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Pourghazi F, Nabian MH, Bakht SS, Laripour R, Zoshk MY. Changes in gait pattern and quality of life of adolescents with flexible flat foot after Calcaneal Lengthening Osteotomy. Foot (Edinb) 2023; 57:101962. [PMID: 37865070 DOI: 10.1016/j.foot.2023.101962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/08/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND Calcaneal Lengthening Osteotomy is a surgical technique to correct flexible flat foot deformities in patients who did not show any change in their symptoms after conservative treatment. In this study, the effects of CLO on the kinematic and kinetic changes of gait was analyzed and the clinical and quality of life improvements in children treated by CLO for moderate to severe symptomatic flexible flat foot deformities were assessed. METHODS Participants were seven adolescents (13 feet) with symptomatic FFF who underwent during 2019-2022 and seven (10 feet) healthy children as control group. Three items were evaluated in each foot before and after surgery including: 1. Clinical examination 2.quality of life (using Pediatric Quality of Life Inventory version 4 questionnaire) 3. Gait analysis (Vicon motion systems, Oxford metrics Inc., UK). Also, the kinetic and kinematic analysis between patients and healthy groups were compared. RESULTS Kinematic results of control was significantly better than FFF group. Ankle range of motion(32.94 ± 13.39 compared to 32.94 ± 13.39,P-Value:0.01),foot progression angle (-9.26 ± 7.67 compared to -16.07 ± 9.00,P-Value:0.01),and internal rotation of ankle was higher in control group compared to FFF. FFF patients demonstrated improvement in kinematic results after CLO surgery. Foot progression angle was improved after surgery (-11.31 ± 6.07 compared to -16.19 ± 7.06, P-value:0.00), maximum plantar flexion decreased after CLO surgery due to achil tendon procedure during CLO surgery. Kinetic results of FFF patients showed significant increase in ankle Power in coronal and transverse plane, Also knee and hip power showed similar results.Quality of life parameters showed significant improve in all parameters (Physical,Social, emotional and school function), Also ADKE and ADKF improved after surgery. CONCLUSION CLO surgery significantly improved patients' quality of life of patients with symptomatic FFF. Also, kinetic results showed improvement in some parameters of gait results after CLO surgery. Thus, our study suggested CLO surgery as an excellent surgical option for symptomatic FFF.
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Affiliation(s)
- Farzad Pourghazi
- Surgery and Trauma Research Center, AJA University of Medical Science, Iran
| | - Mohammad Hossein Nabian
- Center for Orthopedic Trans-disciplinary Applied Research, Department of Orthopedic Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Reza Laripour
- Surgery and Trauma Research Center, AJA University of Medical Science, Iran
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Brijwasi T, Borkar P. A comprehensive exercise program improves foot alignment in people with flexible flat foot: a randomised trial. J Physiother 2023; 69:42-46. [PMID: 36526555 DOI: 10.1016/j.jphys.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
QUESTION In people with flexible flat foot, what is the effect of a comprehensive exercise program on navicular drop height and medial longitudinal arch angle compared with a control regimen of brief active range of motion exercises? DESIGN Randomised controlled trial with concealed allocation, blinding of assessors and intention-to-treat analysis. PARTICIPANTS Fifty-two people with flexible flat foot. INTERVENTION The experimental group undertook 30-minute exercise sessions three times per week for 6 weeks. The exercises involved active dorsiflexion and plantarflexion, foot shortening exercises, gluteal muscle strengthening, and stretching. The control group performed active dorsiflexion and plantarflexion only for 6 weeks. OUTCOME MEASURES Navicular drop height and longitudinal arch angle. RESULTS Randomisation allocated 26 participants to each group. One participant from the experimental group and two from the control group did not complete the study. After 6 weeks, the participants in the experimental group improved their navicular drop height by 0.4 cm (95% CI 0.4 to 0.5) more than those in the control group. These participants also improved their longitudinal arch angle by 16 deg (95% CI 13 to 19) more than those in the control group. CONCLUSION In people with flexible flat foot, a comprehensive 6-week exercise program improved the navicular drop height and longitudinal arch angle more than active dorsiflexion and plantarflexion alone. This improved the cosmetic appearance of the foot and reduced progression towards more severe flat foot, which typically becomes symptomatic. TRIAL REGISTRATION CTRI/2021/07/034599.
