Flexible FlatfootNCT04480177
Effect of Foot Muscles Training and Foot Orthosis on the Medial Arch in Flatfoot Subjects
A study testing foot insole and short foot exercise in people with Flexible Flatfoot, run by Imam Abdulrahman Bin Faisal University at 1 site in Saudi Arabia.
Trial summary
Orthotic therapy or exercise therapy is the standard conservative treatment for flexible flat foot. Little is known about the effectiveness of their interaction on managing flatfoot. Read more about this study
- Who is it for?
- Ages 18 to 36 yearsHealthy volunteers can take part
- Conditions the study is for
- Flexible Flatfoot
- What is being tested?
- foot insole and short foot exercise
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 30 participants
- Where
- 1 siteSaudi Arabia
- Study dates
- 27 Oct 2018to 1 Mar 2020
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 36 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- Females and males aged between 18 and 36
- Bilateral symptomatic flexible flatfoot, with symptoms including foot pain and lower limb fatigue
- Participants must show positive physical examination findings, including a positive result for the "too many toes" sign, the navicular drop test, and the foot toe raising test (Carr et al., 2016). A positive result for the "too many toes" sign occurs when more toes can be seen on the lateral side of each foot due to external rotation and abduction of the feet, and the positive result for the toe rising test is the reconstruction of the medial longitudinal arch secondary to the tightness of the plantar fascia (Carr et al., 2016). A positive result for the navicular drop test is an arch height more than or equal to 10 mm(Aenumulapalli et al., 2017)
Who cannot join
- An anatomical discrepancy in leg length
- Pathologic or neurologic disorders of the feet
- A history of traumatic foot injury or surgery within the last six months
- History of wearing foot orthoses within the past two years
Trial locations and contacts
1 site in 1 country.
Saudi Arabia1 site
Imam Abdulrahman Bin Faisal University
Dammam, Eastren
About this study
Official title: Effect of Intrinsic Foot Muscles Training and Foot Orthosis on the Medial Longitudinal Arch in Flexible Flatfoot Subjects
Orthotic therapy or exercise therapy is the standard conservative treatment for flexible flat foot. Little is known about the effectiveness of their interaction on managing flatfoot.
The study aims to evaluate the effect of insoles and short foot exercise on the height and area of the medial longitudinal arch of flexible flatfoot participants as well as the force and pressure.
Read the detailed description
Study design: A parallel, active-control study design was used to conduct a single-blinded randomized controlled trial.
Method: The toe rising test, the "too many toes" sign, and the navicular drop test was used to select 30 participants with flexible flatfoot. Participants was randomly assigned either to an experimental group (n = 15) or a control group (n = 15). The experimental group received short foot exercises (SFE) and insoles, and the control group received only insoles. SFE was implemented 30 times for a duration of three minutes each day over the course of six weeks. The exercise progressed from sitting to standing and finally to one leg stance position within every two weeks. The participants wore shoes containing orthotic insoles for eight hours per day for six weeks. The EMED-x system was used to measure plantar pressure distribution (force, area, and pressure) at baseline and at two-week intervals throughout the six-week intervention. The Lower Extremity Functional Scale (LEFS) was used to evaluate restriction in participants' functional abilities, and the navicular drop test (NDT) was used to assess the medial longitudinal arch (MLA) height. Both variables were measured at baseline and at the sixth week.
Statistics: Mixed-effects ANOVA was used to test for significant interactions between the two groups across time and within-subject observations of the outcomes.
- Conditions
- Flexible Flatfoot
- Being tested
- foot insole, short foot exercise
- Keywords
- Flatfoot, Insole, Short-foot exercise, Orthotic
- Medical subject headings
- Flatfoot
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
foot insoleDevice
the subject was instructed to wear foot insole for 8 hours.
short foot exerciseOther
the subject was instructed to perform exercise once a day 30 repetitions.
| Study group | Role | What they receive |
|---|---|---|
| insole group | Other | the control group receives insole only. Receives: Device: foot insole |
| exercise group | Experimental | the experimental group receives exercise and insole. Receives: Device: foot insole; Other: short foot exercise |
What is being measured
The primary outcome is the main question the study is designed to answer.
