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Flat foot pain is a common complaint that requires therapeutic intervention. Currently, myofascial release techniques are often used in the therapy of musculoskeletal disorders. A group of 60 people suffering from flat feet with associated pain. Patients were assigned to four groups (15 people each): MF—myofascial release, E—the exercise program, MFE—myofascial release and the exercise program, C—no intervention. The rehabilitation program lasted 4 weeks. The NRS scale was used to examine pain intensity and FreeMed ground reaction force platform was used to examine selected static and dynamic foot indicators. Statistically significant pain reduction was obtained in all research. A static test of foot load distribution produced statistically significant changes only for selected indicators. In the dynamic test, statistically significant changes were observed for selected indicators, only in the groups subjected to therapeutic intervention. Most such changes were observed in the MF group. In the dynamic test which assessed the support phase of the foot, statistically significant changes were observed only for selected subphases. Most such changes were observed in the MFE group. Both exercise and exercise combined with myofascial release techniques, and especially myofascial release techniques alone, significantly reduce pain in a flat foot. This study shows a limited influence of both exercises and myofascial release techniques on selected static and dynamic indicators of a flat foot.

Background Achilles tendinopathy is one of the most common overuse injuries in running, and forefoot pronation, seen in flatfeet participants, has been proposed to cause additional loading across the Achilles tendon. Foot orthoses are one of the common and effective conservative treatment prescribed for Achilles tendinopathy, it works by correcting the biomechanical malalignment and reducing tendon load. Previous studies have shown reduction of Achilles Tendon load (ATL) during running by using customized arch support orthosis (CASO) or an orthotic heel lift (HL). However, there are still little biomechanical evidence and comparative studies to guide orthotic prescriptions for Achilles tendinopathy management. Therefore, this study seeks to investigate the two currently employed orthotic treatment options for Achilles tendinopathy: CASO and HL for the reduction of ATL and Achilles tendon loading rate (ATLR) in recreational runners with flatfeet. Methods Twelve participants were recruited and run along the runway in the laboratory for three conditions: (1) without orthoses, (2) with CASO (3) with HL. Kinematic and kinetic data were recorded by 3D motion capturing system and force platform. Ankle joint moments and ATL were computed and compared within the three conditions. Results Participants who ran with CASO ( p  = 0.001, d = 0.43) or HL (p = 0.001, d = 0.48) associated with a significant reduction in ATL when compared to without orthotics while there was no significant difference between the two types of orthoses, the mean peak ATL of CASO was slightly lower than HL. Regarding the ATLR, both orthoses, CASO ( p  = 0.003, d = 0.93) and HL ( p  = 0.004, d = 0.78), exhibited significant lower value than the control but similarly, no significant difference was noted between them in which the use of CASO yielded a slightly lower loading rate than that of HL. Conclusions Both CASO and HL were able to cause a significant reduction in peak ATL and ATLR comparing to without orthotics condition. There were subtle but no statistically significant differences in the biomechanical effects between the two types of orthoses. The findings help to quantify the effect of CASO and HL on load reduction of Achilles tendon and suggests that foot orthoses may serve to prevent the incidence of Achilles tendon pathologies. Trial registration NCT04003870 on clinicaltrials.gov 1 July 2019.

In adults, flexible symptomatic flat foot is treated conservatively with supportive foot orthoses. Sensorimotor foot orthoses, however, are controversial due to insufficient data. Comparison of the effectiveness of sensorimotor and supportive foot orthoses in adults. In 73 patients, in addition to foot gymnastics, supportive, sensorimotor or placebo insoles were compared over 3 measurement points during 1 year as part of a double-blind, prospective, randomised placebo-controlled clinical trial using Numeric Rating-Scala, the Foot and Ankle Disability Index, as well as pedobarography and valgus index. The statistical analysis was performed using ANOVA with repeated measures. The valgus index increased significantly with supportive foot orthoses. In the follow-up, the foot contact area was only significantly reduced with sensorimotor foot orthoses in static and dynamic measurements. Supportive foot orthoses led to a faster reduction in pain, but without reducing the contact area of the foot. There were no relevant differences in functionality. The reduction of the contact surface in combination with sensorimotor foot orthoses shows the potential for muscular addressing of the flexible flat foot. There were no disadvantages compared to other treatments. Supportive foot orthoses led to a faster reduction in subjective complaints, but appear to weaken the muscles supporting the arch of the foot. In the longer term, consistent foot muscle training also appears to be effective, as wearing placebo foot orthoses also led to an improvement in subjective well-being without significant biomechanical changes.