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Affiliation(s)
- Tanya Brijwasi
- Orthopaedic Physiotherapy Department, Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences Loni, Ahmednagar, India.
| | - Pradeep Borkar
- Orthopaedic Physiotherapy Department, Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences Loni, Ahmednagar, India
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Wako M, Fujimaki T, Koyama K, Furuya N, Shinohara R, Otawa S, Kobayashi A, Horiuchi S, Kushima M, Yamagata Z, Haro H. A cross-sectional study on the correlations between floating toe, plantar arch posture, and body composition in 8-year-old children. Foot Ankle Surg 2022; 28:1035-1039. [PMID: 35210187 DOI: 10.1016/j.fas.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/01/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Floating toe (FT): inadequately in contact with the ground and flexible flat foot (FFF) are frequently seen in children. According to some reports, inadequate foot muscle strength may cause FT or FFF.Therefore, a relationship may exist between arch formation, FT, and pedal muscle strength. This study aimed to evaluate the correlation of FT with plantar arch posture and body composition, including overall muscle mass. METHODS We conducted our own cohort study in addition to the Japan Environment and Children's Study conducted by the Ministry of the Environment, Japan. Out of 705 eight-year-old children participating in this adjunct study, 578 with recorded footprints were included. Body composition (body weight, body fat percentage, and predicted muscle mass) was assessed using body composition analyzer. Presence of FT or FFF was evaluated using foot pressure plate. We calculated the FT score (small FT score indicates insufficient ground contact of the toes) and the Chippaux-Smirak Index (CSI) using images of the plantar footprint. RESULTS The FT score (an indicator of FT) showed no significant correlation with CSI (an indicator of plantar arch posture). Moreover, no significant correlations between the predicted muscle mass, FT score, and CSI were observed. CONCLUSIONS This is the first report that assessed the relationship of FT with plantar arch posture and body composition in children. This study indicated that muscle strength might not be a major factor for FT and FFF development in children.
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Affiliation(s)
- Masanori Wako
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan.
| | - Taro Fujimaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Kensuke Koyama
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Naoto Furuya
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Ryoji Shinohara
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Sanae Otawa
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Anna Kobayashi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Sayaka Horiuchi
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Megumi Kushima
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Zentaro Yamagata
- Center for Birth Cohort Studies, Interdisciplinary Graduate School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
| | - Hirotaka Haro
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi, Japan
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Jung D, Yi C, Choi WJ, You JSH. Effect of dynamic guidance-tubing short foot gait exercise on muscle activity and navicular movement in people with flexible flatfeet. NeuroRehabilitation 2020; 47:217-226. [PMID: 32741785 DOI: 10.3233/nre-203106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Navicular drop is a common plantar deformity which makes the plantar medial longitudinal arch (MLA) collapse and leads to other deformities in lower extremities. Active structures are from intrinsic and extrinsic foot muscle activities such as abductor hallucis (AbdH), tibialis anterior (TA), tibialis posterior, flexor hallucis brevis, flexor digitorum brevis during dynamic situations. As AbdH plays a role as a dynamic elevator of MLA, the importance of AbdH has been emphasized and the proper recruitment of both intrinsic and extrinsic muscle is crucial for stabilization of MLA during dynamic weight bearing condition. Because the short foot (SF) exercise is difficult to perform and tends to activate the intrinsic muscles concentrically rather than a natural coordination of concentric-isometric-eccentric activation, we have developed the guidance-tubing SF gait (GFG) exercise. OBJECTIVE We investigated the effect of GFG exercise on muscle activity, AbdH:TA activity ratio, MLA angle, and foot pressure distribution during walking compared to SF gait (SFG) exercise. METHODS Thirty-two subjects with flexible flat feet were divided into two groups and performed SFG exercise with (GFG) and without guidance-tubing (SFG) for seven serial days. RESULTS AbdH muscle activity significantly increased from foot flat to heel rise in the GFG group (p = 0.006). The AbdH:TA activity ratio significantly increased in both the SFG (p = 0.015) group and GFG group (p = 0.006). MLA angles significantly decreased in both the SFG group (p = 0.001) and GFG group (p = 0.000), and the decrement was significantly higher in the GFG group (p = 0.001). The foot pressure distribution did not show any statistically significant change. CONCLUSIONS The result of this study provides a clinical implication for training MLA supporter muscles in individuals with flat feet. The overactive muscle must be inhibited first, then facilitation and strengthening are followed respectively.
