Pes CavusNCT07764393
Analysing The Impact of Foot Arch Height on Leg Muscle Tone and Balance in Young Adults.
An observational study of Pes Cavus and Pes Planus, run by Istinye University at 1 site in Turkey (Türkiye).
Trial summary
The goal of this observational study is to explore how the shape of the foot arch affects muscle tone, strength, and balance in healthy young adults aged 18-25, of all genders. The main questions it aims to answer are: 1. Read more about this study
- Who is it for?
- Ages 18 to 25 yearsHealthy volunteers can take part
- Conditions the study is for
- Pes Cavus, Pes Planus, Muscle Tone
- What is being tested?
- Arch Height Index, Foot Posture Index and Single Leg Stance
- How many people
- 60 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 2 Jul 2025to 29 Apr 2026
- How long will I take part?
- 1 Day
- Phase
- Observational
- 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 25 years
- All sexes
- Healthy volunteers accepted
- Adult
Study population: young adults
Who may be able to join
- Aged 18-25 years old-
- Not diagnosed with other medical conditions, fractures, or deformities
- No prior foot or lower limb surgeries affecting musculoskeletal health
- Wears sport shoes majority of the time
Who cannot join
- Neurological Disorders: Conditions affecting balance or muscle tone
- Balance Disorders like vestibular or inner ear conditions
- Women that wears high heels majority of the time
- Men that wear stiff and hard material shoes majority of the time
Trial locations and contacts
1 site in 1 country.
Turkey (Türkiye)1 site
Fizyoterapi ve Rehabilitasyon Uygulama ve Araştırma Merkezi (İSÜFİZYOTEM).
Istanbul, Zeytinburnu, 34010
About this study
Official title: Analysing The Effects of Different Foot Arch Heights on The Leg Muscle Tone and Balance in Young Adults.
The goal of this observational study is to explore how the shape of the foot arch affects muscle tone, strength, and balance in healthy young adults aged 18-25, of all genders.
The main questions it aims to answer are:
Read more
- Does foot postures as Pes Planus, Pes Cavus, and Normal arch has significant effect on static and dynamic balance performance, lower limb muscle tone, or muscle strength in young adults?
- What is the functional impact of foot posture on stability, movement efficiency, and injury risk?
Participants will be grouped based on foot arch type: flat (pes planus), high (pes cavus), or normal using Arch Height Index (AHI).
The investigators will compare groups to see if differences in foot arch affect postural stability, muscle tone, and strength. Participants will:
- Complete a sociodemographic questionnaire (Age, gender, physical activity level, dominant leg, and footwear habits), and anthropometric measurements (Height, weight, and BMI).
- Undergo static balance test for both legs:
Single Leg Stance, counting the errors made in 30 seconds for 3 trials.
- Undergo dynamic balance tests for both legs: Star Excursion Balance Test (SEBT) by reaching in 8 directions while balancing on one foot, and Single-Leg Hop for Distance by hopping forward on one leg.
- Have muscle tone and stiffness assessed using the MyotonPRO device on specified lower limb muscles.
- Have muscle strength measured using a handheld dynamometer (MicroFET2) across major specified leg muscles.
People have different types of foot arches. Some have flat feet (pes planus), some have high arches (pes cavus), and others have normal arches. These variations affect how the body aligns during movement and balance. Flat feet may cause inward rolling (overpronation), fatigue, and pain. High arches may cause stiffness, poor shock absorption, and a higher risk of ankle injuries.
Both arch types can reduce postural control and increase the risk of imbalance. Since lower body muscles are critical for maintaining posture, weak or poorly coordinated muscles can worsen these effects. However, no previous study has comprehensively explored the combination of foot arch structure, muscle tone, muscle strength, and both static and dynamic balance. This study aims to fill that gap.
The results may help healthcare professionals develop better screening and treatment strategies, such as exercise programs, rehabilitation approaches, and shoe recommendations for individuals with flat or high arches. By understanding these factors, the investigators can improve movement efficiency, prevent injuries, and support better quality of life.
All participants will be informed of the study procedures and will provide both written and verbal consent. The study will be conducted in compliance with ethical standards.
Read the detailed description
Foot posture abnormalities due to high or low arches, such as pes planus (flatfoot) and pes cavus (high-arched foot), significantly impact daily activities, particularly among young adults engaged in prolonged standing, walking, or physical activities. Pes planus is commonly associated with ligamentous laxity, muscle weakness, or genetic predisposition, leading to diminished medial, lateral, and transverse arches, resulting in excessive pronation, instability, and compromised shock absorption. This has been linked to knee pain and altered lower extremity alignment, and individuals with pes planus often experience foot pain, fatigue, and reduced physical performance.
Conversely, pes cavus is characterized by an exaggerated medial and lateral arch and diminished transverse arch, often linked to neuromuscular disorders, tight plantar fascia, or congenital factors. This condition leads to reduced shock absorption and uneven weight distribution, increasing the risk of recurrent ankle sprains, calluses, and metatarsalgia. Individuals with pes cavus frequently encounter discomfort during weight-bearing tasks and difficulties maintaining balance, which can hinder participation in physical and social activities.
Pes planus is linked to excessive pronation, while pes cavus is associated with excessive supination and rigidity, limiting adaptive responses to uneven surfaces. Both conditions have been associated with deficits in static and dynamic balance due to altered foot and lower limb alignment, leading to postural instability and increased sway during quiet standing and movement tasks. These balance deficits highlight the need for comprehensive assessments to identify individuals at greater risk of mobility impairments.
