Foot-Core Training With/Without Visual Feedback in Pediatric FPP

Comparison of Foot-Core Training With and Without Visual Feedback on Gait and Foot Posture in Children With Flexible Pes Planus

This study investigates flexible pes planus (flat feet) in children, a condition where the medial arch collapses during weight-bearing, affecting gait, balance, and foot function. Although foot-core strengthening and visual feedback individually improve arch stability and motor control, their combined effect in pediatric populations remains underexplored. To address this gap, a randomized controlled trial will be conducted at Rafia Grammar School, involving 24 children aged 7-12 years with clinically confirmed flexible pes planus. Participants will be randomly assigned into two groups: one receiving foot-core training alone and the other receiving foot-core training with visual feedback, with interventions carried out twice weekly for 8 weeks. Changes in foot posture and gait will be assessed using standardized outcome measures, and data will be analyzed using SPSS version 23.0. The study aims to determine whether adding visual feedback enhances treatment effectiveness and supports the development of more targeted, evidence-based pediatric rehabilitation strategies.

Flexible pes planus, commonly observed in children, is characterized by a collapse of the medial longitudinal arch during weight-bearing, which can impair gait efficiency, balance, and foot function if unaddressed. While intrinsic foot muscle (foot-core) strengthening has been shown to improve arch stability and functional outcomes, and visual feedback is recognized for enhancing motor control through real-time sensory input, current literature lacks empirical evidence on the combined effect of these interventions in pediatric flatfoot populations.

Most studies examine either strengthening exercises or feedback mechanisms independently, often without tailoring protocols to the unique neuromuscular learning needs of children. This gap limits the development of comprehensive rehabilitation strategies for flexible pes planus. Therefore, this study aims to compare the effectiveness of foot-core training with and without visual feedback on foot posture and gait parameters in children with flexible pes planus, thereby contributing to the advancement of targeted, evidence-based pediatric rehabilitation approaches. This randomized controlled trial will be conducted at Rafia Grammar School. Using a convenience sampling technique, children aged 7-12 years with clinically confirmed flexible pes planus will be recruited based on predefined inclusion and exclusion criteria, including cognitive readiness and flexibility of the medial arch. After baseline assessment, participants will be randomly allocated into two intervention groups (n1=12, n2=12): one receiving foot-core training alone, and the other receiving foot-core training with visual feedback. The intervention will be performed 2 times per week for 8 weeks. The study will assess changes in gait and foot posture using standardized physical and functional outcome measures. Ethical approval will be secured before starting the study, and all evaluations will be carried out consistently throughout the trial. Data will be analyzed through SPSS version 23.0.

Inclusion Criteria:

• Children aged 7-12 years with confirmed flat feet
• Both Genders
• Flexibility of flatfeet; tested using Tip toe standing test and Jack's test.
• Navicular Drop (>10mm)
• Mini Mental State Examination score > 21
• Visual acuity of 20/40 (6/12) or better in both eyes, confirmed by Snellen chart test.
• Foot Posture Index-6 (FPI-6, > +6)
• Children demonstrate altered gait parameters consistent with flexible pes planus as measured by temporal-distance gait analysis.
• Arch Height Index (< 0.31)
• Medial Longitudinal Arch Angle (<130°)
• Calcaneal Eversion Angle ( >5° eversion)
• Subtalar ROM (Dorsiflexion <10°)
• Footprint Index (Staheli >1.0 or Chippaux >45%)
• Dynamic Balance; Y-Balance Test (<85% composite score)
• Functional Scale (LEFS) (<60%)

Exclusion Criteria:

• Children with tarsal coalitions
• Congenital defects of lower limbs
• Previous foot surgery
• Foot/ankle trauma within the last six (6) months
• Received balance training or feet muscle strengthening within the last 3 months
• Visual and vestibular disturbance
• A history of head injury within the last 3 months
• Weakness of lower extremities (Manual Muscle testing grade <5)