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Affiliation(s)
- Dohee Jung
- Department of Physical Therapy, Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | - Chunghwi Yi
- Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
| | | | - Joshua Sung H You
- Department of Physical Therapy, Sports Movement Artificial-Intelligence Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea.,Department of Physical Therapy, Yonsei University, Wonju, Republic of Korea
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Choi JY, Lee DJ, Kim SJ, Suh JS. Does the long-term use of medial arch support insole induce the radiographic structural changes for pediatric flexible flat foot? - A prospective comparative study. Foot Ankle Surg 2020; 26:449-456. [PMID: 31201010 DOI: 10.1016/j.fas.2019.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Several conservative treatment methods, from intrinsic muscle exercises to orthoses, including insoles or specially designed shoes, have been introduced for pediatric flexible flat foot (PFFF). However, the structural effects of a long-term use of medial arch support insole remain unclear because the normal physiological maturation of the medial longitudinal arch cannot be ruled out. METHODS From January 2005 to June 2015, 18 patients (34 feet) in group 1 (continuously insole applied group) and 13 patients (26 feet) in group 2 (untreated group) were enrolled. Medial arch support insole was applied from the age 10-11years to radiographic physeal closure. RESULTS In group 1, talonavicular coverage angle, lateral talo-1st metatarsal angle, calcaneal pitch angle and medial cuneiform height were significantly changed at final follow-up, although all values were still within the abnormal range. Further, no significant differences were found in any of the increments of the radiographic parameters between group 1 and 2. CONCLUSIONS Radiographic improvements were found in both of medial arch support insole treated or untreated group despite all radiographic values were still within the abnormal range. It was meaningful that the PFFF could be improved somewhat until the physes were closed. And the hindfoot alignment remained unchanged regardless of medial arch support insole application.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Dong Joo Lee
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Seung Joo Kim
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea.
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Choi JY, Hong WH, Suh JS, Han JH, Lee DJ, Lee YJ. The long-term structural effect of orthoses for pediatric flexible flat foot: A systematic review. Foot Ankle Surg 2020; 26:181-8. [PMID: 30765257 DOI: 10.1016/j.fas.2019.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/20/2018] [Accepted: 01/23/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to evaluate the structural effects of the long-term use of orthoses for pediatric flexible flat foot (PFFF) using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies. METHODS A comprehensive literature search using five databases, namely MEDLINE, the Cochrane Library, Scopus, the Web of Science, and EMBASE, was performed for pertinent articles published before March 30, 2018. Studies with quantitative data on the effects of the long-term use of orthoses for PFFF were included. The search strategy was adapted as appropriate for all other databases searched considering the differences in indexing terms and search syntax for each database. RESULTS Randomized controlled trials and prospective cohort studies could not prove the estimated effects of orthoses on the medial longitudinal arch. They revealed that flexible flat feet in young children slowly improved with growth, regardless of the type of footwear used. However, three of four case series studies revealed that positive long-term effects could be achieved using orthoses. CONCLUSION There is no strong evidence that the long-term use of orthoses improved the structural problem of PFFF.
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Jafarnezhadgero AA, Shad MM, Majlesi M. Effect of foot orthoses on the medial longitudinal arch in children with flexible flatfoot deformity: A three-dimensional moment analysis. Gait Posture 2017; 55:75-80. [PMID: 28419877 DOI: 10.1016/j.gaitpost.2017.04.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 03/01/2017] [Accepted: 04/05/2017] [Indexed: 02/02/2023]
Abstract
Foot orthoses are often used to correct altered gait patterns. The purpose of this study was to investigate how foot orthoses can modify the magnitude of three dimensional moments of ankle, knee, and hip joints during a stride of gait in children with flexible flat feet. Bilateral gait data were collected from fourteen male children (age 10.2±1.4 years) suffering from flat feet syndrome. In order to obtain the kinematics data, a Vicon system with six cameras (100Hz) was used and two Kistler force plates (1000Hz) to record the kinetics data under each leg. Arc support foot orthoses were used as an intervention. Paired-sample T-test was used for within-group comparisons (α=0.05). The results of data analysis showed that foot orthoses can decrease the ankle evertor moment, knee and hip abductor moments and hip flexor moment in dominant lower limb. In non-dominant lower limb, using the orthoses can decrease evertor and internal rotator moments at the ankle, flexor and internal rotator moments at the knee and extensor moment at the hip, while it can increase dorsiflexor moment at the ankle. The findings imply that effects of orthoses on three dimensional moments differ in dominant and non-dominant lower limbs. Furthermore, results demonstrated that dominant and non-dominant lower limbs would also show different responses to the same intervention.
