programs for fall prevention in older adults.

Can therapeutic exercises improve proprioception in chronic ankle instability? a systematic review and network meta-analysis

OBJECTIVE

To assess exercise therapies that aim to enhance proprioception in individuals with chronic ankle instability (CAI).

DATA SOURCES

Five databases (PubMed, Embase, Cochrane Library, Web of Science, and EBSCO) were searched in October 2021.

STUDY SELECTION

Randomized controlled trials involving exercise therapy conducted on individuals with CAI were included.

DATA EXTRACTION

Data were extracted by two independent reviewers using a standardized form. Methodological quality and risk of bias were assessed with the PEDro scale.

DATA SYNTHESIS

The end-trial weighted mean difference and standard deviations were analyzed, and the synthetic value for the improvement in error scores of ankle joint position sense (JPS) in multiple directions was evaluated.

RESULTS

Eleven trials with 333 participants were eligible for inclusion in this systematic review and were included in the Network Meta-Analysis. Foot and ankle muscle strengthening exercise showed the highest probability of being among the best treatments (surface under the cumulative ranking (SUCRA)=74.6%). The next two were static balance exercise only (SUCRA=67.9%) and corrective exercise (SUCRA=56.1%). The SUCRA values of proprioceptive exercise, dynamic balance exercise only, aquatic exercise, rehabilitation exercise with brace, mixed static/dynamic balance exercise, and control were at relatively low levels, and scored at 49.6%, 48.8%, 47.8%, 47.7%, 44.0%, and 13.5%, respectively.

CONCLUSIONS

Foot and ankle muscle strengthening exercise may have a good effect when used to improve JPS in individuals with CAI. Probably, the more complex balance exercise intervention becomes, the less effective the proprioceptive outcome.

PROSPERO REGISTRATION NUMBER

CRD42021240331.

The Effectiveness of Proprioceptive Training for Improving Motor Performance and Motor Dysfunction: A Systematic Review

Objective

Proprioceptive training is any intervention aiming to improve proprioceptive function with the ultimate goal to enhance motor function and performance. It has been promoted as an approach to enhance athletic performance and as a tool for sensorimotor rehabilitation. Numerous studies sought to provide evidence on the effectiveness of the approach. However, many different training regimes claiming to train proprioception report a variety of sensorimotor measures that are not directly comparable. This, in turn, makes it difficult to assess effectiveness across approaches. It is the objective of this study to systematically review recent empirical evidence to gain an understanding of which outcome measures are most sensitive, which populations may benefit most from proprioceptive training, and what are the effects on proprioceptive and motor systems.

Methods

Four major databases were searched. The following inclusion criteria were applied: (1) A quantified pre- and post-treatment measure of proprioceptive function. (2) An intervention or training program believed to influence or enhance proprioceptive function. (3) Contained at least one form of treatment or outcome measure that is indicative of somatosensory function and not confounded by information from other sensory modalities. 4) The study reported of at least one quantified measure of motor performance.

Results

Of the 3,297 articles identified by the database search, 70 studies met the inclusion criteria and were included for further review. Across studies, proprioceptive training led to comparable gains in both proprioceptive (+46%) and motor performance (+45%). The majority of studies (50/70) applied active movement interventions. Interventions applying somatosensory stimulation were most successful in clinical populations. Joint position sense error (JPSE) was the most commonly used proprioceptive measure and presents a reliable and feasible measure for clinical use.

Conclusion

Proprioceptive training can lead to significant improvements in proprioceptive and motor function across a range healthy and clinical populations. Regimens requiring active movement of the trainee tended to be most successful in improving sensorimotor performance. Conclusive evidence on how long training gains are retained is still lacking. There is no solid evidence about the underlying long-term neuroplastic changes associated proprioceptive training.

The effect of interventions anticipated to improve plantar intrinsic foot muscle strength on fall-related dynamic function in adults: a systematic review

Background

The plantar intrinsic foot muscles (PIFMs) have a role in dynamic functions, such as balance and propulsion, which are vital to walking. These muscles atrophy in older adults and therefore this population, which is at high risk to falling, may benefit from strengthening these muscles in order to improve or retain their gait performance. Therefore, the aim was to provide insight in the evidence for the effect of interventions anticipated to improve PIFM strength on dynamic balance control and foot function during gait in adults.

