Exercises vs shoe modifications for paediatric flat foot

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Comparing the efficacy of exercise, internal and external shoe modification in pes planus: A clinical and pedobarographic study.
Taspinar O et al
J Back Musculoskelet Rehabil. 2016 Nov 11.

 

Within groups analysis rather than a between groups analysis. Fail. Next.

 

Comparing the Effects of Simultaneous Eight-Week Stretching /
Strengthening Trainings with Core Stability Exercises on the Flat Foot
Deformity of 9- to13- Year -Old Female Students
Rahele Khamooshi et al
International Journal of Musculoskeletal Pain prevention
Volume 1, Number.4, Autumn 2016

 

exact some number in each group follow randomization ... that really hard to do --> red flag.
data in table and sloppy stats analysis do not support the conclusion.
next.

 

EVALUATION OF EFFECTS OF CORRECTIVE EXERCISES
ON PES PLANOVALGUS IN PRESCHOOL CHILDREN
Miroslava Šutvajová et al
CBU INTERNATIONAL CONFERENCE ON INNOVATIONS IN SCIENCE AND EDUCATION 2020 (MEDICINE AND PHARMACY)
MARCH 18-20, 2020, PRAGUE, CZECH REPUBLIC

 

Clinical and radiological outcomes of corrective exercises and neuromuscular electrical stimulation in children with flexible flatfeet: A randomized controlled trial⋆
M.Abd-Elmonem et al
Gait & Posture; 12 June 2021

 

Effects of Plyometric Exercises versus Flatfoot Corrective Exercises on Postural Control and Foot Posture in Obese Children with a Flexible Flatfoot
Hatem H. Allam et al
Volume 2021 |Article ID 3635660 | https://doi.org/10.1155/2021/3635660

 

Efficacy of Tibialis Posterior Strengthening Exercise with Obesity Reduction Program in Flexible Flatfoot among Obese School Children.
Karthika, N.; Kumar, R. Mukesh; Kumar, R. V. Vijaya; Vasanthan
Indian Journal of Physiotherapy & Occupational Therapy . Apr-Jun2022, Vol. 16 Issue 2, p120-127. 7p.

 

Comparison of 2 Conservative Treatment Approaches for the Flat Foot in Children Aged 5 to 10: Foot Orthoses Versus Foot Orthoses Supplemented With Zukunft-Huber Manual Therapy
Anna Boryczka-Trefler et al
Clin Pediatr (Phila). 2023 May 11

 

EFFECTS OF INSOLES WITH AND WITHOUT SHORT FOOT EXERCISES ON PAIN, DISABILITY AND FOOT POSTURE IN CHILDREN WITH PES PLANUS
Dr Eram Aslam et al
Source

 

Differential Effects of Intrinsic- Versus Extrinsic-First
Corrective Exercise Programs on Morphometric Outcomes
and Navicular Drop in Pediatric Pes Planus
Jafar Ketabchi et al
Research Square

 

Now this is an interesting result. Intrinsic foot muscle exercises, like the short foot exercise, are more effective at reducing navicular drop than exercises aimed at the extrinsic foot muscles, like the tibialis posterior ( foot supination against a resistance band ).

". Intrinsic foot exercises The intrinsic foot exercise program commenced with non-weight-bearing (unloaded) exercises, such as sitting, and advanced to weight-bearing (loaded) scenarios such as standing and single-leg stances once muscle activation proficiency was achieved [3]. Activities included short foot exercises, toe spreading, first toe extensions, and extensions of the second to fifth toes (Fig. 2). Gooding et al. [17] noted that these exercises led to heightened intrinsic muscle activation. Similarly, Jung et al. [19] found that short foot exercises elicited greater electromyographic activity in the ABH compared to conventional toe curls. 2.4.2.

Extrinsic foot exercise The extrinsic foot exercise program was structured to activate and strengthen the extrinsic foot muscles, with a particular emphasis on the posterior tibialis muscle due to its critical function in supporting the MLA [20]. It comprised exercises such as foot adduction, heel raises, and foot supination, which were performed both with an elastic band and against gravity, as illustrated in Fig. 3. Research by Kulig and colleagues [21] has demonstrated that the first three exercises are particularly effective in selectively engaging the extrinsic muscles of the foot, most notably the tibialis posterior. Initially, exercises were performed with minimal resistance, gradually incorporating heavier loads facilitated by an elastic band. 2.5. Stati"

 

3. Merely extrinsic muscle-focused corrective exercises can lead to the deterioration of intrinsic foot muscle

Fascinating conclusion .
It would appear that if you concentrate on strengthening the extrinsic foot muscles during rehab for flexible flat feet( mostly the tibialis posterior via inversion against elasticated bands ), you will cause deterioration of the intrinsic foot muscles . IMO likely you will then alter gait in relation to toe off.

If you are going to do just one exercise it would probably be short foot whilst pressing the toes down ( research shows better activation of intrinsics than toes relaxed )


"In conclusion, the study impeccably postulates an intrinsic-first rehabilitative strategy as a cornerstone in managing flexible flatfoot in children, with findings that could revolutionize current therapy protocols. The detailed investigation into the interrelationship between intrinsic and extrinsic muscle training offers a valuable lens through which future researches can refine and corroborate these results. It sets the stage for a new direction in therapeutic interventions—one that favors a bottom-up approach in musculoskeletal rehabilitation, aiming not only for symptomatic relief but also for the optimized structural and functional development of the foot.

4.1. Highlights
1. The intrinsic-first strategy proved to positively influence the thickness and CSA of intrinsic foot muscles, specifically the ABH and FDB, without adversely affecting extrinsic foot muscle morphometry.

2. Both the intrinsic- and extrinsic-first corrective exercise programs could reduce navicular drop, yet the intrinsic-first strategy proved to be more effective.

3. Merely extrinsic muscle-focused corrective exercises can lead to the deterioration of intrinsic foot muscle

 

Jafar Ketabchi et al seems to support the concept of a "foot core", a concept that is still unpopular amongst some ( education related bias? )

It's just one paper of course, but it does raise some interesting questions for those treating a range of foot and ankle problems.

For example, the paper implies that using extrinsic only exercises like inversion and eversion for chronic ankle instability, may be a mistake and intrinsic exercise must also be included . Which ones ? Well, not toe curls anyway since these target muscles like the abductor hallucis almost not at all.

The authors used the short foot exercise and it is now know this works best with an active toes pressed down action ( doming ) .
Doming is not hard to teach if you know how. 5 mins tops .