The EMED (force-area-pressure)
The feet plantar pressure was measured at baseline and at two-week intervals throughout the six-week intervention.
Measured: 6 weeks
Secondary outcomes (1)
Lower extremities functional scale, navicular drop test
The Lower extremities functional scale was used to evaluate restriction in participants' functional abilities, The score ranges from 0 to 80, and if it is higher indicating less functional restrictions. The navicular drop test was used to assess the medial longitudinal arch (MLA) height, A positive result for the navicular drop test is an arch height more than or equal to 10 mm. Both variables were measured at baseline and at the sixth week.
Measured: 6 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted21 Jul 2020
- Study start27 Oct 2018
- Primary completion1 Mar 2020
- Study completion1 Mar 2020
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Flexible FlatfootStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Investigator
- Enrolment
- 30 participants (actual)
Sponsor and investigators
- Lead sponsor
- Imam Abdulrahman Bin Faisal University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Shaikha Uthman, Imam Abdulrahman Bin Faisal University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04480177
- Sponsor's protocol ID
- PGS-2018-03-184
- Status last verified
- Jul 2020
- First submitted
- 2 Jul 2020
- Last updated
- 21 Jul 2020
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Abdel-Fattah, M.M., Hassanin, M.M., Felembane, F.A., Nassaane, M.T., 2006. Flat foot among Saudi Arabian army recruits: prevalence and risk factors. East. Mediterr. Health J. Rev. Sante Mediterr. Orient. Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit 12, 211-217. Abousayed, M.M., Tartaglione, J.P., Rosenbaum, A.J., Dipreta, J.A., 2016. Classifications in Brief: Johnson and Strom Classification of Adult-acquired Flatfoot Deformity. Clin. Orthop. 474, 588-593. Aenumulapalli, A., Kulkarni, M.M., Gandotra, A.R., 2017. Prevalence of Flexible Flat Foot in Adults: A Cross-sectional Study. J. Clin. Diagn. Res. JCDR 11, AC17-AC20. Allen, M.K., Glasoe, W.M., 2000. Metrecom Measurement of Navicular Drop in Subjects with Anterior Cruciate Ligament Injury. J. Athl. Train. 35, 403-406. Alnahdi, A.H., Alrashid, G.I., Alkhaldi, H.A., Aldali, A.Z., 2016. Cross-cultural adaptation, validity and reliability of the Arabic version of the Lower Extremity Functional Scale. Disabil. Rehabil. 38, 897-904. Aminian, G., Safaeepour, Z., Farhoodi, M., Pezeshk, A.F., Saeedi, H., Majddoleslam, B., 2013. The effect of prefabricated and proprioceptive foot orthoses on plantar pressure distribution in patients with flexible flatfoot during walking. Prosthet. Orthot. Int. 37, 227-232. Banwell, H.A., Mackintosh, S., Thewlis, D., 2014. Foot orthoses for adults with flexible pes planus: a systematic review. J. Foot Ankle Res. 7, 23. Buldt, A.K., Forghany, S., Landorf, K.B., Levinger, P., Murley, G.S., Menz, H.B., 2018. Foot posture is associated with plantar pressure during gait: A comparison of normal, planus and cavus feet. Gait Posture 62, 235-240. https://doi.org/10.1016/j.gaitpost.2018.03.005 Carr, J.B., Yang, S., Lather, L.A., 2016. Pediatric Pes Planus: A State-of-the-Art Review. Pediatrics 137, e20151230. Chen, Y.-C., Lou, S.-Z., Huang, C.-Y., Su, F.-C., 2010. Effects of foot orthoses on gait patterns of flat feet patients. Clin. Biomech. Bristol Avon 25, 265-270. Cheng, Y., Yang, H., Ni, L., Song, D., Zhang, H., 2015. Stress fracture of the distal fibula in flatfoot patients: case report. Int. J. Clin. Exp. Med. 8, 6303-6307. Chuter, V., Spink, M., Searle, A., Ho, A., 2014. The effectiveness of shoe insoles for the prevention and treatment of low back pain: a systematic review and meta-analysis of randomised controlled trials. BMC Musculoskelet. Disord. 