Methods

A systematic literature search was performed in five electronic databases. The eligibility of peer-reviewed papers, published between January 1, 2010 and July 8, 2020, reporting controlled trials and pre-post interventional studies was assessed by two reviewers independently. Results from moderate- and high-quality studies were extracted for data synthesis by summarizing the standardized mean differences (SMD). The GRADE approach was used to assess the certainty of evidence.

Results

Screening of 9199 records resulted in the inclusion of 11 articles of which five were included for data synthesis. Included studies were mainly performed in younger populations. Low-certainty evidence revealed the beneficial effect of PIFM strengthening exercises on vertical ground reaction force (SMD: − 0.31-0.37). Very low-certainty evidence showed that PIFM strength training improved the performance on dynamic balance testing (SMD: 0.41–1.43). There was no evidence for the effect of PIFM strengthening exercises on medial longitudinal foot arch kinematics.

Conclusions

This review revealed at best low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control. There is a need for high-quality studies that aim to investigate the effect of functional PIFM strengthening exercises in large samples of older adults. The outcome measures should be related to both fall risk and the role of the PIFMs such as propulsive forces and balance during locomotion in addition to PIFM strength measures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-021-00509-0.

Fat Is Consistently Present within the Plantar Muscular Space of the Human Foot—An Anatomical Study

Background and Objectives: The foot comprises of active contractile and passive connective tissue components, which help maintain stability and facilitate movement during gait. The role of age- or pathology-related degeneration and the presence of fat within muscles in foot function and pain remains unclear. The existence of fat has to date not been quantified or compared between individuals according to age, sex, side or subregion. Materials and Methods: 18 cadaveric feet (mean age 79 years) were sectioned sagittally and photographed bilaterally. Fat in the plantar muscular space of the foot (PMSF) was quantified through the previously validated manual fat quantification method, which involved observing photographs of each section and identifying regions using OsiriX. Fat volume and percentage was calculated using a modified Cavalieri’s method. Results: All feet had fat located within the PMSF, averaging 25.8% (range, 16.5–39.4%) of the total PMSF volume. The presence of fat was further confirmed with plastination and confocal microscopy. Conclusions: These findings suggest that fat within the PMSF is a consistent but highly variable finding in elderly cohorts. Fat within the foot muscles may need to be considered a norm when comparing healthy and non-healthy subjects, and for therapeutic interventions to the foot. Further work is required to understand in detail the morphological and mechanical presence of fat in the foot, and compare these findings with pathological cohorts, such as sarcopenia. Additionally, future work should investigate if fat may compensate for the degeneration of the intrinsic muscles of the foot, with implications for both the use of orthotics and pain management.

Effects of Kinesiology Taping on Muscle Strength, Dynamic balance, and Functional Movement in Wrestlers with Chronic Ankle Instability

OBJECTIVES This study aimed to investigate the effect of the Kinesio taping on ankle strength, Dynamic balance and, functional movement in wrestlers with chronic ankle instability.METHODS Twenty wrestlers who registered in the Korea Wrestling Association were participated in this study. They were divided into two groups (chronic ankle instability group [n=10] or control group [n=10]) based on Cumberland’s ankle instability questionnaire. Ankle strength (dorsiflexion, plantarflexion, inversion, and eversion) were measured using manual muscle tester, and the dynamic balance was measured using Y-Balance test (anterior, postero-medial, postero-lateral, and composite). Functional movement hop test (side hop, square hop, and figure-of-8 hop) were used to evaluate functional movement.RESULTS The significant interaction was observed between group and time on the Y-balance test (composite score), and functional movement hop test (figure-of-8 hop) (group × time, all P for interaction < 0.05).CONCLUSIONS These results suggest that Kinesio taping has a positive effect on dynamic balance and functional movement. Also, Kinesio taping may be able to use an alternative and effective methods to maintain ankle stability and performance in the wrestlers with chronic ankle instability.

Effects of intrinsic-foot-muscle exercise combined with the lower extremity resistance training on postural stability in older adults with fall risk: study protocol for a randomised controlled trial

BACKGROUND

Falls are one of the most common accidents in older adults, often leading to injury, disability and quality-of-life declines. Foot core function contributes to postural stability in most static postures and dynamic activities. As efficient foot core training, the intrinsic-foot-muscle exercise has been proposed to improve postural control. However, the effects of the exercise on postural stability in the elderly remain unclear. Therefore, this study attempts to investigate the effect of 12-week intrinsic-foot-muscle exercise on postural stability in older adults with fall risk.

