Modification of Pronated Foot Posture after a Program of Therapeutic Exercises

Relationships between flexion strength and dexterity of the toes and physical performance

BACKGROUND

Toe function is characterised by the strength and dexterity of toe motion. However, previous studies have mostly focused on the importance of toe strength.

OBJECTIVE

This study aimed to investigate the relationships between flexion strength and dexterity of the toes and physical performance.

METHODS

Twenty healthy participants were included in this study. The flexion force of each toe was measured using a digital force gauge, and the toe dexterity was evaluated using the marble pick-up and rock-paper-scissors tests. These parameters were statistically analysed in relation to physical performance, including repeated side step and balance ability, which was evaluated using centre of pressure (COP) data during single-leg standing, tiptoe standing, and single-leg drop-jumping.

RESULTS

A significant correlation was found between the first toe flexion force and the total trajectory length of the COP during one-leg standing and between the time required for marble pick-up and the rock-paper-scissors score and the COP during single-leg drop-jumping.

CONCLUSION

The results underscore the importance of flexion strength and dexterity of the toes in human physical performance and the necessity for the evaluation and improvement of both functions.

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.

Activation Capacity of the Intrinsic Musculature of the Foot in Handball Athletes with Chronic Ankle Instability

Chronic ankle instability (CAI) is a common pathology in handball. The role of the intrinsic musculature of the foot in these players in relation to proprioception and stability has not been stablished. The objective of this study was to compare the ultrasound morphology of the heel fat pad of the foot in professional handball players to CAI in healthy players and establish relationships between CAI and physical and psychological variables. The study has been a descriptive observational case-control study in which 20 professional handball male players over 18 years of age were divided into 8 cases (CAI) and 12 controls (healthy). An ultrasound evaluation, the thickness and/or cross-sectional area at rest and the contraction measurement of the Abductor Digiti Minimi, Abductor Hallucis, Flexor Digitorum Brevis and Quadratus Plantae muscles were analyzed. Moreover, the compressibility index of the heel fat pad and the activation of the abdominal wall musculature (ultrasound), the flexion strength of the hallux and lesser toes (dynamometry), the foot functionality (Bristol Foot Score (BFS) questionnaire) and the psychological variables (self-reported questionnaires) were measured. There were no significant differences between the activation capacity values of the foot muscles of healthy and CAI athletes. Significant differences were found between groups regarding the BFS score (p = 0.007), d = 1.404), and significant correlations were also found between hallux flexion strength and lesser toes flexion strength in the total sample. Although there were no differences between the two groups, the identification of the activation pattern of these muscles in handball athletes is essential to the improvement of performance and preventing injuries such as CAI.

Pilot Study: The Relationship between Foot Posture and Movement Quality in Non-Professional Male Football Players

(1) Background: This study focusses on establishing the relationship between quality of movement (based on the functional movement screen, or FMS) and foot posture (based on the foot posture index, or FPI-6). We hypothesised that a poor FMS test score may be derived from the foot position in the space measured by FPI-6. (2) Methods: a quasi-experimental and cross-sectional study was designed to analyse foot posture in 30 healthy football players, using the foot posture index and the functional movement screen. (3) Results: No significant relationships were found between movement quality and foot posture. Poor movement quality is present in more than half of all foot positions, supination, pronation, and neutral. Good quality seems to be more associated with a neutral foot position (23.3%) and supinated (16.6%) than a pronated foot position (6.6%). (4) Conclusions: this study found no relationship between the two tests; therefore, we cannot demonstrate that foot posture is relevant in the quality of the movement of the football players studied.

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. 

Effect of intrinsic foot muscles training on foot function and dynamic postural balance: A systematic review and meta-analysis

This systematic review aimed to analyse the effects of intrinsic foot muscle (IFM) training on foot function and dynamic postural balance. Keywords related to IFM training were used to search four databases (PubMed, CINAHL, SPORTDiscus and Web of Science databases.) for relevant studies published between January 2011 and February 2021. The methodological quality of the intervention studies was assessed independently by two reviewers by using the modified Downs and Black quality index. Publication bias was also assessed on the basis of funnel plots. This study was registered in PROSPERO (CRD42021232984). Sixteen studies met the inclusion criteria (10 with high quality and 6 with moderate quality). Numerous biomechanical variables were evaluated after IFM training intervention. These variables included IFM characteristics, medial longitudinal arch morphology and dynamic postural balance. This systematic review demonstrated that IFM training can exert positive biomechanical effects on the medial longitudinal arch, improve dynamic postural balance and act as an important training method for sports enthusiasts. Future studies should optimise standardised IFM training methods in accordance with the demands of different sports.

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

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

Assessment of Selected Spatio-Temporal Gait Parameters on Subjects with Pronated Foot Posture on the Basis of Measurements Using OptoGait. A Case-Control Study

Walking is part of daily life and in asymptomatic subjects it is relatively easy. The physiology of walking is complex and when this complex control system fails, the risk of falls increases. As a result, gait disorders have a major impact on the older adult population and have increased in frequency as a result of population aging. Therefore, the OptoGait sensor is intended to identify gait imbalances in pronating feet to try to prevent falling and injury by compensating for it with treatments that normalize such alteration. This study is intended to assess whether spatiotemporal alterations occur in the gait cycle in a young pronating population (cases) compared to a control group (non-pronating patients) analyzed with OptoGait. Method: a total of n = 142 participants consisting of n = 70 cases (pronators) and n = 72 healthy controls were studied by means of a 30 s treadmill program with a system of 96 OptoGait LED sensors. Results: Significant differences were found between the two groups and both feet in stride length and stride time, gait cycle duration and gait cadence (in all cases p < 0.05). Conclusions: pronating foot posture alters normal gait patterns measured by OptoGait; this finding presents imbalance in gait as an underlying factor. Prevention of this alteration could be considered in relation to its relationship to the risk of falling in future investigations.

The Use of Infrared Thermography to Develop and Assess a Wearable Sock and Monitor Foot Temperature in Diabetic Subjects

One important health problem that could affect diabetics is diabetic foot syndrome, as risk of ulceration, neuropathy, ischemia and infection. Unnoticed minor injuries, subsequent infection and ulceration may end in a foot amputation. Preliminary studies have shown a relationship between increased skin temperature and asymmetries between the same regions of both feet. In the preulceration phase, to develop a smart device able to control the temperature of these types of patients to avoid this risk might be very useful. A statistical analysis has been carried out with a sample of foot temperature data obtained from 93 individuals, of whom 44 are diabetics and 49 nondiabetics and among them 43% are men and 57% are women. Data obtained with a thermographic camera has been successful in providing a set of regions of interest, where the temperature could influence the individual, and the behavior of several variables that could affect these subjects provides a mathematical model. Finally, an in-depth analysis of existing sensors situated in those positions, namely, heel, medial midfoot, first metatarsal head, fifth metatarsal head, and first toe has allowed for the development of a smart sock to store temperatures obtained every few minutes in a mobile device.