Esnek pes planuslu bireylerde silikon tabanlıkların farklı egzersiz yöntemleriyle birlikte uygulanmasının etkileri

Öz

Amaç: Pes planus ayak deformitesinin varlığı, dengeyi olumsuz etkileyerek küçük postüral bozukluklara ve farklı denge stratejilerinin gelişimine yol açmaktadır. Bu durumda, intrinsik ayak kaslarının güçlendirilmesi büyük önem taşımaktadır. Bu çalışmanın amacı, esnek pes planusa sahip bireylerde intrinsik kas güçlendirme ve dinamik denge egzersizlerinin etkilerini araştırmaktır. Yöntem: Çalışmaya pes planusu olan, 18–35 yaş aralığında 45 katılımcı dahil edildi. Birinci grup kısa ayak egzersizleri (KAE) ile intrinsik kas kuvvetlendirme eğitimi aldı ve silikon tabanlık kullandı. İkinci grup dinamik dengeyi geliştiren balance board egzersizleri yaptı ve silikon tabanlık kullandı. Üçüncü grup ise yalnızca silikon tabanlık kullandı. Tedavi süresi 8 hafta ve haftada 3 gün olacak şekilde planlandı. Ayak deformitesi; medial longitudinal ark açısı ve subtalar açı ölçümleriyle değerlendirildi. Ayak pronasyon seviyesi navicular düşme testiyle değerlendirildi. Ayak postürü ayak postür indeksi (API) ile, statik denge Flamingo Denge Testi ile, dinamik denge ise dinamik postüral kontrolü ölçen BOBO Health Platform with Gaming® cihazı kullanılarak değerlendirildi. Bulgular: Müdahale sonrasında Grup 1’de medial longitudinal ark açısı ve API skorlarında istatistiksel olarak anlamlı iyileşme gözlendi. Kısa ayak egzersizlerinin; ayak arkını, subtalar açıyı, naviküler seviyeyi ve API skorlarını iyileştirdiği, ayrıca statik ve dinamik dengeyi artırdığı bulundu (p≤0,05). Yalnızca silikon tabanlık kullanımının ise medial longitudinal ark, API ve denge parametrelerinde anlamlı bir değişiklik oluşturmadığı saptandı (p>0,05). Sonuç: Esnek pes planusun yönetiminde silikon tabanlık kullanımının egzersiz tedavisine ek olarak kullanılması, dengeyi ve ayak postürünü iyileştirmektedir.

Anahtar Kelimeler

• Pes planus
• Tabanlık
• Denge
• Egzersiz

Effects of silicone insoles combined with different exercise methods in individuals with flexible pes planus

Öz

Purpose : Presence of a pes planus foot deformity negatively affects the balance of the individual, revealing disturbances and different balance strategies. In this situation, the training of intrinsic muscles is of great importance. The purpose of this study is to investigate the effects of intrinsic strengthening and dynamic balance exercises in participants having flexible pes planus. Methods: Forty-five participants with pes planus aged 18 to 35 years were enrolled in the study, and the first group underwent intrinsic foot muscle strengthening training with short foot exercises (SFE) and used insoles. The second group trained using the dynamic balance board, which promotes dynamic balance and used insoles. The third group used only insoles. The total duration of treatment was 8weeks/3days. The degree of foot deformity was assessed with the medial longitudinal arch (MLA) angle, measurements of subtalar angle. Navicular drop test was assessed with foot pronation level. Foot posture assessed using Foot Posture Index (FPI) Static balance was assessed with the Flamingo Balance Test and dynamic balance was assessed using the BOBO Health Platform with Gaming®, a technology-based system designed to measure dynamic postural control. Results: After the intervention, statistically significant improvements were observed in the medial longitudinal arch angle and foot posture index scores in Group 1. SFE were found to improve foot arch, subtalar angle, navicular level, and foot posture index scores, as well as static and dynamic balance(p≤0.05). No significant changes were observed in the medial longitudinal arch, foot posture index, or balance parameters with the use of silicone insoles alone (p > 0.05). Conclusion: The use of silicone insoles in addition to exercise therapy in the management of flexible pes planus improves balance and foot posture.

Anahtar Kelimeler

• Pes planus
• Insole
• Balance
• Exercise

Destekleyen Kurum

This study is funded by Biruni University Scientific Research Projects.

Etik Beyan

The appropriate ethics review boards (Research Ethics Committee of Biruni University (Number: 2021/49-14) approved the study design.