Lower extremity muscle tone plays a critical role in postural stability and overall functional movement, contributing to joint stabilization, shock absorption, and postural control during both static and dynamic activities. Individuals with lower muscle tone and stiffness have been shown to exhibit greater postural sway, indicating reduced postural control. Myotonometry provides reliable, repeatable, and non-invasive measurement of muscle tone, stiffness, and elasticity. Muscle strength and power also play a crucial role in foot function, balance, and postural stability by providing the necessary force for efficient movement and weight-bearing. Deficiencies in muscle power can lead to compensatory movement patterns that increase the risk of falls and injuries, particularly in individuals with foot posture abnormalities.
Prior research has examined dynamic balance, static balance, and muscle tone across different foot arch types separately, but no study has integrated foot posture, static and dynamic balance, muscle tone, and muscle strength within a single framework. This study addresses that gap by evaluating these factors together to provide a more comprehensive understanding of how foot posture abnormalities influence postural stability across genders.
Aim of Study
This study aims to examine how different foot arch types (pes planus, pes cavus, and normal arch) affect lower extremity muscle tone, muscle strength, and static and dynamic balance, in order to better understand their impact on postural stability and movement efficiency. The primary goals are to examine the relationship between foot posture abnormalities and muscle tone, balance performance, and strength in young adults; to identify differences in these factors based on gender; and to determine the functional impact of foot posture on stability, movement efficiency, and injury risk.
Hypotheses
The null hypothesis states that foot posture (pes planus, pes cavus, and normal arch) has no significant effect on static and dynamic balance performance, lower limb muscle tone, or muscle strength. The alternative hypothesis states that foot posture significantly affects static and dynamic balance performance, lower limb muscle tone, and muscle strength, with variations in arch structure influencing postural stability and muscle function, and that this effect differs between male and female participants.
Overview of Procedures
Participants will be classified into one of three foot arch groups using the Arch Height Index and confirmed with the Foot Posture Index-6. Each participant will complete a sociodemographic questionnaire and anthropometric measurements, followed by static balance assessment (Single Leg Stance), dynamic balance assessment (Star Excursion Balance Test and Single-Leg Hop for Distance), muscle tone assessment using a myometer, and muscle strength assessment using a handheld dynamometer. Assessments will be conducted in a standardized order for all participants to minimize order-related bias. Detailed eligibility thresholds and outcome measure definitions are provided in the corresponding registration modules.
- Conditions
- Pes Cavus, Pes Planus, Muscle Tone, Balance Assessment, Muscle Strength, Static Balance
- Being tested
- Arch Height Index, Foot Posture Index, Single Leg Stance, Star Excrusion Blance Test (SEBT), Single-Leg Hop for Distance
- Keywords
- Pes Cavus, Pes Planus, Static Balance, Dynamic Balance, Foot Arch, Muscle Tone, Muscle Strength
- Medical subject headings
- Talipes Cavus, Flatfoot
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Arch Height IndexDiagnostic test
The goal of this assessment is to objectively classify foot posture as low-arched, high-arched, or normal using the Arch Height Index (AHI). Participants will sit with hips and knees at 90°, feet lightly weight-bearing (~10%), and measurements will be taken with a caliper and paper. AHI is calculated as arch height at 50% of total foot length divided by truncated foot length. Feet with a ratio ≥ 0.356 are classified as high-arched, ≤ 0.275 as low-arched, and 0.276-0.355 as normal. Both feet will be assessed, focusing on the medial longitudinal arch. AHI demonstrates excellent inter-rater and test-retest reliability (ICC = 0.98-1.00).
Foot Posture IndexDiagnostic test
The participant will be asked to stand still with arms along the side, looking forward and their feet will be assessed according to the index components while being observed by the physiotherapist. Scores between 0 and+5 indicate normal feet; +6 to+9 indicate pronated feet; ≥ +10 indicate highly pronated feet;-1 to-4 indicate supinated feet;-5 to-12 indicate highly supinated feet. The goal of this assessment is to help classifying the participants' foot arch. High inter-rater and test-retest reliability for FPI scoring (ICC values of 0.923 and 0.931).
Single Leg StanceDiagnostic test
Static balance will be assessed using the Single Leg Stance (SLS) test. Participants will stand barefoot on one leg with arms along the sides and the non-stance foot lifted clear of the ground. Timing begins when the foot is lifted and ends when balance is lost, defined as placement of the lifted foot, movement of the stance foot, or grasping for support. Each leg will be assessed for a maximum of 30 seconds over three trials, and the mean value will be used for analysis. Longer durations indicate better static postural control. The test will be performed under eyes-open conditions. The SLS test has demonstrated good to excellent test-retest reliability in healthy adults, with ICC values ranging from 0.79 to 0.95, and has shown acceptable reliability and predictive validity for balance assessment in clinical settings.
Star Excrusion Blance Test (SEBT)Diagnostic test
Participants will perform the Star Excursion Balance Test (SEBT) barefoot, standing on one leg at the center of a star-shaped layout with 8 directions: ANT, AM, M, PM, P, PL, L, and AL, each at 45° angles. With hands on hips to reduce arm compensation, they will reach in each direction using the opposite leg without shifting weight or losing balance. Reach distance will be marked and trials repeated if form is compromised. Three trials per leg will be completed with 2-minute rests to reduce fatigue. Reach distances will be normalized to leg length (ASIS to medial or lateral malleolus) to ensure fair comparison. The SEBT assesses dynamic balance and has shown good reliability (ICC = 0.75-0.9).
