EFFECTS OF INSOLES WITH AND WITHOUT SHORT FOOT EXERCISES ON PAIN, DISABILITY AND FOOT POSTURE IN CHILDREN WITH PES PLANUS

Main Article Content

Dr Eram Aslam
Dr. Maryam Nasim
Dr. Arooj Shabir
Dr. Arnab Altaf
Aamna Hassan
Dr. Mubashra Tariq
Kiran Aslam
Dr. Sidra Shafeeq

Keywords

Pes Planus, Flatfoot, Short Foot Exercise, Shoe Insoles, Randomized Controlled Trial, Pediatric Podiatry

Abstract

Background: Pes Planus, commonly known as flatfoot, is a condition that can lead to significant discomfort and functional impairment. While various treatments have been proposed, the effectiveness of combining shoe insoles with Short Foot Exercise (SFE) has not been extensively studied.


Objective: To evaluate the efficacy of combined shoe insole and SFE intervention in improving symptoms of flatfoot compared to shoe insoles alone.


Methods: This randomized controlled trial recruited 26 children aged 8-16 years with symptomatic bilateral pes planus. Participants were divided into two groups: an experimental group receiving SFE with internal shoe modification, and a control group receiving only internal shoe modification. The intervention lasted for six weeks. Outcome measures included Foot Posture Index (FPI) and Foot Function Index (FFI), assessed before and after the intervention.


Results: At baseline, no significant differences were observed between groups in FPI and FFI scores. Post-intervention, the experimental group showed a significant improvement in FPI scores, from a median of 5.00 [−1.50 – 8.00] to 3.00 [−1.00 – 4.50], and in FFI scores, from 39.00 [22.00 – 45.00] to 30.00 [20.00 – 40.00]. In contrast, the control group showed less pronounced improvements. The differences between groups post-intervention were statistically significant, with P-values of 0.03 for FPI and 0.02 for FFI.


Conclusion: The combination of shoe insoles and SFE is more effective in improving foot posture and function in children with symptomatic flatfoot than shoe insoles alone. This study suggests that a multimodal approach may be beneficial in managing pes planus.