15, 140. https://doi.org/10.1186/1471-2474-15-140 Daniels, T.R., Lau, J.T., Hearn, T.C., 1998. The effects of foot position and load on tibial nerve tension. Foot Ankle Int. 19, 73-78. https://doi.org/10.1177/107110079801900204 Dars, S., Uden, H., Kumar, S., Banwell, H.A., 2018. When, why and how foot orthoses (FOs) should be prescribed for children with flexible pes planus: a Delphi survey of podiatrists. PeerJ 6, e4667. https://doi.org/10.7717/peerj.4667 Giacomozzi, C., 2010. Appropriateness of plantar pressure measurement devices: A comparative technical assessment. Gait Posture 32, 141-144. https://doi.org/10.1016/j.gaitpost.2010.03.014 Hafer, J.F., Lenhoff, M.W., Song, J., Jordan, J.M., Hannan, M.T., Hillstrom, H.J., 2013. Reliability of plantar pressure platforms. Gait Posture 38, 544-548. https://doi.org/10.1016/j.gaitpost.2013.01.028 Hatfield, G.L., Cochrane, C.K., Takacs, J., Krowchuk, N.M., Chang, R., Hinman, R.S., Hunt, M.A., 2016. Knee and ankle biomechanics with lateral wedges with and without a custom arch support in those with medial knee osteoarthritis and flat feet. J. Orthop. Res. Off. Publ. Orthop. Res. Soc. 34, 1597-1605. https://doi.org/10.1002/jor.23174 Hegedus, E.J., Cook, C., Fiander, C., Wright, A., 2010. Measures of arch height and their relationship to pain and dysfunction in people with lower limb impairments. Physiother. Res. Int. 15, 160-166. https://doi.org/10.1002/pri.459 Hsieh, R.-L., Peng, H.-L., Lee, W.-C., 2018. Short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children: A randomized controlled trial. Medicine (Baltimore) 97, e10655. https://doi.org/10.1097/MD.0000000000010655 Huang, Y.-C., Wang, L.-Y., Wang, H.-C., Chang, K.-L., Leong, C.-P., 2004. The relationship between the flexible flatfoot and plantar fasciitis: ultrasonographic evaluation. Chang Gung Med. J. 27, 443-448. Imhauser, C.W., Abidi, N.A., Frankel, D.Z., Gavin, K., Siegler, S., 2002. Biomechanical evaluation of the efficacy of external stabilizers in the conservative treatment of acquired flatfoot deformity. Foot Ankle Int. 23, 727-737.
Study at a glance
From the registry record, last updated by the sponsor on 21 Jul 2020. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Intrinsic Foot Muscles Training and Foot Orthosis on the Medial Longitudinal Arch in Flexible Flatfoot Subjects
- ClinicalTrials.gov ID
- NCT04480177
- Acronym / sponsor ID
- PGS-2018-03-184
- Conditions
- Flexible Flatfoot
- Keywords
- Flatfoot, Insole, Short-foot exercise, Orthotic
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 30 participants (actual)
- Lead sponsor
- Imam Abdulrahman Bin Faisal UniversityUniversity, hospital or other
- Study start
- 27 Oct 2018 (actual)
- Primary completion
- 1 Mar 2020 (actual)
- Study completion
- 1 Mar 2020 (actual)
- First posted
- 21 Jul 2020 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Orthotic therapy or exercise therapy is the standard conservative treatment for flexible flat foot. Little is known about the effectiveness of their interaction on managing flatfoot.
The study aims to evaluate the effect of insoles and short foot exercise on the height and area of the medial longitudinal arch of flexible flatfoot participants as well as the force and pressure.
Detailed description
Study design: A parallel, active-control study design was used to conduct a single-blinded randomized controlled trial.