Single-Leg Hop for DistanceDiagnostic test
The participant will be asked to assume a single-leg stance behind a marked starting line and will be instructed to hop forward as far as possible using a single explosive movement. They must land on the same leg while maintaining stability for at least 2-3 seconds. If the participant loses balance, touches the ground with the other foot, or falls forward, the attempt is not counted. Each participant will perform 3 trials per leg, with a rest period of 30-60 seconds between trials. The longest valid hop distance is recorded for each leg to calculate Leg Symmetry Index. The goal of single-leg hop for distance is to assess the dynamic balance, and it has excellent ICC values for test-retest reliability exceeded 0.86.
Myometer DeviceDiagnostic test
Muscle tone, stiffness, and elasticity will be measured using the MyotonPRO device, a non-invasive tool for evaluating muscle biomechanical properties. Participants will assume standardized positions, and measurements will be taken from the broadest cross-sectional area of the following muscles: M. Peroneus Longus, M. Tibialis Anterior, M. Gastrocnemius, Quadriceps (Vastus Medialis, Rectus Femoris, Vastus Lateralis), and Hamstrings (Biceps Femoris, Semitendinosus). The probe will be placed perpendicular to the skin. Five parameters will be recorded: frequency, stiffness, decrement, mechanical stress relaxation time, and creep. The method demonstrates high intra-rater (ICC = 0.63-0.99) and inter-rater (ICC = 0.63-0.97) reliability for lower limb muscles.
DynamometerDiagnostic test
Muscle strength will be assessed using a handheld dynamometer (HOGGAN MICROFET2), following the manual muscle testing protocols outlined by Kendall. Target muscles include: M. Peroneus Longus, M. Tibialis Anterior, M. Gastrocnemius, Quadriceps, Hamstrings, M. Extensor Hallucis Longus, and Toe Flexors (M. Flexor Hallucis Brevis and M. Flexor Digitorum Brevis). Participants will perform isolated muscle actions against the device at standardized joint angles. Each test will be repeated for 3 trials, with average values recorded. This method effectively detects muscle imbalances and strength changes, and shows high reliability (ICCs often > 0.9), strong validity versus isokinetic dynamometers, and an MCIT of ~0.58-17.2 N.
HeightOther
Standing height was measured using a flexible metal measure to the nearest 0.1 cm
WeightOther
Body weight was measured using a calibrated digital scale to the nearest 0.1 kg.
Body Mass IndexOther
Body mass index (BMI) was calculated as weight (kg) divided by height squared (m²) .
| Study group | Role | What they receive |
|---|---|---|
| Pes Cavus | Not described Receives: Diagnostic Test: Arch Height Index; Diagnostic Test: Foot Posture Index; Diagnostic Test: Single Leg Stance; Diagnostic Test: Star Excrusion Blance Test (SEBT); Diagnostic Test: Single-Leg Hop for Distance; Diagnostic Test: Myometer Device; Diagnostic Test: Dynamometer; Other: Height; Other: Weight; Other: Body Mass Index | |
| Pes Planus | Not described Receives: Diagnostic Test: Arch Height Index; Diagnostic Test: Foot Posture Index; Diagnostic Test: Single Leg Stance; Diagnostic Test: Star Excrusion Blance Test (SEBT); Diagnostic Test: Single-Leg Hop for Distance; Diagnostic Test: Myometer Device; Diagnostic Test: Dynamometer; Other: Height; Other: Weight; Other: Body Mass Index | |
| Normal Foot Arch | Not described Receives: Diagnostic Test: Arch Height Index; Diagnostic Test: Foot Posture Index; Diagnostic Test: Single Leg Stance; Diagnostic Test: Star Excrusion Blance Test (SEBT); Diagnostic Test: Single-Leg Hop for Distance; Diagnostic Test: Myometer Device; Diagnostic Test: Dynamometer; Other: Height; Other: Weight; Other: Body Mass Index |
What is being measured
The primary outcome is the main question the study is designed to answer.
Lower Extremity Muscle Tone
Muscle tone of the lower extremity will be measured using the MyotonPRO device, which provides non-invasive assessment of muscle biomechanical properties including tone, stiffness, and elasticity. Target muscles include the quadriceps, hamstrings, tibialis anterior, gastrocnemius, and peroneus longus.
Measured: At baseline (single session)
Lower Extremity Muscle Strength
Muscle strength will be assessed using a handheld dynamometer (MicroFET2) following Kendall's manual muscle testing positions. Participants will perform isolated maximal effort contractions for key lower limb muscles including the quadriceps, hamstrings, gastrocnemius, tibialis anterior, and toe flexors. The average value across 3 trials will be recorded in KgF.
Measured: At baseline (single session)
Single Leg Stance (Static Balance)
The Single Leg Stance (SLS) test assesses static balance by timing how long a person can stand on one leg (in seconds) without support or losing position. Arms are kept by the sides or on the hips, the non-stance leg is lifted, and the trial ends when the lifted foot touches down, the stance foot moves, or support is needed. It is quick, low-cost, and widely used in clinical trials to quantify balance and fall risk.
Measured: At baseline (single session)
Star Excursion Balance Test (Dynamic Balance)
The Star Excursion Balance Test is a dynamic balance assessment in where participant stands on one leg at the center of an 8-direction star and reaches as far as possible (measured in centimeters) along each line with the opposite foot while maintaining control and not shifting weight onto the reaching leg. Reach distances are usually normalized to leg length and averaged over multiple trials.