METHODS

We will conduct a prospective, single-blind randomised controlled trail on 120 older adults with fall risk. Participants will be randomly assigned to an intrinsic-foot-muscle exercise combining the lower extremity resistance training group (IFM group), an extrinsic-foot-muscle exercise combining the lower extremity resistance training group (EFM group) and a control group. The control group will perform lower extremity resistance training. The IFM and EFM groups will be given additional short-foot exercise or towel-curl exercise training, respectively. After the intervention, participants will be followed up for another 12 weeks with no active intervention. The outcome measures will include the postural stability measurements, self-reported postural stability, number of falls, intrinsic-foot-muscle strength and foot arch function. Furthermore, adverse events will be recorded and analysed. If any participant withdraws from the trial, an intention-to-treat analysis will be performed.

DISCUSSION

The trial is designed to investigate the efficacy of a 12-week intrinsic foot muscle training combined with the lower extremity resistance training on postural stability outcomes in elderly people with fall risk. The trial will also examine the comprehensive outcomes of postural stability during static standing and dynamic movements. The function of intrinsic foot muscle to support the arch will also be evaluated. Important features of this trial mainly include intervention setting, outcome measure selection and study duration. The results of this study will determine the effectiveness and provide scientific evidence to establish comprehensive fall prevention intervention.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2000033623. Registered on 7 June 2020. http://www.chictr.org.cn/showproj.aspx?proj=54741.

Examining the Use of Kinesiology Tape During Weight Bearing Exercises on Proprioception in Participants With Functional Ankle Instability

The aim of this study was to examine the effect of tape worn during weight bearing exercises on proprioception (i.e., ankle angle repositioning error) in participants with functional ankle instability. We employed a randomized, controlled clinical study in a laboratory setting, with 56 participants with functional ankle instability. Participants were randomly assigned to three groups: (a) weight bearing exercises without tape (n = 18), (b) weight bearing exercises with tape (n = 19) and controls not engaged in weight bearing exercises (n = 19). Weight bearing exercises included six weeks of bilateral squats in partial form with up to 45 degrees of knee flexion, and unilateral partial squats with full heel raise, and with full toe raise. In the taped condition, participants wore tape for six weeks with up to three tape replacements per week. Proprioception was measured as ankle repositioning error. Results showed that the mean angle repositioning error among participants in the active weight bearing groups was decreased by the taping intervention, relative to the control group's performance (p = 0.042). There were no significant differences between weight bearing exercise groups and control groups. The addition of kinesiology tape in weight bearing exercises can improve proprioception in active conditions.

Effects of Two Foot-Ankle Interventions on Foot Structure, Function, and Balance Ability in Obese People with Pes Planus

Obese people are prone to foot deformities such as flat feet. Foot management programs are important to prevent them. This study investigated the effects of two foot-ankle interventions on balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions in obese people with pes planus for four weeks. The experiment was designed as a randomized controlled trial. Twenty-four participants who met the inclusion criteria were selected, and they were randomly assigned to either a short foot group (SFG) or proprioceptive neuromuscular facilitation group (PNFG) according to foot-ankle intervention. Two interventions were commenced three times a week for 20 min over four weeks. The tests were conducted at two intervals: pre-intervention and at four weeks. The tests were conducted in the following order: the patient-specific functional scale test (PSFS), an ultrasound of the plantar fascia, the navicular drop test, balance test, and the four-way ankle strength test. Two groups showed significant differences in balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions between pre-test and post-test (p < 0.05). PNFG had significantly higher dorsiflexor and invertor strength than SFG (p < 0.05). SF and PNF interventions were effective to improve balance ability, foot arch, ankle strength, plantar fascia thickness, and foot functions in obese people with pes planus. Additionally, PNF intervention is more beneficial in increasing the dorsiflexor and invertor strength compared to SF intervention.

Comparison Of Short-Term Effects Of Virtual Reality and Short Foot Exercises In Pes Planus

BACKGROUND

Virtual reality exercises (VRE) offers functional, multipurpose usage with a motivational approach. This study aimed to compare VRE and short foot exercises (SFE) in individuals with flexible pes planus.

METHODS

Forty participants with pes planus were assigned to the SFE group (n = 20) or VR exercise group (n = 20). Both groups performed exercises three times a week for four weeks. The groups were assessed with a navicular drop test for the height of the medial longitudinal arch, craig Test for femoral anteversion, Star Excursion Test for balance,10 step test for performance.

