Pes Planusta Konservatif Tedavinin Fonksiyonel Duruma Etkisi

Öz

Pes planus hem statik hem de dinamik hareketler sırasında zemine temas eden ayak taban yüzeyinin arttığı ve hem yetişkin hem de çocuk popülasyonunda sıklıkla karşılaşılan bir durumdur. Görülme sıklığı tüm popülasyonda %13,60 ila %26,62 arasındadır. Pes planuslu bireylerde bozulmuş ayak postürü duyusal girdi, kas aktivasyonu ve fonksiyonel durumu olumsuz etkiler ve ağrıya neden olur. Tedavi öncelikle konservatiftir. Konservatif müdahaleler hastaların %83 ila %87,5’inde başarılı sonuç vermiştir. Konservatif tedavide ilk hedef medial longitidunal arkı desteklemektir. Bu amaçla sıklıkla kullanılan müdahaleler ayak iç kaslarına veya çevre kaslara egzersiz, rijit ve esnek bantlama, elektroterapi, ortez veya tabanlıklardır. Bu yöntemlerin tedavideki etkinliği sıklıkla ayak postürü, basınç dağılımı, kas kuvveti ve kas kesit alanının artması ile değerlendirilmiştir. Ancak pes planusun bireylerde denge bozukluğu, azalmış sıçrama yüksekliği, azalmış yürüme mesafesine neden olarak fonksiyonu etkilediği bilinmektedir. Çünkü pes planusta meydana gelen medial longitidunal ark yüksekliğinin azalması, ayak pronasyonunun artması ve plantar fleksiyon kas gücünün azalması ayağın medial kısmında plantar basıncın artmasına neden olur. Plantar basınçtaki değişiklik ise kinetik zincir aracılığıyla tüm vücut segmentlerinde hizalanma ve yüklenmeyi değiştirerek kişinin fonksiyonel performansını etkiler. Konservatif tedavilerin pes planuslu bireylerde fonksiyonlar üzerine etkileri belirsizdir. Bu nedenle bu derlemede esnek pes planuslu yetişkinlerde kullanılan güncel konservatif tedavi yöntemlerinin fonksiyonel durum üzerine etkileri sunulmuştur. Sonuçta pes planuslu yetişkin bireylerde intrinsik kasları hedef alan egzersizler ve tabanlıklar statik ve dinamik denge ile fonksiyonu iyileştirmede ve ağrıyı azaltmada etkili görünmektedir. Bantlama tekniklerinin fonksiyona etkileri tartışmalıdır. Elektroterapi yöntemlerinin ise fonksiyonel duruma etkileri daha fazla araştırılmaya muhtaçtır. Sonuç olarak pes planuslu bireylerde hedef fonksiyona göre etkili olduğu bildirilmiş konservatif tedavi yöntemleri tercih edilmelidir.

Anahtar Kelimeler

• Düztaban
• egzersiz
• konservatif tedavi
• pronasyon

The Effect of Conservative Treatment of Pes Planus on Functional Status

Öz

Pes planus is a frequently encountered condition in both adult and pediatric populations, characterized by an increased contact area between the plantar surface of the foot and the ground during both static and dynamic movements. Its prevalence in the general population ranges from 13.60% to 26.62%. In individuals with pes planus, impaired foot posture negatively affects sensory input, muscle activation, and functional status, and can lead to pain. Treatment is primarily conservative, with successful outcomes reported in approximately 83% to 87.5% of cases. The initial goal of conservative treatment is to support the medial longitudinal arch. Frequently used conservative interventions include exercises targeting intrinsic or surrounding foot muscles, rigid and flexible taping techniques, electrotherapy, orthoses, and insoles. The effectiveness of these methods is commonly assessed through improvements in foot posture, pressure distribution, muscle strength, and increases in muscle cross-sectional area. However, pes planus is known to impair functional performance by causing balance disturbances, reduced jump height, and decreased walking distance. This is primarily due to the decrease in medial longitudinal arch height, increased foot pronation, and reduced plantar flexor muscle strength, which collectively lead to increased plantar pressure on the medial aspect of the foot. This alteration in plantar pressure affects the alignment and loading of all body segments through the kinetic chain, thereby influencing overall functional performance. Despite the prevalence of conservative treatments, their effectiveness in improving these functional limitations remains unclear. Accordingly, this review presents the current evidence regarding the effects of conservative treatment methods on functional status in adults with flexible pes planus. Findings suggest that exercises targeting intrinsic foot muscles and the use of insoles appear to be effective in enhancing both static and dynamic balance, improving function, and reducing pain. The effects of taping techniques on function remain controversial, while the impact of electrotherapy on functional status requires further investigation. In conclusion, conservative treatment strategies that have been shown to be effective for specific functional goals should be prioritized in the management of individuals with pes planus.

Anahtar Kelimeler

• Conservative treatment
• exercise
• pes planus
• pronation

Kaynakça

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