S. Alotaibi1, W. Elsayed2
1King Saud Medical City Hospital, Department of Physical Therapy, Riyadh, Saudi Arabia, 2Imam Abdulrahman Bin Faisal University, Department of Physical Therapy, Dammam, Saudi Arabia
Background: Flexible flatfoot management is variable. Orthotic therapy or exercise therapy is the standard conservative treatment for flexible flatfoot. There is no consensus about the effect of their interaction on managing flatfoot.
Purpose: To evaluate the effect of insole use plus short foot exercise (SFE) compared to insoles solely. Comparison made in terms of changes on the medial longitudinal arch height of flexible flatfoot participants and lower extremity functional scale (LEFS) as well as foot pressure.
Methods: A parallel, active-control study design was used to conduct a single-blinded randomized controlled trial. The toe rising test, the “too many toes” sign, and the navicular drop test (NDT) was used to select 30 participants with flexible flatfoot. Participants were randomly assigned either to control, or experimental group. The control group received only insoles. The experimental group received SFE and insoles. Exercises were implemented 30 times for a duration of three minutes a day over the course of six weeks. The exercise progressed every two weeks, from sitting to standing and finally to one leg stance. All participants wore shoes containing orthotic insoles for eight hours per day for six weeks, and the NDT was used to assess the medial longitudinal arch (MLA) height, and the LEFS was used to evaluate restriction in participants’ functional abilities. Both variables were measured at baseline and at the sixth week. Plantar pressure distribution (force, area, and pressure) was measured at baseline and at two-week intervals throughout the six-weeks intervention.
Results: Thirty subjects with flexible flatfoot were recruited and randomized to either control (n=15, 4 males) with mean ± SD age, weight, and height of (24.0 ± 4.4 years, 65.6 ±17.3 kg, 1.6 ±0.1 meters) respectively, and experimental group (n=15, 6 males), with mean±SD age, weight, and height of (25.4 ± 5.8 years, 72.2 ±16.1 kg, 1.6 ±0.1 meters) respectively. Twenty eight subjects completed the intervention and analyzed. There was significant improvement of NDT, and LEFS for both groups across time p=0.000. However, there was no significant interaction between the groups for the NDT Rt and Lt foot (p = 0.44, p = 0.62), and LEFS p = 0.58. There was a statistically significant interaction between treatment arms, across time, for dynamic pressure only ( p = 0.026, partial eta-squared = 0.13). Dynamic pressure improved only for experimental group Rt and Lt. foot (p =0.000, p =0.001).
Conclusion(s): Management of flexible flatfoot using orthotic insole only or insoles plus SFE could effectively improve the NDT, and LEFS. Adding SFE to the insole use in flexible flatfoot rehabilitation could improve foot dynamic plantar pressure through six weeks of treatment.
Implications: In this clinical trial, using insoles only or integrate them with SFE were equivalent on improving medial longitudinal arch height and lower limb functional abilities through short-term protocol. Combining a rehabilitation protocol of SFE with the use of foot orthosis could effectively improve flatfoot dynamic pressure.
However, further studies are necessary to examine the long-term effect of SFE and insoles on plantar pressure of adults with flexible flatfoot.
However, further studies are necessary to examine the long-term effect of SFE and insoles on plantar pressure of adults with flexible flatfoot.
Funding, acknowledgements: This project is unfunded
Keywords: Flexible Flatfoot, Short foot exercise, Foot orthosis
Topic: Musculoskeletal: lower limb
Did this work require ethics approval? Yes
Institution: Imam Abdulrahman Bin Faisal University
Committee: IRB of Imam Abdulrahman Bin Faisal University
Ethics number: IRB-PGS-2018-03-184
All authors, affiliations and abstracts have been published as submitted.