Background The prevalence of diabetes mellitus has reached epidemic proportions, this condition may result in multiple and chronic invalidating long term complications. Among these, the diabetic foot, is determined by the simultaneous presence of both peripheral neuropathy and vasculopathy that alter the biomechanics of the foot with the formation of callosity and ulcerations. To diagnose and treat the diabetic foot is crucial to understand the foot complex kinematics. Most of gait analysis protocols represent the entire foot as a rigid body connected to the shank. Nevertheless the existing multisegment models cannot completely decipher the impairments associated with the diabetic foot. Methods A four segment foot and ankle model for assessing the kinematics of the diabetic foot was developed. Ten normal subjects and 10 diabetics gait patterns were collected and major sources of variability were tested. Repeatability analysis was performed both on a normal and on a diabetic subject. Direct skin marker placement was chosen in correspondence of 13 anatomical landmarks and an optoelectronic system was used to collect the data. Results Joint rotation normative bands (mean plus/minus one standard deviation) were generated using the data of the control group. Three representative strides per subject were selected. The repeatability analysis on normal and pathological subjects results have been compared with literature and found comparable. Normal and pathological gait have been compared and showed major statistically significant differences in the forefoot and midfoot dorsi-plantarflexion. Conclusion Even though various biomechanical models have been developed so far to study the properties and behaviour of the foot, the present study focuses on developing a methodology for the functional assessment of the foot-ankle complex and for the definition of a functional model of the diabetic neuropathic foot. It is, of course, important to evaluate the major sources of variation (true variation in the subject's gait and artefacts from the measurement procedure). The repeatability of the protocol was therefore examined, and results showed the suitability of this method both on normal and pathological subjects. Comparison between normal and pathological kinematics analysis confirmed the validity of a similar approach in order to assess neuropathics biomechanics impairment.

Purpose. To compare outcomes of different conservative treatments for flatfoot using the foot print index and valgus index. Methods. 150 symptomatic flatfoot patients and 50 controls (without any flatfoot or lower limb deformity) aged older than 8 years were evaluated. The diagnosis was based on pain during walking a distance, the great toe extension test, the valgus index, the foot print index (FPI), as well as eversion/inversion and dorsiflexion at the ankle. The patients were unequally randomised into 4 treatment groups: (1) foot exercises (n=60), (2) use of the Thomas crooked and elongated heel with or without arch support (n=45), (3) use of the Rose Schwartz insoles (n=18), and (4) foot exercises combined with both footwear modifications (n=27). Results. Of the 150 symptomatic flatfoot patients, 96 had severe flatfoot (FPI, >75) and 54 had incipient flatfoot (FPI, 45–74). The great toe extension test was positive in all 50 controls and 144 patients, and negative in 6 patients (p=0.1734, one-tailed test), which yielded a sensitivity of 96% and a positive predictive value of 74%. Symptoms correlated with the FPI (Chi squared=9.7, p=0.0213). Combining foot exercises and foot wear modifications achieved best outcome in terms of pain relief, gait improvement, and decrease in the FPI and valgus index. Conclusion. The great toe extension test was the best screening tool. The FPI was a good tool for diagnosing and grading of flatfoot and evaluating treatment progress. Combining foot exercises and foot wear modifications achieved the best outcome.

Flexible flat feet are one of the most common musculoskeletal concerns presenting to paediatric health services, despite this being an expected finding in children under 10 years and only requiring management when symptoms are associated. Understanding which symptoms are associated with symptomatic presentations of flexible flat foot in children will provide clarity in identifying those that require further assessment and/or intervention. A scoping review of the literature was conducted to gather all known symptoms related to symptomatic flexible flat foot in the child. Data was mapped using the ‘F-words’ framework, a child friendly, six-item tool based on the International Classification of Functioning, Disability and Health Framework 11 (ICF-11). This review identified 42 individual symptoms relative to symptomatic presentations of flexible flat foot, which were allocated into five of the six ‘F-words’ categories ( fitness, functioning, friends, family and future) . Of these, pain was the most reported symptom, identified in 124 (of 133) included citations, followed by symptoms associated with reduced lower limb function (altered gait patterns, reduced balance and stability and increased tripping), fatigue and reduced participation. Other less frequently reported symptoms include callus formation, night pain and cramps. When present, these symptoms may occur independently or may co-exist at the same time. No symptoms were allocated to the fun category of the ‘F-words’. A multitude of symptoms are reportedly associated with symptomatic flexible flatfoot in the child, with no discernible pattern or coherence noted. Further research should examine development and progression of symptoms and seek to better understand causality of relationship between symptoms and foot posture.

