Toe Spread Out Exercise With and Without Walking Surface Training in Children With Autism

Official title

Effects of Toe Spread Out Exercise With and Without Walking Surface Training on Navicular Drop and Jumping Performance in Children With Autism

Overview

Flatfoot is a common postural deformity in children, characterized by the collapse of the medial longitudinal arch, leading to abnormal foot posture, gait disturbances, and postural instability. Arch collapse in flatfoot is also due to navicular drop a condition where the navicular bone, located in the midfoot, shifts downward excessively when bearing weight. This excessive drop reflects poor structural support in the foot and is often linked to weakness in the intrinsic foot muscles. The intrinsic and extrinsic muscles of the foot, particularly the abductor hallucis (AbdH), play a vital role in maintaining arch stability. Strengthening exercises like toe spread out movements are specifically designed to target these muscles by abducting and flexing the toes, helping to support and elevate the medial arch. This study aims to investigate the combined effect of toe spread out exercises and walking surface training on navicular drop and jumping performance in children with ASD, focusing on muscle strength and sensory-motor integration to support functional movement and postural control. This randomized controlled trial will be conducted over ten months at Step Up Autism Center and Rehab Care, Lahore, following ethical approval from the Research Ethical Committee of Riphah International University Islamabad (Lahore Campus). Children aged 7 to 12 years, clinically diagnosed with autism spectrum disorder, navicular drop, and poor locomotor skills will be recruited through non-probability convenient sampling. After obtaining informed consent from guardians, eligible participants will be randomly allocated into two groups. Group A will perform toe spread out exercises only, while Group B will perform toe spread out exercises combined with walking surface training. Both interventions will be carried out three times a week for eight weeks. This will be a single-blinded study, where the assessor will remain unaware of the group allocations. Data collection will involve pre- and post intervention assessment using the Navicular Drop Test, Wet Footprint Test (Clarke's Angle), Horizontal Jump Test, and the Test of Gross Motor Development-Second Edition (TGMD-2) to evaluate changes in foot posture, arch structure, lower limb power, and locomotor skills in participating children.

Interventions

• Other Toe spread out exercise
  Partcipant will sit on the edge of chair with hips and knees at 90 degree flexion, with foot flat on the floor. This position makes sure that there is equal weight distibution across the calcaneus, metatarsals and phalanges. It is also made sure that the feet are hip width apart.Then the participant is asked to lift the toes off the ground(dorsiflexion) , keeping the heel and ball(metarsals) of foot on the ground. While maintaining dorsiflexion of toes, the participant will be asked to flex the
• Other Toe spread out exercises with walking surface training
  Walking Surface • The participant will be barefoot and will be asked to walk in their usual manner and speed. • There will be three different surfaces i.e pile carpet (18mm thickness) for soft sensation, vinyl tile for flat smooth and loose gravel (average height of 14mm) for uneven sensation respectively. • The participant will be asked to walk on the 4 meter walking surface, taking 10 rounds on each

Primary outcome measures

• Navicular Drop by Navicular Drop Test [Time frame: Baseline and 8th Week]
• Jumping Performance by using Horizontal Jump Test [Time frame: Baseline and 8th Week]

Eligibility criteria

Inclusion criteria

• Children aged 7 to 12 years of age
• Children of both genders male and female
• children having navicular drop >9mm

Exclusion criteria

• Neurological conditions affecting movement (e.g., CP)
• Inability to follow simple verbal commands
• Visual or auditory impairment impacting motor performance

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Special needs and autism community center — Lahore

Publications

• A-C, BOCA I-C, RUSU M-E, CRISTEA D. The Benefits of Physical Therapy in the Rehabilitation of Flat Feet in Autism Students between the ages of 10 and 14. Romanian Journal of Physical Therapy/Revista Romana de Kinetoterapie. 2023;29(51)
• Kim J, Lee J, Kim D, Islomjon B, Lee K, Yoon T. Acute response of toe-spread-out exercise on medial longitudinal arch height and balance. The Asian Journal of Kinesiology. 2021;23(1):27-33
• Kang M-H, Cha S-M, Oh J-S. The effect of toe-tap exercise on abductor hallucis activity and medial longitudinal arch angle in individuals with pes planus. Isokinetics and Exercise Science. 2020;28(4):415-22
• Lee H-j, Kim S-h, Baik S-m, Cynn H-s. Comparison of Foot Muscle Activity During Short Foot and Toe Spread-out Exercises in Different Weight Bearing Conditions in Individuals With Pes Planus. Physical Therapy Korea. 2024;31(1):63-71.

Identifiers

NCT: NCT07438665 · Eman Amjad

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