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

Three-dimensional foot-ankle exercise versus clam exercise in addition to short-foot exercise in individuals with flexible flatfoot: a randomized controlled trial

BACKGROUND

Three-Dimensional (3D) foot-ankle exercise and clam exercise have been used to improve foot posture in flatfoot. However, studies on this topic are limited, and more supporting evidence is needed to investigate the benefits of these exercises on flatfoot.

PURPOSE

To compare the effects of 3D foot-ankle and clam exercise in addition to Short-Foot exercise on navicular drop, foot posture and structure in individuals with flexible flatfoot.

METHODS

Single-blind, randomized controlled trial. Fifty-six participants were divided into Foot Exercise Group (FEG), Hip Exercise Group (HEG), and a Control Group (CG). FEG performed 3D foot-ankle+Short-Foot exercise. HEG performed clam+Short-Foot exercise. CG performed only Short-Foot exercise. The Navicular Drop Test (NDT), Foot Posture Index-6 (FPI-6), Clarke's Angle (CA), Staheli Index (SI), Wejsflog Index, hallux valgus angle, and varus deformity angle of the fifth toe were assessed pre-and post-intervention (six week later).

RESULTS

Post-intervention, NDT, CA, and SI scores improved significantly more in FEG compared to other groups (p  =  <0.001, η2 = 0.425-0.802). FPI-6 score decreased similarly in FEG and HEG (p = .477), significantly more than in CG (p  =  <0.001, r = -0.692; p  =  <0.001, r= -0.560, respectively). CA and SI scores improved more in HEG than in CG (p =  <0.001, r = -0.851; p =  <0.001, r= -0.536, respectively).

CONCLUSION

The 3D foot-ankle and clam exercise may be an effective intervention that provides satisfactory functional results for navicular drop, foot pronation, and anthropometric properties of the foot in flexible flatfoot.

CLINICAL TRIAL REGISTRATION NUMBER

NCT06313125.

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.

The Effectiveness of Video-Based Game Exercise Therapy Applications in Pes Planus Rehabilitation: Protocol for a Randomized Controlled Trial

BACKGROUND

Pes planus is one of the most common foot deformities. Although there are many studies on the effectiveness of various exercise methods in pes planus rehabilitation, the number of studies on video-based game exercise therapy applications is very limited.

OBJECTIVE

This study aims to evaluate the effectiveness of 2 video-based game exercise therapies and structured exercise practices in pes planus rehabilitation.

METHODS

This study is a 3-arm, parallel-group, single-blinded randomized controlled trial. The study will include 69 patients with flexible pes planus aged between 18 and 25 years who attend the orthopedics and traumatology clinic and meet the inclusion criteria. The primary outcomes are measures of navicular drop and pedobarographic analysis before and after the intervention, and the secondary outcomes include balance, femoral anteversion, and lower extremity muscle strength. Participants will be evaluated with a navicular drop test for medial longitudinal arch height, a pedobarographic analysis system for plantar pressure analysis, a Craig test for femoral anteversion, the Becure Balance System for balance measurement, and a myometer device for lower extremity muscle strength measurement. Participants will be randomly assigned to a structured exercise group, an exergame group, or a serious game group according to their order of arrival. The structured exercise group will use a short foot exercise, a towel-picking exercise, and various walking and balance exercises. Patients in the serious play group will play the lower extremity games in the Becure Balance System. Patients in the exergame group will play balance games on the Nintendo Wii game console. All participants will participate in 18 exercise sessions (3 days a week for 6 weeks). After the treatment, the initial measurements will be repeated.

RESULTS

The study started in January 2023. It is expected to be completed in June 2024.

CONCLUSIONS

This study will be the first randomized controlled study to evaluate the effectiveness of 2 different video-based game exercise therapy applications in pes planus rehabilitation. Through this study, the use of video-based game exercise therapy in pes planus rehabilitation, together with the developing technology, will be a guide. In addition, a new exercise protocol, including serious game exercises, will be added to the literature. In the future, it is expected that our study on the development of different game systems, especially for the ankle, will provide pioneering feedback.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05679219; https://clinicaltrials.gov/study/NCT05679219.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51772.