Current Exercise Approaches in Adults with Flexible Pes Planus: A Review

Öz

Flexible pes planus (flat foot) deformity is a common pathological condition characterized by decreased medial longitudinal arch height, especially during loading. There is no consensus yet on the treatment algorithm for flexible pes planus. Conservative treatments are generally considered as the first step in treatment. In conservative treatments, exercise methods are one of the most frequently used interventions. It has been reported that exercise can improve functional outcomes such as navicular drop, plantar pressure distribution, foot posture, balance, and muscle strength in adults with flexible pes planus. Therefore, knowing and understanding the different current exercise approaches used in the rehabilitation of individuals with pes planus is important in order for this population to obtain optimum benefit from conservative treatment and to contribute to the exercise prescribing ability of healthcare professionals who do not yet have sufficient clinical experience in foot-ankle rehabilitation. In this review, current exercise approaches used in the conservative treatment of adult individuals with flexible pes planus were examined. As supported by the study results, structured comprehensive exercise programs should be recommended in the conservative treatment of flexible pes planus, as rich treatment programs that include exercises for the ankle and gluteal muscles combined with foot exercises may be more effective in improving clinical outcomes for pes planus compared to foot exercises alone. Future studies should focus on creating standardized exercise protocols that provide optimum benefit in accordance with the patient's demands. Exercise is an effective intervention method that provides satisfactory functional results for adults with pes planus.

Anahtar Kelimeler

• Short-foot exercise
• navicular drop
• proprioceptive neuromuscular facilitation
• three-dimensional foot-ankle exercises
• adult-acquired flatfoot deformity

Esnek Pes Planuslu Yetişkinlerde Güncel Egzersiz Yaklaşımları: Derleme

Öz

Esnek pes planus (düz taban) deformitesi, özellikle yüklenme sırasında medial longitudinal ark yüksekliğinin azalması ile karakterize yaygın bir patolojik durumdur. Esnek pes planusun tedavi algoritmasıyla ilgili henüz fikir birliği bulunmamaktadır. Genellikle tedavide ilk basamak olarak konservatif tedaviler düşünülmektedir. Konservatif tedavilerde ise en sık başvurulan müdahalelerin başında egzersiz yöntemleri gelmektedir. Egzersizin, esnek pes planuslu yetişkinlerde, naviküler düşme, plantar basınç dağılımı, ayak postürü, denge ve kas kuvveti gibi fonksiyonel sonuçları iyileştirebileceği bildirilmiştir. Dolayısıyla, pes planuslu bireylerin rehabilitasyonunda kullanılan farklı güncel egzersiz yaklaşımlarının bilinmesi ve anlaşılması, bu popülasyonun konservatif tedaviden optimum fayda sağlayabilmesi ve ayak-ayak bileği rehabilitasyonunda henüz yeterli klinik deneyimi olmayan sağlık profesyonellerinin egzersiz reçeteleyebilme yetisine katkıda bulunabilmesi açısından önem arz etmektedir. Bu derlemede, esnek pes planuslu yetişkin bireylerin konservatif tedavisinde kullanılan güncel egzersiz yaklaşımları incelenmiştir. Çalışma sonuçlarının da desteklediği şekilde, ayak egzersizleri ile kombine ayak bileği ve gluteal kaslara yönelik egzersiz uygulamalarını içeren zengin içerikli tedavi programları, tek başına ayak egzersizlerine kıyasla pes planusa yönelik klinik sonuçları iyileştirmede daha etkili olabileceği için, esnek pes planusun konservatif tedavisinde yapılandırılmış kapsamlı egzersiz programları önerilmelidir. Gelecekteki çalışmalarda, hastanın taleplerine uygun olarak optimum fayda sağlayıcı standartlaştırılmış egzersiz protokollerinin oluşturulmasına odaklanılmalıdır. Egzersiz, pes planuslu yetişkin bireyler için tatmin edici fonksiyonel sonuçlar veren etkili bir müdahale yöntemidir.