Method: The toe rising test, the "too many toes" sign, and the navicular drop test was used to select 30 participants with flexible flatfoot. Participants was randomly assigned either to an experimental group (n = 15) or a control group (n = 15). The experimental group received short foot exercises (SFE) and insoles, and the control group received only insoles. SFE was implemented 30 times for a duration of three minutes each day over the course of six weeks. The exercise progressed from sitting to standing and finally to one leg stance position within every two weeks. The participants wore shoes containing orthotic insoles for eight hours per day for six weeks. The EMED-x system was used to measure plantar pressure distribution (force, area, and pressure) at baseline and at two-week intervals throughout the six-week intervention. The Lower Extremity Functional Scale (LEFS) was used to evaluate restriction in participants' functional abilities, and the navicular drop test (NDT) was used to assess the medial longitudinal arch (MLA) height. Both variables were measured at baseline and at the sixth week.
Statistics: Mixed-effects ANOVA was used to test for significant interactions between the two groups across time and within-subject observations of the outcomes.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| insole group | Other | Device: foot insolethe control group receives insole only. |
| exercise group | Experimental | Device: foot insole, Other: short foot exercisethe experimental group receives exercise and insole. |
Who may qualify
- Ages
- 18 to 36 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (3 listed)
- Females and males aged between 18 and 36
- Bilateral symptomatic flexible flatfoot, with symptoms including foot pain and lower limb fatigue
- Participants must show positive physical examination findings, including a positive result for the "too many toes" sign, the navicular drop test, and the foot toe raising test (Carr et al., 2016). A positive result for the "too many toes" sign occurs when more toes can be seen on the lateral side of each foot due to external rotation and abduction of the feet, and the positive result for the toe rising test is the reconstruction of the medial longitudinal arch secondary to the tightness of the plantar fascia (Carr et al., 2016). A positive result for the navicular drop test is an arch height more than or equal to 10 mm(Aenumulapalli et al., 2017)
Key exclusion criteria (4 listed)
- An anatomical discrepancy in leg length
- Pathologic or neurologic disorders of the feet
- A history of traumatic foot injury or surgery within the last six months
- History of wearing foot orthoses within the past two years
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| foot insolethe subject was instructed to wear foot insole for 8 hours. | Device | exercise group, insole group |
| short foot exercisethe subject was instructed to perform exercise once a day 30 repetitions. | Other | exercise group |
Primary outcome
The EMED (force-area-pressure)
Time frame: 6 weeks
The feet plantar pressure was measured at baseline and at two-week intervals throughout the six-week intervention.
1 secondary outcome
Lower extremities functional scale, navicular drop test
Time frame: 6 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 21 Jul 2020.
- BackgroundAbdel-Fattah, M.M., Hassanin, M.M., Felembane, F.A., Nassaane, M.T., 2006. Flat foot among Saudi Arabian army recruits: prevalence and risk factors. East. Mediterr. Health J. Rev. Sante Mediterr. Orient. Al-Majallah Al-Sihhiyah Li-Sharq Al-Mutawassit 12, 211-217. Abousayed, M.M., Tartaglione, J.P., Rosenbaum, A.J., Dipreta, J.A., 2016. Classifications in Brief: Johnson and Strom Classification of Adult-acquired Flatfoot Deformity. Clin. Orthop. 474, 588-593. Aenumulapalli, A., Kulkarni, M.M., Gandotra, A.R., 2017. Prevalence of Flexible Flat Foot in Adults: A Cross-sectional Study. J. Clin. Diagn. Res. JCDR 11, AC17-AC20. Allen, M.K., Glasoe, W.M., 2000. Metrecom Measurement of Navicular Drop in Subjects with Anterior Cruciate Ligament Injury. J. Athl. Train. 