Background Flexible flatfoot is a prevalent musculoskeletal condition in pediatric populations, often regarded as a benign and self-limiting developmental variation. However, persistent cases may contribute to discomfort, functional limitations, and reduced physical activity levels. Despite its frequency, few studies have comprehensively evaluated its functional impact using standardized clinical and functional assessment tools in school-aged children. Objectives This study aimed to (1) determine the prevalence of flexible flatfoot among children aged 6–12 years using standardized clinical criteria and the Foot Posture Index-6 (FPI-6); and (2) evaluate its functional implications by analyzing associations with pain intensity, physical activity levels, and body mass index (BMI). Methods A cross-sectional clinical study was conducted among 326 school-aged children. Flexible flatfoot was diagnosed based on clinical examination and an FPI-6 score > + 6. Pain was measured using the Visual Analogue Scale (VAS), physical activity using the Physical Activity Questionnaire for Children (PAQ-C), and BMI using standard anthropometric techniques. Results Flexible flatfoot was identified in 98 children (30.06%; 95% CI: 25.08–35.04), with a predominance of bilateral cases and higher prevalence among males. Affected children showed significantly higher VAS pain scores (4.12 ± 1.03 vs. 2.91 ± 0.89; p  < 0.001), lower PAQ-C physical activity scores (2.53 ± 0.54 vs. 3.05 ± 0.61; p  < 0.001), and elevated FPI-6 and BMI values compared to their non-flatfooted peers. Multiple regression analyses identified FPI-6 scores and BMI as independent predictors of both pain and reduced physical activity, accounting for 31% and 26% of the variance, respectively. Conclusion Flexible flatfoot in school-aged children is significantly associated with increased pain perception, decreased physical activity, and elevated BMI. These findings underscore the importance of early detection and functional assessment, particularly in children with modifiable risk factors such as obesity and sedentary behavior, to support timely and targeted musculoskeletal interventions.

Background Flexible flat foot is a normal observation in typically developing children, however, some children with flat feet present with pain and impaired lower limb function. The challenge for health professionals is to identify when foot posture is outside of expected findings and may warrant intervention. Diagnoses of flexible flat foot is often based on radiographic or clinical measures, yet the validity and reliability of these measures for a paediatric population is not clearly understood. The aim of this systematic review was to investigate how paediatric foot posture is defined and measured within the literature, and if the psychometric properties of these measures support any given diagnoses. Methods Electronic databases (MEDLINE, CINAHL, EMBASE, Cochrane, AMED, SportDiscus, PsycINFO, and Web of Science) were systematically searched in January 2017 for empirical studies where participants had diagnosed flexible flat foot and were aged 18 years or younger. Outcomes of interest were the foot posture measures and definitions used. Further articles were sought where cited in relation to the psychometric properties of the measures used. Results Of the 1101 unique records identified by the searches, 27 studies met the inclusion criteria involving 20 foot posture measures and 40 definitions of paediatric flexible flat foot. A further 18 citations were sought in relation to the psychometric properties of these measures. Three measures were deemed valid and reliable, the FPI-6 > + 6 for children aged three to 15 years, a Staheli arch index of > 1.07 for children aged three to six and ≥ 1.28 for children six to nine, and a Chippaux-Smirak index of > 62.7% in three to seven year olds, > 59% in six to nine year olds and ≥ 40% for children aged nine to 16 years. No further measures were found to be valid for the paediatric population. Conclusion No universally accepted criteria for diagnosing paediatric flat foot was found within existing literature, and psychometric data for foot posture measures and definitions used was limited. The outcomes of this review indicate that the FPI – 6, Staheli arch index or Chippaux-Smirak index should be the preferred method of paediatric foot posture measurement in future research.

Objective To estimate the prevalence of flatfoot and to analyze the gender difference of plantar pressure in third-year high school students in Tongzhou District Beijing. Methods From March 2019 to March 2021, 1217 third-year high school students in Tongzhou District, Beijing were tested for plantar pressure. The prevalence of flatfoot was calculated and related plantar pressure parameters were analyzed, including contact area and plantar pressure. The differences of plantar pressure parameters between different genders were analyzed. Results The prevalence of flatfoot among third-year high school students in Tongzhou District, Beijing was 5.5% (95% CI: 4.3–6.7%), among which, the prevalence of flatfoot among boys was 5.3% (95% CI: 3.8–6.8%) and that among girls was 5.9% (95% CI: 3.9–7.9%). There was no significant difference in the prevalence of flatfoot among different genders ( P  = 0.326), and the left and right foot types were basically the same. The mean BMI of the study population was 22.6 ± 3.4 kg/m², with males having a slightly higher mean BMI (23.1 ± 3.6 kg/m²) compared to females (21.9 ± 3.0 kg/m²). In static phase, there were statistically significant differences in contact area, plantar pressure at great toe, plantar pressure at 2nd − 5th toe, plantar pressure at 2nd − 4th metatarsal, and plantar pressure at middle foot( P  < 0.05) between male students and female students. In dynamic phase, there were significant differences in contact area, plantar pressure at great toe, plantar pressure at 2nd − 5th toe and plantar pressure at 5th metatarsal ( P  < 0.05). Conclusion The findings of this study suggest that while flatfoot prevalence is similar between genders in third-year high school students, significant gender-specific differences exist in plantar pressure distribution patterns. These differences persist in both static and dynamic phases, with potential implications for gender-specific foot health assessment and preventive interventions. Understanding these patterns may help in early detection of foot abnormalities and implementation of appropriate interventions to prevent long-term biomechanical issues in this age group.