Measured: At baseline (single session)
Height
Standing height was measured using a flexible metal measure to the nearest 0.1cm
Measured: At baseline (single session)
Weight
Standing weight was measured using a calibrated digital scale to the nearest 0.1 kg
Measured: At baseline (single session)
Body Mass Index (BMI)
Weight in kilograms and height in meters will be combined to report BMI in kg/m^2.
Measured: At baseline (single session)
Secondary outcomes (2)
Effect of Gender on the outcomes
Differences in muscle tone, strength (KgF), static balance (s), and dynamic balance (cm) will be compared between male and female participants across all foot posture groups.
Measured: At baseline (single session)
Leg Symmetry Index
The symmetry of dynamic balance between dominant and non-dominant legs will be evaluated using the Single-Leg Hop for Distance to determine leg functional imbalances.
Measured: At baseline (single session)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted13 Aug 2026
- Study start2 Jul 2025
- Primary completion20 Apr 2026
- Study completion29 Apr 2026
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (31)Papers the sponsor has linked to this study.
- Other trials for Pes CavusStudies of the same condition, open and under way.
- More trials run by Istinye UniversityThe sponsor's other registered studies.
- 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
- Observational
- Observational model
- Other
- Time perspective
- Cross-sectional
- Enrolment
- 60 participants (actual)
- Target duration
- 1 Day
Sponsor and investigators
- Lead sponsor
- Istinye University
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Prof. Dr. Habibe Serap İNAL, Doctor of Physical Therapy, Principal investigator, Istinye University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07764393
- Sponsor's protocol ID
- 25-81-2025
- Status last verified
- Aug 2026
- First submitted
- 26 Dec 2025
- Last updated
- 13 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Jackson SM, Cheng MS, Smith AR Jr, Kolber MJ. Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device. Musculoskelet Sci Pract. 2017 Feb;27:137-141. doi: 10.1016/j.math.2016.07.010. Epub 2016 Jul 21.
PubMed 27476066Douma RK, Soer R, Krijnen WP, Reneman M, van der Schans CP. Reference values for isometric muscle force among workers for the Netherlands: a comparison of reference values. BMC Sports Sci Med Rehabil. 2014 Feb 25;6(1):10. doi: 10.1186/2052-1847-6-10.
PubMed 24568140Baron M, Divernois G, Grandjean B, Guex K. Validity and Reliability of Handheld Dynamometry to Assess Isometric Hamstrings and Quadriceps Strength at Varying Muscle Lengths. J Sport Rehabil. 2024 Apr 1;33(4):267-274. doi: 10.1123/jsr.2023-0256. Print 2024 May 1.
PubMed 38560999Matuszczyk, F., Trybulski, R., Gałęziok, K., Olaniszyn, G., Terbalyan, A., & Wilk, M. (2025). Effect of 10-Week Plyometric Training on Anaerobic Performance and Biomechanical Properties of the Muscles in Football Players: Randomized Controlled Trial. Applied Sciences, 15(3), 1451. https://doi.org/10.3390/app15031451.
Lettner J, Krolikowska A, Ramadanov N, Oleksy L, Hakam HT, Becker R, Prill R. Evaluating the Reliability of MyotonPro in Assessing Muscle Properties: A Systematic Review of Diagnostic Test Accuracy. Medicina (Kaunas). 2024 May 23;60(6):851. doi: 10.3390/medicina60060851.
PubMed 38929468Bąkowski, P., Cisowski, P., Rubczak, S., Wolff-Stefaniak, M., Bąkowska, A., & Piontek, T. (2017). Clinical functional assessment of patients after Achilles tendon percutaneous suture. Issue Rehabil Orthop Neurophysiol Sport Promot, 21, 19-29.
McManigal M, Post A, Allen M, Jorgensen A, Rosenthal M, Wellsandt M, Tao M, Wellsandt E. Reliability of Spatiotemporal Characteristics During Single-Legged Hop and Bilateral Drop Jump Tasks Using an Instrumented Pressure Walkway. Int J Sports Phys Ther. 2024 Jun 1;19(6):704-713. doi: 10.26603/001c.117401. eCollection 2024.
PubMed 38835980Pierobon A, Raguzzi I, Solino S, Salzberg S, Vuoto T, Gilgado D, Perez Calvo E. Minimal detectable change and reliability of the star excursion balance test in patients with lateral ankle sprain. Physiother Res Int. 2020 Oct;25(4):e1850. doi: 10.1002/pri.1850. Epub 2020 May 26.
PubMed 32458531Hebert-Losier K. Clinical Implications of Hand Position and Lower Limb Length Measurement Method on Y-Balance Test Scores and Interpretations. J Athl Train. 2017 Oct;52(10):910-917. doi: 10.4085/1062-6050-52.8.02. Epub 2017 Sep 22.
PubMed 28937801Amin, D. J., Coleman, J., & Herrington, L. C. (2014). The test-retest reliability and minimal detectable change of the balance error scoring system. J Sports Sci, 2, 200-7.
Bell DR, Guskiewicz KM, Clark MA, Padua DA. Systematic review of the balance error scoring system. Sports Health. 2011 May;3(3):287-95. doi: 10.1177/1941738111403122.
PubMed 23016020Muscat-Inglott, M. (2020). The Modified Flamingo Test: A Convenient Assessment of Balance for Planning Exercise Interventions with Older Adults. Social Science Research Network. https://doi.org/10.2139/ssrn.3594107.
Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clin Biomech (Bristol). 2006 Jan;21(1):89-98. doi: 10.1016/j.clinbiomech.2005.08.002. Epub 2005 Sep 21.