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Affiliation(s)
- Amir Ali Jafarnezhadgero
- Department of Physical Education and Sport Sciences, Faculty of Educational Science and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | | | - Mahdi Majlesi
- Department of Sport Biomechanics, Faculty of Humanities, Islamic Azad University, Hamedan Branch, Hamedan, Iran
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Um GM, Wang JS, Park SE. An analysis on muscle tone of lower limb muscles on flexible flat foot. J Phys Ther Sci 2015; 27:3089-92. [PMID: 26644650 PMCID: PMC4668141 DOI: 10.1589/jpts.27.3089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/06/2015] [Indexed: 12/04/2022] Open
Abstract
[Purpose] The aim of this study was to examine differences in the muscle tone and
stiffness of leg muscles according to types of flexible flat foot. [Subjects and Methods]
For 30 subjects 10 in a normal foot group (NFG), 10 in group with both flexible flat feet
(BFFG), and 10 in a group with flexible flat feet on one side (OFFG), myotonometry was
used to measure the muscle tone and stiffness of the tibialis anterior muscle (TA), the
rectus femoris muscle (RF), the medial gastrocnemius (MG), and the long head of the biceps
femoris muscle (BF) of both lower extremities. [Results] In the measurement results, only
the stiffness of TA and MG of the NFG and the BFFG showed significant differences. The
muscle tone and stiffness were highest in the BFFG, followed by the OFFG and NFG, although
the difference was insignificant. In the case of the OFFG, there was no significant
difference in muscle tone and stiffness compared to that in the NGF and the BFFG.
Furthermore, in the NFG, the non-dominant leg showed greater muscle tone and stiffness
than the dominant leg, although the difference was insignificant. [Conclusion] During the
relax condition, the flexible flat foot generally showed a greater muscle tone and
stiffness of both lower extremities compared to the normal foot. The stiffness was
particularly higher in the TA and MG muscles. Therefore, the muscle tone and stiffness of
the lower extremity muscles must be considered in the treatment of flat foot.
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Affiliation(s)
- Gi-Mai Um
- Department of Physical Therapy, Yeoju Institute of Technology: 338 Sejong-ro, Yeoju-si, Gyeonggi-do, Republic of Korea
| | - Joong-San Wang
- Department of Physical Therapy, Yeoju Institute of Technology: 338 Sejong-ro, Yeoju-si, Gyeonggi-do, Republic of Korea
| | - Si-Eun Park
- Department of Physical Therapy, Yongin University, Republic of Korea
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Saeedi H, Mousavi ME, Majddoleslam B, Rahgozar M, Aminian G, Tabatabai Ghomshe F, Movahedi Yeganeh M. The evaluation of modified foot orthosis on muscle activity and kinetic in a subject with flexible flat foot : single case study. Prosthet Orthot Int 2014; 38:160-6. [PMID: 23824545 DOI: 10.1177/0309364613492170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Due to blocking of pronation/dorsiflexion in flexible flat foot and restriction of these movements in using the University of California Berkeley Laboratory orthosis, provided pressures in sole by the orthosis were increased. Therefore, this article describes the evaluation of modified foot orthosis with flexible structure in the management of individuals with flexible flat foot. CASE DESCRIPTION AND METHOD: The patient was a 21-year-old male who had symptomatic flat foot. The modified foot orthosis included movable surface and the outside structure. The modified foot orthosis was evaluated by standing foot X-ray, comfort rate, electromyography of leg muscle and vertical ground reaction force during walking. FINDINGS AND OUTCOMES The modified foot orthosis improved the foot alignment and decreased the symptoms of flat foot with more comfort. Subtalar position by sub-maximum supination had higher position than neutral in sagittal plane. It may increase the muscle activity of peroneus longus by 7% compared to barefoot, and there was a decrease of 11% ground reaction force in mid stance. CONCLUSION The result of this single case evaluation only proposed the feasibility of this modified insole as the orthotic treatment in flexible flat foot. Clinical relevance The modified foot orthosis, which is mobile in the midfoot, is an orthosis for walking and standing in subjects with flexible flat foot.
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Affiliation(s)
- Hassan Saeedi
- 1Department of orthotics and prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Iran
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