AutismNCT07438665
Toe Spread Out Exercise With and Without Walking Surface Training in Children With Autism
A study testing Toe spread out exercise and Toe spread out exercises with walking surface training in people with Autism, run by Riphah International University at 1 site in Pakistan.
Trial summary
Flatfoot is a common postural deformity in children, characterized by the collapse of the medial longitudinal arch, leading to abnormal foot posture, gait disturbances, and postural instability. Read more about this study
- Who is it for?
- Ages 7 to 12 years
- Conditions the study is for
- Autism
- What is being tested?
- Toe spread out exercise and Toe spread out exercises with walking surface training
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 34 participants
- Where
- 1 sitePakistan
- Study dates
- 4 Feb 2026to 30 Aug 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
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 7 to 12 years
- All sexes
- No healthy volunteers
- Child
Who may be able to join
- Children aged 7 to 12 years of age
- Children of both genders male and female
- children having navicular drop >9mm
Who cannot join
- Neurological conditions affecting movement (e.g., CP)
- Inability to follow simple verbal commands
- Visual or auditory impairment impacting motor performance
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Pakistan1 site
Special needs and autism community center
Lahore, Punjab Province
Fareeha Kausar, 03216758180, fareeha.kouser@gmail.com
Eman Amjad, MSPPT
About this study
Official title: Effects of Toe Spread Out Exercise With and Without Walking Surface Training on Navicular Drop and Jumping Performance in Children With Autism
Flatfoot is a common postural deformity in children, characterized by the collapse of the medial longitudinal arch, leading to abnormal foot posture, gait disturbances, and postural instability. Arch collapse in flatfoot is also due to navicular drop a condition where the navicular bone, located in the midfoot, shifts downward excessively when bearing weight.
This excessive drop reflects poor structural support in the foot and is often linked to weakness in the intrinsic foot muscles. The intrinsic and extrinsic muscles of the foot, particularly the abductor hallucis (AbdH), play a vital role in maintaining arch stability.
Strengthening exercises like toe spread out movements are specifically designed to target these muscles by abducting and flexing the toes, helping to support and elevate the medial arch. This study aims to investigate the combined effect of toe spread out exercises and walking surface training on navicular drop and jumping performance in children with ASD, focusing on muscle strength and sensory-motor integration to support functional movement and postural control. This randomized controlled trial will be conducted over ten months at Step Up Autism Center and Rehab Care, Lahore, following ethical approval from the Research Ethical Committee of Riphah International University Islamabad (Lahore Campus). Children aged 7 to 12 years, clinically diagnosed with autism spectrum disorder, navicular drop, and poor locomotor skills will be recruited through non-probability convenient sampling. After obtaining informed consent from guardians, eligible participants will be randomly allocated into two groups. Group A will perform toe spread out exercises only, while Group B will perform toe spread out exercises combined with walking surface training. Both interventions will be carried out three times a week for eight weeks. This will be a single-blinded study, where the assessor will remain unaware of the group allocations. Data collection will involve pre- and post intervention assessment using the Navicular Drop Test, Wet Footprint Test (Clarke's Angle), Horizontal Jump Test, and the Test of Gross Motor Development-Second Edition (TGMD-2) to evaluate changes in foot posture, arch structure, lower limb power, and locomotor skills in participating children.
- Conditions
- Autism
- Being tested
- Toe spread out exercise, Toe spread out exercises with walking surface training
- Medical subject headings
- Autistic Disorder
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Toe spread out exerciseOther
Partcipant will sit on the edge of chair with hips and knees at 90 degree flexion, with foot flat on the floor. This position makes sure that there is equal weight distibution across the calcaneus, metatarsals and phalanges. It is also made sure that the feet are hip width apart.Then the participant is asked to lift the toes off the ground(dorsiflexion) , keeping the heel and ball(metarsals) of foot on the ground. While maintaining dorsiflexion of toes, the participant will be asked to flex the first toe medially (bending downward and toward the midline), similarly the fifth toe will be flexed laterally (bending downward and away from the midline) .The position will be held for 3 to 5 seconds with 10 repetiotns.
Toe spread out exercises with walking surface trainingOther
Walking Surface • The participant will be barefoot and will be asked to walk in their usual manner and speed. • There will be three different surfaces i.e pile carpet (18mm thickness) for soft sensation, vinyl tile for flat smooth and loose gravel (average height of 14mm) for uneven sensation respectively. • The participant will be asked to walk on the 4 meter walking surface, taking 10 rounds on each
| Study group | Role | What they receive |
|---|---|---|
| Toe spread out exercise group | Active comparator | Not described Receives: Other: Toe spread out exercise |
| Toe spread out exercises with walking surface training group | Experimental | Not described Receives: Other: Toe spread out exercise; Other: Toe spread out exercises with walking surface training |
What is being measured
The primary outcome is the main question the study is designed to answer.