Anahtar Kelimeler

• Kısa-ayak egzersizi
• naviküler düşme
• proprioseptif nöromusküler fasilitasyon
• üç boyutlu ayak-ayak bileği egzersizleri
• yetişkinlerde-edinilen düz taban deformitesi

Kaynakça

1. 1. Richie DH, Jr, Biomechanics and clinical analysis of the adult acquired flatfoot. Clin Podiatr Med Surg. 2007;24(4):617-44.
2. 2. Lee MS, Vanore JV, Thomas JL, Catanzariti AR, Kogler G, Kravitz SR. Diagnosis and treatment of adult flatfoot. J Foot Ankle Surg. 2005;44(2):78-113.
3. 3. Esen DH, Kafa N, Atalay Güzel N, Akarcesme C. The effect of medial longitudinal arch supporting Dynamic® tape application on plantar pressure distribution in adolescent volleyball players. Kinesiol. Slov. 2022;28(3):30-42.
4. 4. Giza EG, Cush G, Schon LC. The flexible flatfoot in the adult. Foot Ankle Clin. 2007;12(2):251-71.
5. 5. Bhoir T, Anap DB, Diwate A. Prevalence of flat foot among 18-25 years old physiotherapy students: cross sectional study ındian. J Basic Appl Med Res. 2014;3(4):272-8.
6. 6. Collado P, Gonzalez-Fernandez ML. The paediatric foot: prevalence and differentiation of sonographic and podiatric findings in juvenile arthritis and healthy children. Clin Exp Rheumatol. 2022;40(3):655-661.
7. 7. Gutteck N, Schilde S, Delank KS, Arbab D. [Etiology, pathogenesis, clinical features, diagnostics and conservative treatment of adult flatfoot]. Orthopade. 2020;49(11):942-953.
8. 8. Pecheva M, Devany A, Nourallah B, Cutts S, Pasapula C. Long-term follow-up of patients undergoing tibialis posterior transfer: is acquired pes planus a complication? The Foot. 2018;34:83-89.