Kaynakça

1. 1. Hillstrom HJ, Song J, Kraszewski AP, et al. Foot type biomechanics part 1: Structure and function of the asymptomatic foot. Gait Posture. 2013;37:445-451.
2. 2. Wenger DR, Mauldin D, Speck G, et al. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Jt Surg - Ser A. 1989;71:800-810.
3. 3. Banwell HA, Mackintosh S, Thewlis D. Foot orthoses for adults with flexible pes planus: A systematic review. J Foot Ankle Res. 2014;7:23.
4. 4. Kim EK, Kim JS. The effects of short foot exercises and arch support insoles on improvement in the medial longitudinal arch and dynamic balance of flexible flatfoot patients. J Phys Ther Sci. 2016;28:3136-3139.
5. 5. Birinci T, Demirbas SB. Relationship between the mobility of medial longitudinal arch and postural control. Acta Orthop Traumatol Turc. 2017;51:233-237.
6. 6. Sezer B, Yıldız Ş. Comparative analysis of foot biomechanical characteristics in adolescent football and handball players and sedentary individuals: a retrospective study. J Exerc Ther Rehabil. 2026;13:40-47.
7. 7. Nelson RT, Bandy W. Deep water running: an alternative to distance training on land. J Aquat Phys Ther. 2004;12:17-23.
8. 8. Lee KS, Park DJ. Three-dimensional ankle exercise with combined isotonic technique for an obese subject with plantar fasciitis: A case study. Med. 2020;56:190. 9. Fiolkowski P, Brunt D, Bishop M, et al. Intrinsic pedal musculature support of the medial longitudinal arch: An electromyography study. J Foot Ankle Surg. 2003;42:327-333.

9. 10. Headlee DL, Leonard JL, Hart JM, et al. Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol. 2008;18:420-425.
10. 11. Kahleel AL, Sadiq GS. Manufacturing and analysis custom foot orthotic for flexible flatfoot. Int J Mech Eng Technol. 2018;9:1253-1263.
11. 12. Kido M, Ikoma K, Hara Y, et al. Effect of therapeutic insoles on the medial longitudinal arch in patients with flatfoot deformity: A three-dimensional loading computed tomography study. Clin Biomech. 2014;29:1095-1098.
12. 13. Vadivelan K. Comparison of foot taping versus custom-made medial arch support on pronated flatfoot ın school going children. Int J Physiother. 2015;2:491-501.
13. 14. Nielsen RG, Rathleff MS, Simonsen OH, et al. Determination of normal values for navicular drop during walking: A new model correcting for foot length and gender. J Foot Ankle Res. 2009;2:12.
14. 15. Algaba-Del Castillo J, Coheña-Jiménez M, Páez-Tudela A, et al. Foot posture index: A literature review. Rev Andal Med Deporte. 2019;12:376-380.
15. 16. Unver B, Erdem EU, Akbas E. Effects of short-foot exercises on foot posture, pain, disability, and plantar pressure in pes planus. J Sport Rehabil. 2020;29:336-340.
16. 17. Langley B, Cramp M, Morrison SC. Clinical measures of static foot posture do not agree. J Foot Ankle Res. 2016;9:45.
17. 18. Zuil-Escobar JC, Martínez-Cepa CB, Martín-Urrialde JA, et al. Medial longitudinal arch: accuracy, reliability, and correlation between navicular drop test and footprint parameters. J Manipulative Physiol Ther. 2018;41:672-679.
18. 19. Brody DM. Techniques in the evaluation and treatment of the injured runner. Orthop Clin North Am. 1982;13:541-558.
19. 20. Nilsson MK, Friis R, Michaelsen MS, et al. Classification of the height and flexibility of the medial longitudinal arch of the foot. J Foot Ankle Res. 2012;17:3.
20. 21. Rami PV, Prabhakar MM. Comparison of static balance in male football and basketball players by using Flamingo Balance Test. Int J Physiother. 2018;5:162-166.
21. 22. Lynn SK, Padilla RA, Tsang KKW. Differences in static- and dynamic-balance task performance after 4 weeks of intrinsic-foot-muscle training: The short-foot exercise versus the towel-curl exercise. J Sport Rehabil. 2012;21:327-333.
22. 23. Gregory DE, Dunk NM, Callaghan JP. Stability ball versus office chair: Comparison of muscle activation and lumbar spine posture during prolonged sitting. Hum Factors. 2006;48:142-153.
23. 24. Rothermel SA, Hale SA, Hertel J, et al. Effect of active foot positioning on the outcome of a balance training program. Phys Ther Sport. 2004;5:98-103.
24. 25. Huang C, Chen LY, Liao YH, et al. Effects of the short-foot exercise on foot alignment and muscle hypertrophy in flatfoot individuals: A meta-analysis. Int J Environ Res Public Health. 2022;19:11994.
25. 26. Elsayed W, Alotaibi S, Shaheen A, et al. The combined effect of short foot exercises and orthosis in symptomatic flexible flatfoot: a randomized controlled trial. Eur J Phys Rehabil Med. 2023;59:396. 27. Kulig K, Reischl SF, Pomrantz AB, et al. Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: A randomized controlled trial. Phys Ther. 2009;89:26-37.
26. 28. Park DJ, Hwang YI. Comparison of the intrinsic foot muscle activities between therapeutic and three-dimensional foot-ankle exercises in healthy adults: An explanatory study. Int J Environ Res Public Health. 2020;17:7189.
27. 29. Telfer S, Abbott M, Steultjens M, et al. Dose-response effects of customised foot orthoses on lower limb muscle activity and plantar pressures in pronated foot type. Gait Posture. 2013;38:443-449.