Biofeedback-Assisted Short Foot Exercises in Flexible Flatfoot

Active ankle range of motion, including plantarflexion and dorsiflexion, will be measured according to the guidelines described by the American Academy of Orthopaedic Surgeons (AAOS) using a digital goniometer.

Active ankle range of motion, including plantarflexion and dorsiflexion, will be measured in accordance with the guidelines of the American Academy of Orthopaedic Surgeons (AAOS) using a digital goniometer.

The Foot Posture Index (FPI-6) is a clinical assessment tool used to evaluate static foot posture. It consists of six observational criteria: talar head palpation, curvature above and below the lateral malleolus, calcaneal position in the frontal plane, prominence of the talonavicular joint, height and congruence of the medial longitudinal arch, and forefoot abduction/adduction.

Each item is scored on a 5-point scale ranging from -2 (indicating supination) to +2 (indicating pronation), resulting in a total score ranging from -12 to +12.

Lower scores indicate a more supinated foot posture, whereas higher scores indicate a more pronated foot posture. A score close to zero represents a neutral foot alignment.

Interpretation of Scores

• 12 to -5: Highly supinated
• 4 to -1: Slightly supinated 0 to +5: Neutral
• 6 to +9: Pronated
• 10 to +12: Highly pronated

The Navicular Drop Test is a clinical assessment used to evaluate the degree of medial longitudinal arch collapse by measuring the difference between non-weight-bearing and weight-bearing positions of the foot.

During the test, the vertical height of the navicular tuberosity from the floor is measured in both a seated (non-weight-bearing) and a standing (weight-bearing) position using a ruler or digital caliper. The difference between these two measurements, expressed in millimeters (mm), represents the navicular drop value.

A greater navicular drop value indicates increased pronation and lowering of the medial longitudinal arch, whereas smaller values suggest a more neutral or supinated foot posture.

Outcome Metric

Difference in navicular height (mm) between seated and standing positions

Interpretation of Results

< 5 mm: Minimal or no arch drop (supinated tendency)

5-9 mm: Normal range

≥ 10 mm: Excessive pronation / flatfoot tendency

The Y-Balance Test is a dynamic balance assessment tool used to evaluate an individual's ability to maintain postural control while reaching in multiple directions. The participant stands on one leg at the center of a Y-shaped grid and reaches as far as possible with the contralateral leg in three directions: anterior, posteromedial, and posterolateral. The maximum reach distance for each direction is measured in centimeters (cm) and normalized to leg length to reduce inter-individual variability.

The test is performed on both lower extremities, and the mean of three successful trials in each direction is recorded. Greater reach distances indicate better dynamic balance performance, whereas shorter reach distances or asymmetry between limbs may indicate balance deficits.

Outcome Metrics:

Reach distance (cm) in the anterior, posteromedial, and posterolateral directions Composite Y-Balance Score (%) = [(Anterior + Posteromedial + Posterolateral) / (3 × Limb length)] × 100

The Foot Posture Index (FPI-6) is a clinical assessment tool used to evaluate static foot posture. It consists of six observational criteria: talar head palpation, curvature above and below the lateral malleolus, calcaneal position in the frontal plane, prominence of the talonavicular joint, height and congruence of the medial longitudinal arch, and forefoot abduction/adduction.

Each item is scored on a 5-point scale, ranging from -2 (indicating supination) to +2 (indicating pronation), resulting in a total score ranging from -12 to +12.

Lower scores indicate a more supinated foot posture, whereas higher scores indicate a more pronated foot posture. A score close to zero represents a neutral foot alignment.

Interpretation of Scores

• 12 to -5: Highly supinated
• 4 to -1: Slightly supinated 0 to +5: Neutral
• 6 to +9: Pronated
• 10 to +12: Highly pronated

The Y-Balance Test is a dynamic balance assessment tool used to evaluate an individual's ability to maintain postural control while reaching in multiple directions. The participant stands on one leg at the center of a Y-shaped grid and reaches as far as possible with the contralateral leg in three directions: anterior, posteromedial, and posterolateral. The maximum reach distance for each direction is measured in centimeters (cm) and normalized to leg length to reduce inter-individual variability.

The test is performed on both lower extremities, and the mean of three successful trials in each direction is recorded. Greater reach distances indicate better dynamic balance performance, whereas shorter reach distances or asymmetry between limbs may indicate balance deficits.

Outcome Metrics

Reach distance (cm) in the anterior, posteromedial, and posterolateral directions Composite Y-Balance Score (%) = [(Anterior + Posteromedial + Posterolateral) / (3 × Limb length)] × 100

The Navicular Drop Test is a clinical measurement used to assess the degree of medial longitudinal arch collapse by comparing the foot in non-weight-bearing and weight-bearing positions.

During the test, the vertical height of the navicular tuberosity from the floor is measured in both a seated (non-weight-bearing) and a standing (weight-bearing) position using a ruler or digital caliper. The difference between these two measurements, expressed in millimeters (mm), represents the navicular drop value.

A greater navicular drop value indicates increased pronation and lowering of the medial longitudinal arch, whereas smaller values suggest a more neutral or supinated foot posture.

Outcome Metric

Difference in navicular height (mm) between seated and standing positions

Interpretation of Results

< 5 mm: Minimal or no arch drop (supinated tendency)

5-9 mm: Normal range

≥ 10 mm: Excessive pronation / flatfoot tendency