RESULTS

For two groups there is a statistically significant difference between before and after treatments(p < 0.05). There is no difference between VRE and SFE groups after treatments for all parameters(p > 0.05).

CONCLUSIONS

Two different 4-week-exercise programs for pes planus have a similar effect on performance, balance, and navicular drop values in both groups. It was considered that the practice of VR exercises like short foot exercises could also address rehabilitation goals, which included improving balance, performance, and foot posture. CLINICALTRIALS.

GOV IDENTIFIER

NCT04283357.

Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: Systematic review and meta-analysis

AIM

To identify the effects of balance and strength training on function, ankle instability and dynamic balance in people with chronic ankle instability.

METHOD

The search was conducted on randomized controlled trials that investigated the effects of balance training or strength training in people with chronic ankle instability compared to a control group. Therefore, a systematic electronic search was performed until April 2021 in Pubmed/MEDLINE, Cochrane, and Embase databases. Moreover, an additional search was further performed checking the reference lists of the selected articles. The main outcomes were ankle instability, functionality, and dynamic balance. Finally, a qualitative and quantitative synthesis was performed.

RESULTS

Fifteen randomized controlled trials with 457 volunteers were included. Compared to regular exercise, balance training demonstrated to be more effective in terms of improving functionality (0.81 (0.48, 1.14)), ankle instability (0.77 (0.27, 1.26)), and dynamic balance (0.83 (0.57, 1.10)) outcomes. However, when compared to strength training, the effectiveness of balance training was only greater in terms of the functionality outcome (0.49 (0.06, 0.92)), since no differences were found for instability (0.43 (0.00, 0.85)) and dynamic balance (0.21 (-0.15, 0.58)).

CONCLUSIONS

Based on fair-to-high quality evidence, balance training significantly improves functionality, instability, and dynamic balance outcomes in people with chronic ankle instability Moreover, results of the comparison between balance training versus strength training suggest that the former achieves greater benefits for functionality, but not for instability and dynamic balance.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42021224179.

Combined Effects of Strengthening and Proprioceptive Training on Stability, Balance, and Proprioception Among Subjects with Chronic Ankle Instability in Different Age Groups: Evaluation of Clinical Outcome Measures

BACKGROUND

Lateral ankle sprains are among the common injuries in the physically active population in different age groups and progress to chronic ankle instability (CAI). Accordingly, the current study assesses the effectiveness of strengthening and proprioceptive training programs on proprioception and balance in those suffering from CAI.

DESIGN

Quasi-experimental design.

METHODS

Thirty-six individuals with self-reported CAI were assigned into three groups based on age: group 1 (23 ± 1.84), group 2 (35.80 ± 1.68), group 3 (44.25 ± 4.86), then performed strength and balance exercises for 6 weeks. The study furthermore measured pre- and post-training of joint position sense (JPS), static balance, dynamic balance, chronic ankle instability tool (CAIT) and lower extremity functional scale (LEFS).

RESULTS

Statistical analysis showed significant improvement (P < 0.01) on all outcome measures among all groups. In group 1, mainly the plantar flexion JPS improved to 3.7°, while in group 2 and group 3 the eversion JPS improved to 3.1° and 1.78° (P < 0.01). With reference to static balance with one's eyes closed and eyes open, the improvement in group 1 was 4.46, 11.05 s, group 2 was 2.23, 7.85 s and group 3 was 1.69, 4.68 s. In relation to dynamic balance, the development in group 1 was 5.85 cm, while group 2 was 4.71 cm and group 3 was 2.49 cm. Moreover, both CAIT and LEFS showed significant differences (P < 0.01) after training.

CONCLUSION

This study found that combined strengthening and proprioceptive training effectively improves stability, proprioception, balance, and self-reported functional outcomes.