PubMed 16182419Mazzotti, A., Arceri, A., Abdi, P., Artioli, E., Zielli, S. O., Langone, L., Ramponi, L., Ridolfi, A., Faldini, C., & Brognara, L. (2024). An Innovative Clinical Evaluation Protocol after Total Ankle Arthroplasty: A Pilot Study Using Inertial Sensors and Baropodometric Platforms. Applied Sciences, 14(5), 1964. https://doi.org/10.3390/app14051964.
Vico Pardo FJ, Lopez Del Amo A, Pardo Rios M, Gijon-Nogueron G, Yuste CC. Changes in foot posture during pregnancy and their relation with musculoskeletal pain: A longitudinal cohort study. Women Birth. 2018 Apr;31(2):e84-e88. doi: 10.1016/j.wombi.2017.08.114. Epub 2017 Sep 6.
PubMed 28888865
Study at a glance
From the registry record, last updated by the sponsor on 13 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Analysing The Effects of Different Foot Arch Heights on The Leg Muscle Tone and Balance in Young Adults.
- ClinicalTrials.gov ID
- NCT07764393
- Acronym / sponsor ID
- 25-81-2025
- Conditions
- Pes Cavus, Pes Planus, Muscle Tone, Balance Assessment, Muscle Strength, Static Balance
- Keywords
- Pes Cavus, Pes Planus, Static Balance, Dynamic Balance, Foot Arch, Muscle Tone, Muscle Strength
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 60 participants (actual)
- Lead sponsor
- Istinye UniversityUniversity, hospital or other
- Study start
- 2 Jul 2025 (actual)
- Primary completion
- 20 Apr 2026 (actual)
- Study completion
- 29 Apr 2026 (actual)
- First posted
- 13 Aug 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.
The goal of this observational study is to explore how the shape of the foot arch affects muscle tone, strength, and balance in healthy young adults aged 18-25, of all genders.
The main questions it aims to answer are:
- Does foot postures as Pes Planus, Pes Cavus, and Normal arch has significant effect on static and dynamic balance performance, lower limb muscle tone, or muscle strength in young adults?
- What is the functional impact of foot posture on stability, movement efficiency, and injury risk?
Participants will be grouped based on foot arch type: flat (pes planus), high (pes cavus), or normal using Arch Height Index (AHI).
The investigators will compare groups to see if differences in foot arch affect postural stability, muscle tone, and strength. Participants will:
- Complete a sociodemographic questionnaire (Age, gender, physical activity level, dominant leg, and footwear habits), and anthropometric measurements (Height, weight, and BMI).
- Undergo static balance test for both legs:
Single Leg Stance, counting the errors made in 30 seconds for 3 trials.
- Undergo dynamic balance tests for both legs: Star Excursion Balance Test (SEBT) by reaching in 8 directions while balancing on one foot, and Single-Leg Hop for Distance by hopping forward on one leg.
- Have muscle tone and stiffness assessed using the MyotonPRO device on specified lower limb muscles.
- Have muscle strength measured using a handheld dynamometer (MicroFET2) across major specified leg muscles.
People have different types of foot arches. Some have flat feet (pes planus), some have high arches (pes cavus), and others have normal arches. These variations affect how the body aligns during movement and balance. Flat feet may cause inward rolling (overpronation), fatigue, and pain. High arches may cause stiffness, poor shock absorption, and a higher risk of ankle injuries.
Both arch types can reduce postural control and increase the risk of imbalance. Since lower body muscles are critical for maintaining posture, weak or poorly coordinated muscles can worsen these effects. However, no previous study has comprehensively explored the combination of foot arch structure, muscle tone, muscle strength, and both static and dynamic balance. This study aims to fill that gap.
The results may help healthcare professionals develop better screening and treatment strategies, such as exercise programs, rehabilitation approaches, and shoe recommendations for individuals with flat or high arches. By understanding these factors, the investigators can improve movement efficiency, prevent injuries, and support better quality of life.
All participants will be informed of the study procedures and will provide both written and verbal consent. The study will be conducted in compliance with ethical standards.
Detailed description
Foot posture abnormalities due to high or low arches, such as pes planus (flatfoot) and pes cavus (high-arched foot), significantly impact daily activities, particularly among young adults engaged in prolonged standing, walking, or physical activities. Pes planus is commonly associated with ligamentous laxity, muscle weakness, or genetic predisposition, leading to diminished medial, lateral, and transverse arches, resulting in excessive pronation, instability, and compromised shock absorption. This has been linked to knee pain and altered lower extremity alignment, and individuals with pes planus often experience foot pain, fatigue, and reduced physical performance.
Conversely, pes cavus is characterized by an exaggerated medial and lateral arch and diminished transverse arch, often linked to neuromuscular disorders, tight plantar fascia, or congenital factors. This condition leads to reduced shock absorption and uneven weight distribution, increasing the risk of recurrent ankle sprains, calluses, and metatarsalgia. Individuals with pes cavus frequently encounter discomfort during weight-bearing tasks and difficulties maintaining balance, which can hinder participation in physical and social activities.
Pes planus is linked to excessive pronation, while pes cavus is associated with excessive supination and rigidity, limiting adaptive responses to uneven surfaces. Both conditions have been associated with deficits in static and dynamic balance due to altered foot and lower limb alignment, leading to postural instability and increased sway during quiet standing and movement tasks. These balance deficits highlight the need for comprehensive assessments to identify individuals at greater risk of mobility impairments.