9. 9. Abousayed MM, Alley MC, Shakked R, Rosenbaum AJ. Adult-acquired flatfoot deformity: etiology, diagnosis, and management. JBJS Rev. 2017;5(8):e7
10. 10. Bare AA, Haddad SL. Tenosynovitis of the posterior tibial tendon. Foot Ankle Clin. 2001;6(1):37-66.
11. 11. Jung D. Yi C, Choi WJ, You JSH. Effect of dynamic guidance-tubing short foot gait exercise on muscle activity and navicular movement in people with flexible flatfeet. NeuroRehabilitation. 2020;47(2):217-226.
12. 12. Lee D, Choi J. The effects of foot intrinsic muscle and tibialis posterior strengthening exercise on plantar pressure and dynamic balance in adults flexible pes planus. Phys. Ther. Korea. 2016;23(4):27-37.
13. 13. Pinney SJ, Lin SS. Current concept review: acquired adult flatfoot deformity. Foot Ankle Int. 2006;27(1):66-75.
14. 14. Halabchi F, Mazaheri R, Mirshahi M, Abbasian L. Pediatric flexible flatfoot; clinical aspects and algorithmic approach. Iran J Pediatr. 2013;23(3):247-60.
15. 15. Rodriguez N, Choung DJ, Dobbs MB. Rigid pediatric pes planovalgus: conservative and surgical treatment options. Clin Podiatr Med Surg. 2010;27(1):79-92.
16. 16. Richie D. Biomechanics and Orthotic Treatment of the Adult Acquired Flatfoot. Clin Podiatr Med Surg. 2020;37(1):71-89.
17. 17. Öğüt T, Yontar NS. Erişkinlerde pes planus. TOTBİD Dergisi. 2013;12425-32.
18. 18. Zaw H, Calder JD. Operative management options for symptomatic flexible adult acquired flatfoot deformity: a review. Knee Surg Sports Traumatol Arthrosc. 2010;18(2):135-42.
19. 19. Alam F, Raza S, Moiz JA, Bhati P, Anwer S, Alghadir A. Effects of selective strengthening of tibialis posterior and stretching of iliopsoas on navicular drop, dynamic balance, and lower limb muscle activity in pronated feet: A randomized clinical trial. Phys Sportsmed. 2019;47(3):301-311.
20. 20. Esen DH, Kafa N, Atalay Güzel N, Akarcesme C. The effects of Dynamic® taping on vertical jumps in adolescent volleyball players with low medial longitudinal arch. Balt. J. Health Phys. Act. 2022; 14(4): 4.
21. 21. 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(4):436-440.
22. 22. Brijwasi T, Borkar P. A comprehensive exercise program improves foot alignment in people with flexible flat foot: a randomised trial. J Physiother. 2023;69(1):42-46.
23. 23. Engkananuwat P, Kanlayanaphotporn R. Gluteus medius muscle strengthening exercise effects on medial longitudinal arch height in individuals with flexible flatfoot: a randomized controlled trial. J Exerc Rehabil. 2023;19(1):57-66.
24. 24. 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(11):3136-3139.
25. 25. Okamura K, Fukuda K, Oki S, Ono T, Tanaka S, Kanai S. Effects of plantar intrinsic foot muscle strengthening exercise on static and dynamic foot kinematics: A pilot randomized controlled single-blind trial in individuals with pes planus. Gait Posture. 2020;75:40-45.
26. 26. Park DJ, Lee KS, Park SY. Effects of two foot-ankle interventions on foot structure, function, and balance ability in obese people with pes planus. In Healthcare. 2021; (9)6:667.
27. 27. Utsahachant N, Sakulsriprasert P, Sinsurin K, Jensen MP, Sungkue S. Effects of short foot exercise combined with lower extremity training on dynamic foot function in individuals with flexible flatfoot: A randomized controlled trial. Gait Posture. 2023;104:109-115.
28. 28. 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.
29. 29. Pisal SN, Chotai K, Patil S. Effectiveness of Short Foot Exercises Versus Towel Curl Exercises to Improve Balance and Foot Posture in Individuals with Flexible Flat Foot. Indian J Med Forensic Med Toxicol. 2020;14(3).
30. 30. Jeon I, Kim K. Effect of the arch support on the strength of the abductor hallucis during the toe spread out exercise in standing position in individuals with pes planus. Phys. Ther. Korea. 2020;27(3):206-211.
31. 31. Haun C, Brown CN, Hannigan K, Johnson ST. The effects of the short foot exercise on navicular drop: a critically appraised topic. J Sport Rehabil. 2020;30(1):152-157.
32. 32. McKeon PO, Hertel J, Bramble D, Davis, I. The foot core system: a new paradigm for understanding intrinsic foot muscle function. Br J Sports Med. 2015;49(5):290.
33. 33. Pabón-Carrasco M, Castro-Méndez A, Vilar-Palomo S, Jiménez-Cebrián, AM, García-Paya I, Palomo-Toucedo IC.Randomized clinical trial: The effect of exercise of the intrinsic muscle on foot pronation. Int J Environ Res Public Health, 2020;17(13):4882.
34. 34. Lynn SK, Padill RA, Tsang KK. 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(4):327-33.
35. 35. Newsham, KR. Strengthening the intrinsic foot muscles. Int J Athl Ther Train. 2010;15(1):32-35.
36. 36. Chung KA, Lee E, Lee S. The effect of intrinsic foot muscle training on medial longitudinal arch and ankle stability in patients with chronic ankle sprain accompanied by foot pronation. Phys Ther Rehabil Sci. 2016;5(2):78-83.
37. 37. Erten AB, Tarakci D, Cacan MA. The effectiveness of video-based game exercise therapy applications in pes planus rehabilitation: protocol for a randomized controlled trial. Jmir res protoc. 2023;12(1): E51772.
38. 38. Jung DY, Kim MH, Koh EK, Kwon OY, Cynn HS, Lee WH. A comparison in the muscle activity of the abductor hallucis and the medial longitudinal arch angle during toe curl and short foot exercises. Phys Ther Sport. 2011;12(1):30-5.
39. 39. 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 AJK. 2021;23(1):27-33.
40. 40. Kang MH, Cha SM, Oh JS. The effect of toe-tap exercise on abductor hallucis activity and medial longitudinal arch angle in individuals with pes planus.IES. 2020;28(4):415-422.
41. 41. 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(19):7189.
42. 42. Lee KS, Park DJ. Three-dimensional ankle exercise with combined isotonic technique for an obese subject with plantar fasciitis: a case study. Medicina (Kaunas). 2020;56(4):190.
43. 43. Alahmri F, Alsaadi S, Ahsan M, Almousa S. The effect of isokinetic hip muscle strength on normal medial longitudinal arch feet and pes planus. J Med Life. 2022;15(9):1164-1169.
44. 44. Choi JH, Cynn HS, Yi CH, Yoon TL, Baik SM. Effect of isometric hip abduction on foot and ankle muscle activity and medial longitudinal arch during short-foot exercise in individuals with pes planus. J Sport Rehabil, 2020;30(3):368-374.