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

Official title

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

Overview

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.

Detailed description

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.

Interventions

• Other Foot Core Training
  Children will perform exercises 2×/week for 8 weeks with daily home practice. Begin with 1-2 sets of 5-15 reps (hold 5-10 sec), 1-2 min rest, progressing gradually. Session: 30-45 min. 1. Short-Foot Contraction: Lift medial arch without toe curling (5-15 reps, hold 5-10 sec) 2. Tip-Toe Heel Raises: Rise, hold 2 sec, lower (15 reps) 3. Towel Scrunch: Scrunch towel with toes (\~1 min) 4. Marble Pickup: Pick/place objects with toes (\~1 min) 5. Arch Lifting: Lift arch in standing (15 reps) 6. Plan
• Other Foot Core Training with Visual Feedback
  Visual feedback will be delivered via mirror therapy using a 36×36×48 cm mirror box. The child sits with the mirror at midline; one foot is hidden inside the box while the other is visible. While performing foot-core exercises, the mirror creates the illusion of symmetrical movement. The process is repeated by switching feet to ensure bilateral training. Exercises will be done 2×/week for 8 weeks (home practice encouraged), 1-2 sets of 5-15 reps (hold 5-10 sec), 1-2 min rest, session 30-45 min.

Primary outcome measures

• Foot Posture Index [Time frame: Baseline, 8 weeks]
• Temporal Distance Gait Analysis: [Time frame: Baseline, 8 weeks]
• Arch Height Index [Time frame: Baseline, 8 weeks]
• Medial Longitudinal Arch Angle [Time frame: Baseline, 8 weeks]
• Calcaneal Eversion Angle [Time frame: Baseline, 8 weeks]
• Subtalar joint range of motion [Time frame: Baseline, 8 weeks]
• Footprint Index (Staheli or Chippaux): [Time frame: Baseline, 8 weeks]
• Y-Balance Test [Time frame: Baseline, 8 weeks]
• Lower Extremity Functional Scale [Time frame: Baseline, 8 weeks]

Eligibility criteria

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)

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

Other

Study locations

Pakistan · 1 center

• Rafia Grammar School — Lahore

Publications

• Salinas-Torres VM, Salinas-Torres RA, Carranza-Garcia LE, Herrera-Orozco J, Tristan-Rodriguez JL. Prevalence and Clinical Factors Associated With Pes Planus Among Children and Adults: A Population-Based Synthesis and Systematic Review. J Foot Ankle Surg. 2023 Sep-Oct;62(5):899-903. doi: 10.1053/j.jfas.2023.05.007. Epub 2023 Jun 5. PMID 37286098

Identifiers

NCT: NCT07578974 · REC/RCR&AHS/HAFIZASYEDAJAVERIA

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