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In the study, the effects of two different strengthening exercises combined with short foot exercise on lower extremity functional performance and muscle strength will be examined and compared in adults aged 18-45 years with flexible flatfoot. This study was designed as an experimental, 3-arm, parallel group, double-blind randomized controlled study that included a 6-week intervention period.
Participants will be randomly divided into 3 different groups (control group, foot-ankle exercise group, hip exercise group). The control group will be instructed to perform only short foot exercise; the foot-ankle exercise group will be instructed to perform 3-dimensional foot-ankle extension exercise in proprioceptive neuromuscular facilitation (PNF) pattern in addition to short foot exercise; the hip exercise group will be instructed to perform hip abductor and external rotator muscle strengthening exercise (clam exercise) in addition to short foot exercise. Foot-ankle and hip exercises will be performed against resistance with the help of an elastic band, 3 days a week under the supervision of a physiotherapist and progression will be made by changing to a higher level of difficulty band color every 2 weeks. Short foot exercise will be performed every day of the week (3 days under the supervision of a physiotherapist; the rest of the days as a home exercise program) and will be progressed by changing position (sitting, standing, on one leg respectively) every 2 weeks. All exercises will be performed for 6 weeks. Assessments will be performed at the beginning and end of the exercises by another researcher blinded to group allocation. Isometric muscle strength of the intrinsic foot, four-way ankle circumference and hip abductor-external rotator muscles, endurance of the plantar flexors, forward jump and dynamic balance performance will be evaluated respectively.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PNF exercise group | Experimental | All groups will be subjected to exercise training for 6 weeks: PNF exercise group will receive 3-dimensional (3D) foot-ankle extension exercise and short-foot exercise. The exercise will be performed 2 days a week under the supervision of a physiotherapist and 1 day as home exercise; KA exercise will be performed daily, 2 days under the supervision of a physiotherapist and the other days as home exercise. |
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| Clam exercise group | Experimental | All groups will be subjected to exercise training for 6 weeks: Clam exercise group will receive mussel exercise and short-foot exercise. The exercise will be performed 2 days a week under the supervision of a physiotherapist and 1 day as home exercise; KA exercise will be performed daily, 2 days under the supervision of a physiotherapist and the other days as home exercise. |
|
| Control group | Active Comparator | All groups will be subjected to exercise training for 6 weeks: Control group will receive only KA exercise and this exercise will be performed daily, 2 days under the supervision of a physiotherapist and the other days as home exercise. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| PNF exercise | Other | Ankle and foot exercises practiced for 6 weeks. |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Medial longitudinal arch height | Medial longitudinal arch height will be evaluated with the navicular drop test. | 6 weeks |
| Static foot posture | Static foot posture will be evaluated with Foot Posture Index-6. | 6 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Isometric muscle strength | Abductor hallucis, flexor digitorum brevis, flexor hallucis brevis, 4-way ankle muscles and hip abductor/external rotator isometric muscle strength will be evaluated using a digital hand-held dynamometer. | 6 weeks |
| Lower extremity functional performance |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Dilek Esen, PhD. c | Gazi University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Gazi University, Institute of Health Sciences, Department of Physiotherapy and Rehabilitation | Ankara | Çankaya | 06540 | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36231295 | Background | Huang C, Chen LY, Liao YH, Masodsai K, Lin YY. Effects of the Short-Foot Exercise on Foot Alignment and Muscle Hypertrophy in Flatfoot Individuals: A Meta-Analysis. Int J Environ Res Public Health. 2022 Sep 22;19(19):11994. doi: 10.3390/ijerph191911994. | |
| 36910682 | Background | Engkananuwat P, Kanlayanaphotporn R. Gluteus medius muscle strengthening exercise effects on medial longitudinal arch height in individuals with flexible flatfoot: a randomized controlled trial. J Exerc Rehabil. 2023 Feb 23;19(1):57-66. doi: 10.12965/jer.2244572.286. eCollection 2023 Feb. |
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| ID | Term |
|---|---|
| D005413 | Flatfoot |
| D005530 | Foot Deformities |
| ID | Term |
|---|---|
| D000070558 | Talipes |
| D005531 | Foot Deformities, Acquired |
| D009140 | Musculoskeletal Diseases |
| D005532 | Foot Deformities, Congenital |
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| ID | Term |
|---|---|
| D052580 | Muscle Stretching Exercises |
| ID | Term |
|---|---|
| D005081 | Exercise Therapy |
| D012046 | Rehabilitation |
| D000359 | Aftercare |
| D003266 | Continuity of Patient Care |
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This study was designed as an experimental, 3-arm parallel-group, double-blind randomized controlled trial with a 6-week intervention period.
The study will be conducted at Toros University physiotherapy and exercise laboratory.
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The primary researcher will ensure blinding. Participants and the researcher conducting the assessments will be blinded to group information.
| Clam exercise |
| Other |
Hip exercise practiced for 6 weeks. |
|
| Short-foot exercise | Other | Foot exercise practiced together for 6 weeks. |
|
With plantar flexor focused endurance performance heel raise test; with dynamic balance Y balance test; Single leg forward jump performance will be evaluated with the single leg hop for distance test. |
| 6 weeks |
| 31590069 | Background | Okamura K, Fukuda K, Oki S, Ono T, Tanaka S, Kanai S. Effects of plantar intrinsic foot muscle strengthening exercise on static and dynamic foot kinematics: A pilot randomized controlled single-blind trial in individuals with pes planus. Gait Posture. 2020 Jan;75:40-45. doi: 10.1016/j.gaitpost.2019.09.030. Epub 2019 Sep 29. |
| 32645830 | Background | Pabon-Carrasco M, Castro-Mendez A, Vilar-Palomo S, Jimenez-Cebrian AM, Garcia-Paya I, Palomo-Toucedo IC. Randomized Clinical Trial: The Effect of Exercise of the Intrinsic Muscle on Foot Pronation. Int J Environ Res Public Health. 2020 Jul 7;17(13):4882. doi: 10.3390/ijerph17134882. |
| D038061 | Lower Extremity Deformities, Congenital |
| D017880 | Limb Deformities, Congenital |
| D009139 | Musculoskeletal Abnormalities |
| D000013 | Congenital Abnormalities |
| D009358 | Congenital, Hereditary, and Neonatal Diseases and Abnormalities |
| D005791 |
| Patient Care |
| D013812 | Therapeutics |
| D026741 | Physical Therapy Modalities |
| D015444 | Exercise |
| D009043 | Motor Activity |
| D009068 | Movement |
| D009142 | Musculoskeletal Physiological Phenomena |
| D055687 | Musculoskeletal and Neural Physiological Phenomena |