Navicular Drop by Navicular Drop Test
The Navicular Drop (ND) Test evaluates medial longitudinal arch stability by measuring the difference in navicular height between neutral/seated and weight-bearing positions. A drop of 5-9 mm is typical, while > 10mm indicates excessive pronation (arch collapse) or instability, often linked to structural issues
Measured: Baseline and 8th Week
Jumping Performance by using Horizontal Jump Test
Horizontal jump tests, particularly the Standing Long Jump (SLJ) or Broad Jump, measure lower-body explosive power by recording the furthest distance of three attempts from a takeoff line to the nearest heel landing. Elite men typically exceed 2.50 m, while women excel over 2.0 m , often aiming for a distance greater than their height.
Measured: Baseline and 8th Week
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Feb 2026
- Study start4 Feb 2026 (estimated)
- Primary completion30 Jul 2026 (estimated)
- Study completion30 Aug 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for AutismStudies 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
- 34 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Riphah International University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Fareeha Kausar, PPDPT, Principal investigator, Riphah International University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07438665
- Sponsor's protocol ID
- Eman Amjad
- Status last verified
- Feb 2026
- First submitted
- 23 Feb 2026
- Last updated
- 27 Feb 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
A-C, BOCA I-C, RUSU M-E, CRISTEA D. The Benefits of Physical Therapy in the Rehabilitation of Flat Feet in Autism Students between the ages of 10 and 14. Romanian Journal of Physical Therapy/Revista Romana de Kinetoterapie. 2023;29(51)
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 Asian Journal of Kinesiology. 2021;23(1):27-33
Kang M-H, Cha S-M, Oh J-S. The effect of toe-tap exercise on abductor hallucis activity and medial longitudinal arch angle in individuals with pes planus. Isokinetics and Exercise Science. 2020;28(4):415-22
Lee H-j, Kim S-h, Baik S-m, Cynn H-s. Comparison of Foot Muscle Activity During Short Foot and Toe Spread-out Exercises in Different Weight Bearing Conditions in Individuals With Pes Planus. Physical Therapy Korea. 2024;31(1):63-71.
Study at a glance
From the registry record, last updated by the sponsor on 27 Feb 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effects of Toe Spread Out Exercise With and Without Walking Surface Training on Navicular Drop and Jumping Performance in Children With Autism
- ClinicalTrials.gov ID
- NCT07438665
- Acronym / sponsor ID
- Eman Amjad
- Conditions
- Autism
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 34 participants (estimated)
- Lead sponsor
- Riphah International UniversityUniversity, hospital or other
- Study start
- 4 Feb 2026 (estimated)
- Primary completion
- 30 Jul 2026 (estimated)
- Study completion
- 30 Aug 2026 (estimated)
- First posted
- 27 Feb 2026 (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.
Flatfoot is a common postural deformity in children, characterized by the collapse of the medial longitudinal arch, leading to abnormal foot posture, gait disturbances, and postural instability. Arch collapse in flatfoot is also due to navicular drop a condition where the navicular bone, located in the midfoot, shifts downward excessively when bearing weight.
This excessive drop reflects poor structural support in the foot and is often linked to weakness in the intrinsic foot muscles. The intrinsic and extrinsic muscles of the foot, particularly the abductor hallucis (AbdH), play a vital role in maintaining arch stability.
