The Effect of Different Exercises on Lower Extremity Performance in Flexible Flatfoot

Comparison of Effect of Ankle Exercise in PNF Pattern and Clam Exercise on Lower Extremity Muscle Strengh and Performance in Adults With Flexible Flat Feet: A Randomized Controlled Trial

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.

Inclusion Criteria:

• Age range is 18-45 years
• Navicular drop is 10 mm or more
• Getting a value of +6 points or more from the Foot Posture Index-6

Exclusion Criteria:

• Orthopedic and rheumatological diseases of the spinal region and lower extremities
• Surgery history of the spine and lower extremities
• Neurological and systemic disorders
• Describe lower extremity and/or lower back pain in the last 6 months
• Disorders that may affect cognition and balance (otitis media, visual impairment, etc.)
• Body mass index being above normal values (18-24.9 kg/m2)
• Having rigid flat feet and/or hallux rigidus-limitus deformity
• Being involved in regular sports or exercise
• Having received any physiotherapy or rehabilitation treatment for flat feet or hips in the last year