Abstract 372 | pdf Downloads 206

References

1. Salinas-Torres VM, Salinas-Torres RA, Carranza-García LE, Herrera-Orozco J, Tristán-Rodríguez JL. Prevalence and clinical factors associated with pes planus among children and adults: A population-based synthesis and systematic review. The Journal of Foot and Ankle Surgery. 2023.
2. Azhagiri R, Malar A, Hemapriya J, Sumathi G. The cause and frequency of PES Planus (Flat Foot) problems among young adults. Asian Journal of Medical Sciences. 2021;12(7).
3. Alderink GJ, Ashby BM. Ankle/Foot Complex: Recurrent Stress Fractures. Clinical Kinesiology and Biomechanics: A Problem-Based Learning Approach: Springer; 2023. p. 329-96.
4. Liu X, Chen Z, Gao Y, Jin Z. High tibial osteotomy: review of techniques and biomechanics. Journal of healthcare engineering. 2019;2019.
5. Hajizadeh M, Desmyttere G, Carmona J-P, Bleau J, Begon M. Can foot orthoses impose different gait features based on geometrical design in healthy subjects? A systematic review and meta-analysis. The Foot. 2020;42:101646.
6. Liebau K-H, Schmitt AP-L, Fröhlich S, Bünzen C, Mittelmeier W, Schulze C. Comparison of the Influence of Supportive and Sensorimotor Insoles on Flat Feet in Children–a Double-Blind, Prospective, Randomized, Controlled Trial. Ortopedia Traumatologia Rehabilitacja. 2023;25(4):195-206.
7. Elsayed W, Alotaibi S, Shaheen A, Farouk M, Farrag A. The combined effect of short foot exercises and orthosis in symptomatic flexible flatfoot: A randomized controlled trial. European journal of physical and rehabilitation medicine. 2023;59(3):396.
8. Şahan TY, Arslan SA, Demirci C, Oktaş B, Sertel M. Comparison of short-term effects of virtual reality and short foot exercises in pes planus. The Foot. 2021;47:101778.
9. Kuo Y-C, Hsieh R-L, Lee W-C. Customized Arch Support Insoles Improve Physical Functional Performance in Children: A Randomized Controlled Study. 2021.
10. Ueki Y, Sakuma E, Wada I. Pathology and management of flexible flat foot in children. Journal of orthopaedic science. 2019;24(1):9-13.
11. Cho DJ, Ahn SY, Bok S-K. Effect of foot orthoses in children with symptomatic flexible flatfoot based on ultrasonography of the ankle invertor and evertor muscles. Annals of rehabilitation medicine. 2021;45(6):459-70.
12. Hino R. The Effect of Non-Surgical Treatment Interventions for Pediatric Flexible Flatfoot. 2021.
13. Brijwasi T, Borkar P. A comprehensive exercise program improves foot alignment in people with flexible flat foot: a randomised trial. Journal of physiotherapy. 2023;69(1):42-6.
14. Haun C, Brown CN, Hannigan K, Johnson ST. The effects of the short foot exercise on Navicular Drop: A critically appraised topic. Journal of Sport Rehabilitation. 2020;30(1):152-7.
15. Zarali A, Raeisi Z. Effects of Combined Exercises and Short Foot Exercise With and Without Isometric Hip Abduction In Women With Flatfoot. Physical Treatments-Specific Physical Therapy Journal. 2023;13(1):35-44.
16. Kim J, Lee W-C. Joint preservation surgery for varus and posterior ankle arthritis associated with flatfoot deformity. Foot and Ankle Clinics. 2022;27(1):115-27.
17. Khisty A, Kulkarni R, Desai P, Palekar TJ. Effect of Short Foot Exercises on Patients with Flexible Flat Foot: A Pre-Post Experimental Study.
18. Yasin Y, ŞENER G, YAKUT Y. The effect of different foot orthoses on pain and health related quality of life in painful flexible flat foot: a randomized controlled trial. European journal of physical and rehabilitation medicine. 2019;55(1):95-102.
19. Unver B, Erdem EU, Akbas E. Effects of short-foot exercises on foot posture, pain, disability, and plantar pressure in pes planus. Journal of sport rehabilitation. 2019;29(4):436-40.
20. 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.
21. Flores DV, Mejía Gómez C, Fernández Hernando M, Davis MA, Pathria MN. Adult acquired flatfoot deformity: anatomy, biomechanics, staging, and imaging findings. Radiographics. 2019;39(5):1437-60.
22. Wang X, Ji X. Sample size estimation in clinical research: from randomized controlled trials to observational studies. Chest. 2020;158(1):S12-S20.
23. Namsawang J, Eungpinichpong W, Vichiansiri R, Rattanathongkom S. Effects of the short foot exercise with neuromuscular electrical stimulation on navicular height in flexible flatfoot in Thailand: a randomized controlled trial. Journal of Preventive Medicine and Public Health. 2019;52(4):250.
24. Jaffri A, Koldenhoven R, Saliba S, Hertel J. Evidence of intrinsic foot muscle training in improving foot function: a systematic review and meta-analysis. Journal of Athletic Training. 2022.
25. Wang Y, Chen Z, Wu Z, Li J, Li C, Yang J, et al. Reliability of foot posture index (FPI-6) for evaluating foot posture in patients with knee osteoarthritis. Frontiers in Bioengineering and Biotechnology. 2023;11:1103644.
26. Andrews NA, Ray J, Dib A, Harrelson WM, Khurana A, Singh MS, et al. Diagnosis and conservative management of great toe pathologies: a review. Postgraduate Medicine. 2021;133(4):409-20.
27. Hegazy F, Aboelnasr E, Abuzaid M, Kim I-J, Salem Y. Comparing validity and diagnostic accuracy of clarke’s angle and foot posture index-6 to determine flexible flatfoot in adolescents: A cross-sectional investigation. Journal of Multidisciplinary Healthcare. 2021:2705-17.
28. Horii M, Akagi R, Ogawa Y, Yamaguchi S, Kimura S, Ono Y, et al. Foot morphology and correlation with lower extremity pain in Japanese children: A cross-sectional study of the foot posture Index-6. Journal of Orthopaedic Science. 2023;28(1):212-6.
29. Açak M. The effects of individually designed insoles on pes planus treatment. Scientific Reports. 2020;10(1):19715.
30. Patil AR, Jawade S, Somaiya KJ, Boob MA, Somaiya Jr KJ. Efficacy of Faradic Foot Baths and Short Foot Exercises in Symptomatic Flatfoot: A Review. Cureus. 2023;15(10).
31. Rusu L, Marin MI, Geambesa MM, Rusu MR. Monitoring the role of physical activity in children with flat feet by assessing subtalar flexibility and plantar arch index. Children. 2022;9(3):427.
32. Hoang N-T-T, Chen S, Chou L-W. The impact of foot orthoses and exercises on pain and navicular drop for adult flatfoot: A network meta-analysis. International journal of environmental research and public health. 2021;18(15):8063.