Lower extremity muscle tone plays a critical role in postural stability and overall functional movement, contributing to joint stabilization, shock absorption, and postural control during both static and dynamic activities. Individuals with lower muscle tone and stiffness have been shown to exhibit greater postural sway, indicating reduced postural control. Myotonometry provides reliable, repeatable, and non-invasive measurement of muscle tone, stiffness, and elasticity. Muscle strength and power also play a crucial role in foot function, balance, and postural stability by providing the necessary force for efficient movement and weight-bearing. Deficiencies in muscle power can lead to compensatory movement patterns that increase the risk of falls and injuries, particularly in individuals with foot posture abnormalities.
Prior research has examined dynamic balance, static balance, and muscle tone across different foot arch types separately, but no study has integrated foot posture, static and dynamic balance, muscle tone, and muscle strength within a single framework. This study addresses that gap by evaluating these factors together to provide a more comprehensive understanding of how foot posture abnormalities influence postural stability across genders.
Aim of Study
This study aims to examine how different foot arch types (pes planus, pes cavus, and normal arch) affect lower extremity muscle tone, muscle strength, and static and dynamic balance, in order to better understand their impact on postural stability and movement efficiency. The primary goals are to examine the relationship between foot posture abnormalities and muscle tone, balance performance, and strength in young adults; to identify differences in these factors based on gender; and to determine the functional impact of foot posture on stability, movement efficiency, and injury risk.
Hypotheses
The null hypothesis states that foot posture (pes planus, pes cavus, and normal arch) has no significant effect on static and dynamic balance performance, lower limb muscle tone, or muscle strength. The alternative hypothesis states that foot posture significantly affects static and dynamic balance performance, lower limb muscle tone, and muscle strength, with variations in arch structure influencing postural stability and muscle function, and that this effect differs between male and female participants.
Overview of Procedures
Participants will be classified into one of three foot arch groups using the Arch Height Index and confirmed with the Foot Posture Index-6. Each participant will complete a sociodemographic questionnaire and anthropometric measurements, followed by static balance assessment (Single Leg Stance), dynamic balance assessment (Star Excursion Balance Test and Single-Leg Hop for Distance), muscle tone assessment using a myometer, and muscle strength assessment using a handheld dynamometer. Assessments will be conducted in a standardized order for all participants to minimize order-related bias. Detailed eligibility thresholds and outcome measure definitions are provided in the corresponding registration modules.
Study design
- Observational model
- Other
- Time perspective
- Cross-sectional
- Target follow-up
- 1 Day
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Pes Cavus | – | Diagnostic Test: Arch Height Index, Diagnostic Test: Foot Posture Index, Diagnostic Test: Single Leg Stance, Diagnostic Test: Star Excrusion Blance Test (SEBT), Diagnostic Test: Single-Leg Hop for Distance, Diagnostic Test: Myometer Device, Diagnostic Test: Dynamometer, Other: Height, Other: Weight, Other: Body Mass Index |
| Pes Planus | – | Diagnostic Test: Arch Height Index, Diagnostic Test: Foot Posture Index, Diagnostic Test: Single Leg Stance, Diagnostic Test: Star Excrusion Blance Test (SEBT), Diagnostic Test: Single-Leg Hop for Distance, Diagnostic Test: Myometer Device, Diagnostic Test: Dynamometer, Other: Height, Other: Weight, Other: Body Mass Index |
| Normal Foot Arch | – | Diagnostic Test: Arch Height Index, Diagnostic Test: Foot Posture Index, Diagnostic Test: Single Leg Stance, Diagnostic Test: Star Excrusion Blance Test (SEBT), Diagnostic Test: Single-Leg Hop for Distance, Diagnostic Test: Myometer Device, Diagnostic Test: Dynamometer, Other: Height, Other: Weight, Other: Body Mass Index |
Who may qualify
- Ages
- 18 to 25 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
- Study population
- young adults
Key inclusion criteria (4 listed)
- Aged 18-25 years old-
- Not diagnosed with other medical conditions, fractures, or deformities
- No prior foot or lower limb surgeries affecting musculoskeletal health
- Wears sport shoes majority of the time
Key exclusion criteria (4 listed)
- Neurological Disorders: Conditions affecting balance or muscle tone
- Balance Disorders like vestibular or inner ear conditions
- Women that wears high heels majority of the time
- Men that wear stiff and hard material shoes majority of the time
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 |
|---|---|---|
| Arch Height IndexThe goal of this assessment is to objectively classify foot posture as low-arched, high-arched, or normal using the Arch Height Index (AHI). Participants will sit with hips and knees at 90°, feet lightly weight-bearing (~10%), and measurements will be taken with a caliper and paper. AHI is calculated as arch height at 50% of total foot length divided by truncated foot length. Feet with a ratio ≥ 0.356 are classified as high-arched, ≤ 0.275 as low-arched, and 0.276-0.355 as normal. Both feet will be assessed, focusing on the medial longitudinal arch. AHI demonstrates excellent inter-rater and test-retest reliability (ICC = 0.98-1.00). | Diagnostic test | Normal Foot Arch, Pes Cavus, Pes Planus |
| Foot Posture IndexThe participant will be asked to stand still with arms along the side, looking forward and their feet will be assessed according to the index components while being observed by the physiotherapist. Scores between 0 and+5 indicate normal feet; +6 to+9 indicate pronated feet; ≥ +10 indicate highly pronated feet;-1 to-4 indicate supinated feet;-5 to-12 indicate highly supinated feet. The goal of this assessment is to help classifying the participants' foot arch. High inter-rater and test-retest reliability for FPI scoring (ICC values of 0.923 and 0.931). | Diagnostic test | Normal Foot Arch, Pes Cavus, Pes Planus |