Strengthening exercises like toe spread out movements are specifically designed to target these muscles by abducting and flexing the toes, helping to support and elevate the medial arch. This study aims to investigate the combined effect of toe spread out exercises and walking surface training on navicular drop and jumping performance in children with ASD, focusing on muscle strength and sensory-motor integration to support functional movement and postural control. This randomized controlled trial will be conducted over ten months at Step Up Autism Center and Rehab Care, Lahore, following ethical approval from the Research Ethical Committee of Riphah International University Islamabad (Lahore Campus). Children aged 7 to 12 years, clinically diagnosed with autism spectrum disorder, navicular drop, and poor locomotor skills will be recruited through non-probability convenient sampling. After obtaining informed consent from guardians, eligible participants will be randomly allocated into two groups. Group A will perform toe spread out exercises only, while Group B will perform toe spread out exercises combined with walking surface training. Both interventions will be carried out three times a week for eight weeks. This will be a single-blinded study, where the assessor will remain unaware of the group allocations. Data collection will involve pre- and post intervention assessment using the Navicular Drop Test, Wet Footprint Test (Clarke's Angle), Horizontal Jump Test, and the Test of Gross Motor Development-Second Edition (TGMD-2) to evaluate changes in foot posture, arch structure, lower limb power, and locomotor skills in participating children.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (investigator)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Toe spread out exercise group | Active comparator | Other: Toe spread out exercise |
| Toe spread out exercises with walking surface training group | Experimental | Other: Toe spread out exercise, Other: Toe spread out exercises with walking surface training |
Who may qualify
- Ages
- 7 to 12 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child
Key inclusion criteria (3 listed)
- Children aged 7 to 12 years of age
- Children of both genders male and female
- children having navicular drop >9mm
Key exclusion criteria (3 listed)
- Neurological conditions affecting movement (e.g., CP)
- Inability to follow simple verbal commands
- Visual or auditory impairment impacting motor performance
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 |
|---|---|---|
| Toe spread out exercisePartcipant will sit on the edge of chair with hips and knees at 90 degree flexion, with foot flat on the floor. This position makes sure that there is equal weight distibution across the calcaneus, metatarsals and phalanges. It is also made sure that the feet are hip width apart.Then the participant is asked to lift the toes off the ground(dorsiflexion) , keeping the heel and ball(metarsals) of foot on the ground. While maintaining dorsiflexion of toes, the participant will be asked to flex the first toe medially (bending downward and toward the midline), similarly the fifth toe will be flexed laterally (bending downward and away from the midline) .The position will be held for 3 to 5 seconds with 10 repetiotns. | Other | Toe spread out exercise group, Toe spread out exercises with walking surface training group |
| Toe spread out exercises with walking surface trainingWalking Surface • The participant will be barefoot and will be asked to walk in their usual manner and speed. • There will be three different surfaces i.e pile carpet (18mm thickness) for soft sensation, vinyl tile for flat smooth and loose gravel (average height of 14mm) for uneven sensation respectively. • The participant will be asked to walk on the 4 meter walking surface, taking 10 rounds on each | Other | Toe spread out exercises with walking surface training group |
Primary outcome
Navicular Drop by Navicular Drop Test
Time frame: Baseline and 8th Week
The Navicular Drop (ND) Test evaluates medial longitudinal arch stability by measuring the difference in navicular height between neutral/seated and weight-bearing positions. A drop of 5-9 mm is typical, while > 10mm indicates excessive pronation (arch collapse) or instability, often linked to structural issues
Jumping Performance by using Horizontal Jump Test
Time frame: Baseline and 8th Week
Horizontal jump tests, particularly the Standing Long Jump (SLJ) or Broad Jump, measure lower-body explosive power by recording the furthest distance of three attempts from a takeoff line to the nearest heel landing. Elite men typically exceed 2.50 m, while women excel over 2.0 m , often aiming for a distance greater than their height.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Feb 2026.
- BackgroundA-C, BOCA I-C, RUSU M-E, CRISTEA D. The Benefits of Physical Therapy in the Rehabilitation of Flat Feet in Autism Students between the ages of 10 and 14. Romanian Journal of Physical Therapy/Revista Romana de Kinetoterapie. 2023;29(51)
- BackgroundKim 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 Asian Journal of Kinesiology. 2021;23(1):27-33
- BackgroundKang M-H, Cha S-M, Oh J-S. The effect of toe-tap exercise on abductor hallucis activity and medial longitudinal arch angle in individuals with pes planus. Isokinetics and Exercise Science. 2020;28(4):415-22
- BackgroundLee H-j, Kim S-h, Baik S-m, Cynn H-s. Comparison of Foot Muscle Activity During Short Foot and Toe Spread-out Exercises in Different Weight Bearing Conditions in Individuals With Pes Planus. Physical Therapy Korea. 2024;31(1):63-71.
- 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.
Fareeha Kausar, PPDPT principal investigator
Riphah International University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Toe spread out exercise and Toe spread out exercises with walking surface training in people with Autism, run by Riphah International University at 1 site in Pakistan.
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 3 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: opening soon, as of the sponsor's last update on 27 Feb 2026. 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 Pakistan. 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?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Imran Amjad, Phd (03324390125, imran.amjad@riphah.edu.pk), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Navicular Drop by Navicular Drop Test (time frame: Baseline and 8th Week). The study lists 2 primary outcomes in all. 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 NCT07438665, which also lists 4 linked publications.
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 27 Feb 2026.