Effects of Combining High-Definition Transcranial Direct Current Stimulation with Short-Foot Exercise on Chronic Ankle Instability: A Pilot Randomized and Double-Blinded Study

(1) Background: Balance decline is highly prevalent in people suffering from chronic ankle instability (CAI). The control of balance depends upon multiple neurophysiologic systems including the activation of cortical brain regions (e.g., the primary sensorimotor cortex). The excitability of this region, however, is diminished in people with CAI. In this pilot double-blinded randomized controlled trial, we tested the effects of high-definition transcranial direct current stimulation (HD-tDCS) designed to facilitate the excitability of M1 and S1 in combination with short-foot exercise (SFE) training on proprioception and dynamic balance performance in individuals with CAI. (2) Methods: Thirty young adults completed baseline assessments including the Active Movement Extent Discrimination Apparatus (AMEDA), Joint Position Reproduction (JPR) test, Y-balance test, and the Sensory Organization Test (SOT). They were then randomized to receive a four-week intervention of SFE in combination with tDCS (i.e., HD-tDCS+SFE) or sham (i.e., control) stimulation. Baseline assessments were repeated once-weekly throughout the intervention and during a two-week follow-up period. (3) Results: Twenty-eight participants completed this study. Blinding procedures were successful and no adverse events were reported. As compared to the control group, the HD-tDCS+SFE group exhibited significant improvements in the JPR test, the Y balance test, and the SOT at different time points. No group by time interaction was observed in AMEDA test performance. (4) Conclusions: HD-tDCS combined with SFE may improve dynamic balance and proprioception in CAI. Larger, more definitive trials with extended follow-up are warranted.

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.

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

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

Acute Effects of High-Definition Transcranial Direct Current Stimulation on Foot Muscle Strength, Passive Ankle Kinesthesia, and Static Balance: A Pilot Study

This study aimed to examine the effects of single-session anodal high-definition transcranial direct current stimulation (HD-tDCS) on the strength of intrinsic foot muscles, passive ankle kinesthesia, and static balance. Methods: In this double-blinded self-controlled study, 14 healthy younger adults were asked to complete assessments of foot muscle strength, passive ankle kinesthesia, and static balance before and after a 20-minute session of either HD-tDCS or sham stimulation (i.e., control) at two visits separated by one week. Two-way repeated-measures analysis of variance was used to examine the effects of HD-tDCS on metatarsophalangeal joint flexor strength, toe flexor strength, the passive kinesthesia threshold of ankle joint, and the average sway velocity of the center of gravity. Results: All participants completed all study procedures and no side effects nor risk events were reported. Blinding was shown to be successful, with an overall accuracy of 35.7% in the guess of stimulation type (p = 0.347). No main effects of intervention, time, or their interaction were observed for foot muscle strength (p > 0.05). The average percent change in first-toe flexor strength following anodal HD-tDCS was 12.8 ± 24.2%, with 11 out of 14 participants showing an increase in strength, while the change following sham stimulation was 0.7 ± 17.3%, with 8 out of 14 participants showing an increase in strength. A main effect of time on the passive kinesthesia threshold of ankle inversion, dorsiflexion, and anteroposterior and medial–lateral average sway velocity of the center of gravity in one-leg standing with eyes closed was observed; these outcomes were reduced from pre to post stimulation (p < 0.05). No significant differences were observed for other variables between the two stimulation types. Conclusion: The results of this pilot study suggested that single-session HD-tDCS may improve the flexor strength of the first toe, although no statistically significant differences were observed between the anodal HD-tDCS and sham procedure groups. Additionally, passive ankle kinesthesia and static standing balance performance were improved from pre to post stimulation, but no significant differences were observed between the HD-tDCS and sham procedure groups. This may be potentially due to ceiling effects in this healthy cohort of a small sample size. Nevertheless, these preliminary findings may provide critical knowledge of optimal stimulation parameters, effect size, and power estimation of HD-tDCS for future trials aiming to confirm and expand the findings of this pilot study.

The effect of exercises and insoles on the feet in leprosy patients

ABSTRACT The purpose of this study is to analyze the effects of using customized insoles and leg and foot exercises on the feet of patients with neuropathy caused by leprosy. Thirty volunteers diagnosed with leprosy were assigned to one of three groups: (1) Exercise group (n=10): performed exercises for the intrinsic muscles of the foot; (2) Insole group (n=10): used insoles to correct foot positioning; (3) Insole and Exercise group (n=10): used insoles and performed an exercise routine. The results of the treatments were analyzed with photogrammetry using the Alcimagem® and AutoCAD® programs. Left hindfoot posture changed after treatment in the Exercise and Insole groups (hindfoot, pre versus post <0.001). We also found that combining exercise and insoles did not alter the alignment of the feet during the study’s evaluation period (customized insoles and exercises, pre versus post <0.05), which suggests that follow-up for more than four months may be needed. The left hindfoot’s alignment can be changed with supervised exercises and the use of insoles.