| Single Leg StanceStatic balance will be assessed using the Single Leg Stance (SLS) test. Participants will stand barefoot on one leg with arms along the sides and the non-stance foot lifted clear of the ground. Timing begins when the foot is lifted and ends when balance is lost, defined as placement of the lifted foot, movement of the stance foot, or grasping for support. Each leg will be assessed for a maximum of 30 seconds over three trials, and the mean value will be used for analysis. Longer durations indicate better static postural control. The test will be performed under eyes-open conditions. The SLS test has demonstrated good to excellent test-retest reliability in healthy adults, with ICC values ranging from 0.79 to 0.95, and has shown acceptable reliability and predictive validity for balance assessment in clinical settings. | Diagnostic test | Normal Foot Arch, Pes Cavus, Pes Planus |
| Star Excrusion Blance Test (SEBT)Participants will perform the Star Excursion Balance Test (SEBT) barefoot, standing on one leg at the center of a star-shaped layout with 8 directions: ANT, AM, M, PM, P, PL, L, and AL, each at 45° angles. With hands on hips to reduce arm compensation, they will reach in each direction using the opposite leg without shifting weight or losing balance. Reach distance will be marked and trials repeated if form is compromised. Three trials per leg will be completed with 2-minute rests to reduce fatigue. Reach distances will be normalized to leg length (ASIS to medial or lateral malleolus) to ensure fair comparison. The SEBT assesses dynamic balance and has shown good reliability (ICC = 0.75-0.9). | Diagnostic test | Normal Foot Arch, Pes Cavus, Pes Planus |
| Single-Leg Hop for DistanceThe participant will be asked to assume a single-leg stance behind a marked starting line and will be instructed to hop forward as far as possible using a single explosive movement. They must land on the same leg while maintaining stability for at least 2-3 seconds. If the participant loses balance, touches the ground with the other foot, or falls forward, the attempt is not counted. Each participant will perform 3 trials per leg, with a rest period of 30-60 seconds between trials. The longest valid hop distance is recorded for each leg to calculate Leg Symmetry Index. The goal of single-leg hop for distance is to assess the dynamic balance, and it has excellent ICC values for test-retest reliability exceeded 0.86. | Diagnostic test | Normal Foot Arch, Pes Cavus, Pes Planus |
| Myometer DeviceMuscle tone, stiffness, and elasticity will be measured using the MyotonPRO device, a non-invasive tool for evaluating muscle biomechanical properties. Participants will assume standardized positions, and measurements will be taken from the broadest cross-sectional area of the following muscles: M. Peroneus Longus, M. Tibialis Anterior, M. Gastrocnemius, Quadriceps (Vastus Medialis, Rectus Femoris, Vastus Lateralis), and Hamstrings (Biceps Femoris, Semitendinosus). The probe will be placed perpendicular to the skin. Five parameters will be recorded: frequency, stiffness, decrement, mechanical stress relaxation time, and creep. The method demonstrates high intra-rater (ICC = 0.63-0.99) and inter-rater (ICC = 0.63-0.97) reliability for lower limb muscles. | Diagnostic test | Normal Foot Arch, Pes Cavus, Pes Planus |
| DynamometerMuscle strength will be assessed using a handheld dynamometer (HOGGAN MICROFET2), following the manual muscle testing protocols outlined by Kendall. Target muscles include: M. Peroneus Longus, M. Tibialis Anterior, M. Gastrocnemius, Quadriceps, Hamstrings, M. Extensor Hallucis Longus, and Toe Flexors (M. Flexor Hallucis Brevis and M. Flexor Digitorum Brevis). Participants will perform isolated muscle actions against the device at standardized joint angles. Each test will be repeated for 3 trials, with average values recorded. This method effectively detects muscle imbalances and strength changes, and shows high reliability (ICCs often > 0.9), strong validity versus isokinetic dynamometers, and an MCIT of ~0.58-17.2 N. | Diagnostic test | Normal Foot Arch, Pes Cavus, Pes Planus |
| HeightStanding height was measured using a flexible metal measure to the nearest 0.1 cm | Other | Normal Foot Arch, Pes Cavus, Pes Planus |
| WeightBody weight was measured using a calibrated digital scale to the nearest 0.1 kg. | Other | Normal Foot Arch, Pes Cavus, Pes Planus |
| Body Mass IndexBody mass index (BMI) was calculated as weight (kg) divided by height squared (m²) . | Other | Normal Foot Arch, Pes Cavus, Pes Planus |
Primary outcome
Lower Extremity Muscle Tone
Time frame: At baseline (single session)
Muscle tone of the lower extremity will be measured using the MyotonPRO device, which provides non-invasive assessment of muscle biomechanical properties including tone, stiffness, and elasticity. Target muscles include the quadriceps, hamstrings, tibialis anterior, gastrocnemius, and peroneus longus.
Lower Extremity Muscle Strength
Time frame: At baseline (single session)
Muscle strength will be assessed using a handheld dynamometer (MicroFET2) following Kendall's manual muscle testing positions. Participants will perform isolated maximal effort contractions for key lower limb muscles including the quadriceps, hamstrings, gastrocnemius, tibialis anterior, and toe flexors. The average value across 3 trials will be recorded in KgF.
Single Leg Stance (Static Balance)
Time frame: At baseline (single session)
The Single Leg Stance (SLS) test assesses static balance by timing how long a person can stand on one leg (in seconds) without support or losing position. Arms are kept by the sides or on the hips, the non-stance leg is lifted, and the trial ends when the lifted foot touches down, the stance foot moves, or support is needed. It is quick, low-cost, and widely used in clinical trials to quantify balance and fall risk.