35, 403-406. Alnahdi, A.H., Alrashid, G.I., Alkhaldi, H.A., Aldali, A.Z., 2016. Cross-cultural adaptation, validity and reliability of the Arabic version of the Lower Extremity Functional Scale. Disabil. Rehabil. 38, 897-904. Aminian, G., Safaeepour, Z., Farhoodi, M., Pezeshk, A.F., Saeedi, H., Majddoleslam, B., 2013. The effect of prefabricated and proprioceptive foot orthoses on plantar pressure distribution in patients with flexible flatfoot during walking. Prosthet. Orthot. Int. 37, 227-232. Banwell, H.A., Mackintosh, S., Thewlis, D., 2014. Foot orthoses for adults with flexible pes planus: a systematic review. J. Foot Ankle Res. 7, 23. Buldt, A.K., Forghany, S., Landorf, K.B., Levinger, P., Murley, G.S., Menz, H.B., 2018. Foot posture is associated with plantar pressure during gait: A comparison of normal, planus and cavus feet. Gait Posture 62, 235-240. https://doi.org/10.1016/j.gaitpost.2018.03.005 Carr, J.B., Yang, S., Lather, L.A., 2016. Pediatric Pes Planus: A State-of-the-Art Review. Pediatrics 137, e20151230. Chen, Y.-C., Lou, S.-Z., Huang, C.-Y., Su, F.-C., 2010. Effects of foot orthoses on gait patterns of flat feet patients. Clin. Biomech. Bristol Avon 25, 265-270. Cheng, Y., Yang, H., Ni, L., Song, D., Zhang, H., 2015. Stress fracture of the distal fibula in flatfoot patients: case report. Int. J. Clin. Exp. Med. 8, 6303-6307. Chuter, V., Spink, M., Searle, A., Ho, A., 2014. The effectiveness of shoe insoles for the prevention and treatment of low back pain: a systematic review and meta-analysis of randomised controlled trials. BMC Musculoskelet. Disord. 15, 140. https://doi.org/10.1186/1471-2474-15-140 Daniels, T.R., Lau, J.T., Hearn, T.C., 1998. The effects of foot position and load on tibial nerve tension. Foot Ankle Int. 19, 73-78. https://doi.org/10.1177/107110079801900204 Dars, S., Uden, H., Kumar, S., Banwell, H.A., 2018. When, why and how foot orthoses (FOs) should be prescribed for children with flexible pes planus: a Delphi survey of podiatrists. PeerJ 6, e4667. https://doi.org/10.7717/peerj.4667 Giacomozzi, C., 2010. Appropriateness of plantar pressure measurement devices: A comparative technical assessment. Gait Posture 32, 141-144. https://doi.org/10.1016/j.gaitpost.2010.03.014 Hafer, J.F., Lenhoff, M.W., Song, J., Jordan, J.M., Hannan, M.T., Hillstrom, H.J., 2013. Reliability of plantar pressure platforms. Gait Posture 38, 544-548. https://doi.org/10.1016/j.gaitpost.2013.01.028 Hatfield, G.L., Cochrane, C.K., Takacs, J., Krowchuk, N.M., Chang, R., Hinman, R.S., Hunt, M.A., 2016. Knee and ankle biomechanics with lateral wedges with and without a custom arch support in those with medial knee osteoarthritis and flat feet. J. Orthop. Res. Off. Publ. Orthop. Res. Soc. 34, 1597-1605. https://doi.org/10.1002/jor.23174 Hegedus, E.J., Cook, C., Fiander, C., Wright, A., 2010. Measures of arch height and their relationship to pain and dysfunction in people with lower limb impairments. Physiother. Res. Int. 15, 160-166. https://doi.org/10.1002/pri.459 Hsieh, R.-L., Peng, H.-L., Lee, W.-C., 2018. Short-term effects of customized arch support insoles on symptomatic flexible flatfoot in children: A randomized controlled trial. Medicine (Baltimore) 97, e10655. https://doi.org/10.1097/MD.0000000000010655 Huang, Y.-C., Wang, L.-Y., Wang, H.-C., Chang, K.-L., Leong, C.-P., 2004. The relationship between the flexible flatfoot and plantar fasciitis: ultrasonographic evaluation. Chang Gung Med. J. 27, 443-448. Imhauser, C.W., Abidi, N.A., Frankel, D.Z., Gavin, K., Siegler, S., 2002. Biomechanical evaluation of the efficacy of external stabilizers in the conservative treatment of acquired flatfoot deformity. Foot Ankle Int. 23, 727-737.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing foot insole and short foot exercise in people with Flexible Flatfoot, run by Imam Abdulrahman Bin Faisal University at 1 site in Saudi Arabia.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 21 Jul 2020. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Saudi Arabia. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The EMED (force-area-pressure) (time frame: 6 weeks). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT04480177, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Jul 2020.