Star Excursion Balance Test (Dynamic Balance)
Time frame: At baseline (single session)
The Star Excursion Balance Test is a dynamic balance assessment in where participant stands on one leg at the center of an 8-direction star and reaches as far as possible (measured in centimeters) along each line with the opposite foot while maintaining control and not shifting weight onto the reaching leg. Reach distances are usually normalized to leg length and averaged over multiple trials.
Height
Time frame: At baseline (single session)
Standing height was measured using a flexible metal measure to the nearest 0.1cm
Weight
Time frame: At baseline (single session)
Standing weight was measured using a calibrated digital scale to the nearest 0.1 kg
Body Mass Index (BMI)
Time frame: At baseline (single session)
Weight in kilograms and height in meters will be combined to report BMI in kg/m^2.
2 secondary outcomes
Effect of Gender on the outcomes
Time frame: At baseline (single session)
Leg Symmetry Index
Time frame: At baseline (single session)
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 13 Aug 2026.
- Results publication: PubMed 27476066Jackson SM, Cheng MS, Smith AR Jr, Kolber MJ. Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device. Musculoskelet Sci Pract. 2017 Feb;27:137-141. doi: 10.1016/j.math.2016.07.010. Epub 2016 Jul 21.
- Results publication: PubMed 24568140Douma RK, Soer R, Krijnen WP, Reneman M, van der Schans CP. Reference values for isometric muscle force among workers for the Netherlands: a comparison of reference values. BMC Sports Sci Med Rehabil. 2014 Feb 25;6(1):10. doi: 10.1186/2052-1847-6-10.
- Results publication: PubMed 38560999Baron M, Divernois G, Grandjean B, Guex K. Validity and Reliability of Handheld Dynamometry to Assess Isometric Hamstrings and Quadriceps Strength at Varying Muscle Lengths. J Sport Rehabil. 2024 Apr 1;33(4):267-274. doi: 10.1123/jsr.2023-0256. Print 2024 May 1.
- Results publicationMatuszczyk, F., Trybulski, R., Gałęziok, K., Olaniszyn, G., Terbalyan, A., & Wilk, M. (2025). Effect of 10-Week Plyometric Training on Anaerobic Performance and Biomechanical Properties of the Muscles in Football Players: Randomized Controlled Trial. Applied Sciences, 15(3), 1451. https://doi.org/10.3390/app15031451.
- Results publication: PubMed 38929468Lettner J, Krolikowska A, Ramadanov N, Oleksy L, Hakam HT, Becker R, Prill R. Evaluating the Reliability of MyotonPro in Assessing Muscle Properties: A Systematic Review of Diagnostic Test Accuracy. Medicina (Kaunas). 2024 May 23;60(6):851. doi: 10.3390/medicina60060851.
- Results publicationBąkowski, P., Cisowski, P., Rubczak, S., Wolff-Stefaniak, M., Bąkowska, A., & Piontek, T. (2017). Clinical functional assessment of patients after Achilles tendon percutaneous suture. Issue Rehabil Orthop Neurophysiol Sport Promot, 21, 19-29.
- Results publication: PubMed 38835980McManigal M, Post A, Allen M, Jorgensen A, Rosenthal M, Wellsandt M, Tao M, Wellsandt E. Reliability of Spatiotemporal Characteristics During Single-Legged Hop and Bilateral Drop Jump Tasks Using an Instrumented Pressure Walkway. Int J Sports Phys Ther. 2024 Jun 1;19(6):704-713. doi: 10.26603/001c.117401. eCollection 2024.
- Results publication: PubMed 32458531Pierobon A, Raguzzi I, Solino S, Salzberg S, Vuoto T, Gilgado D, Perez Calvo E. Minimal detectable change and reliability of the star excursion balance test in patients with lateral ankle sprain. Physiother Res Int. 2020 Oct;25(4):e1850. doi: 10.1002/pri.1850. Epub 2020 May 26.
- Results publication: PubMed 28937801Hebert-Losier K. Clinical Implications of Hand Position and Lower Limb Length Measurement Method on Y-Balance Test Scores and Interpretations. J Athl Train. 2017 Oct;52(10):910-917. doi: 10.4085/1062-6050-52.8.02. Epub 2017 Sep 22.
- Results publicationAmin, D. J., Coleman, J., & Herrington, L. C. (2014). The test-retest reliability and minimal detectable change of the balance error scoring system. J Sports Sci, 2, 200-7.
- Results publication: PubMed 23016020Bell DR, Guskiewicz KM, Clark MA, Padua DA. Systematic review of the balance error scoring system. Sports Health. 2011 May;3(3):287-95. doi: 10.1177/1941738111403122.
- Results publicationMuscat-Inglott, M. (2020). The Modified Flamingo Test: A Convenient Assessment of Balance for Planning Exercise Interventions with Older Adults. Social Science Research Network. https://doi.org/10.2139/ssrn.3594107.
- 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.
Prof. Dr. Habibe Serap İNAL, Doctor of Physical Therapy principal investigator
Istinye University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Pes Cavus and Pes Planus, run by Istinye University at 1 site in Turkey (Türkiye).
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 4 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 13 Aug 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 Turkey (Türkiye). 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?
Lower Extremity Muscle Tone (time frame: At baseline (single session)). The study lists 7 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 NCT07764393, which also lists 31 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 13 Aug 2026.