Foot-Core Training With/Without Visual Feedback in Pediatric FPP
Comparison of Foot-Core Training With and Without Visual Feedback on Gait and Foot Posture in Children With Flexible Pes Planus
Riphah International University
24 participants
Apr 13, 2026
INTERVENTIONAL
Conditions
Summary
This study investigates flexible pes planus (flat feet) in children, a condition where the medial arch collapses during weight-bearing, affecting gait, balance, and foot function. Although foot-core strengthening and visual feedback individually improve arch stability and motor control, their combined effect in pediatric populations remains underexplored. To address this gap, a randomized controlled trial will be conducted at Rafia Grammar School, involving 24 children aged 7-12 years with clinically confirmed flexible pes planus. Participants will be randomly assigned into two groups: one receiving foot-core training alone and the other receiving foot-core training with visual feedback, with interventions carried out twice weekly for 8 weeks. Changes in foot posture and gait will be assessed using standardized outcome measures, and data will be analyzed using SPSS version 23.0. The study aims to determine whether adding visual feedback enhances treatment effectiveness and supports the development of more targeted, evidence-based pediatric rehabilitation strategies.
Eligibility
Inclusion Criteria15
- Children aged 7-12 years with confirmed flat feet
- Both Genders
- Flexibility of flatfeet; tested using Tip toe standing test and Jack's test.
- Navicular Drop (>10mm)
- Mini Mental State Examination score > 21
- Visual acuity of 20/40 (6/12) or better in both eyes, confirmed by Snellen chart test.
- Foot Posture Index-6 (FPI-6, > +6)
- Children demonstrate altered gait parameters consistent with flexible pes planus as measured by temporal-distance gait analysis.
- Arch Height Index (< 0.31)
- Medial Longitudinal Arch Angle (<130°)
- Calcaneal Eversion Angle ( >5° eversion)
- Subtalar ROM (Dorsiflexion <10°)
- Footprint Index (Staheli >1.0 or Chippaux >45%)
- Dynamic Balance; Y-Balance Test (<85% composite score)
- Functional Scale (LEFS) (<60%)
Exclusion Criteria8
- Children with tarsal coalitions
- Congenital defects of lower limbs
- Previous foot surgery
- Foot/ankle trauma within the last six (6) months
- Received balance training or feet muscle strengthening within the last 3 months
- Visual and vestibular disturbance
- A history of head injury within the last 3 months
- Weakness of lower extremities (Manual Muscle testing grade <5)
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Interventions
Children will perform exercises 2×/week for 8 weeks with daily home practice. Begin with 1-2 sets of 5-15 reps (hold 5-10 sec), 1-2 min rest, progressing gradually. Session: 30-45 min. 1. Short-Foot Contraction: Lift medial arch without toe curling (5-15 reps, hold 5-10 sec) 2. Tip-Toe Heel Raises: Rise, hold 2 sec, lower (15 reps) 3. Towel Scrunch: Scrunch towel with toes (\~1 min) 4. Marble Pickup: Pick/place objects with toes (\~1 min) 5. Arch Lifting: Lift arch in standing (15 reps) 6. Plantar Roll + Calf Stretch: Ball roll + stretch (15-30 sec ×2-3) 7. Toe Spread \& Squeeze: Spread and squeeze toes
Visual feedback will be delivered via mirror therapy using a 36×36×48 cm mirror box. The child sits with the mirror at midline; one foot is hidden inside the box while the other is visible. While performing foot-core exercises, the mirror creates the illusion of symmetrical movement. The process is repeated by switching feet to ensure bilateral training. Exercises will be done 2×/week for 8 weeks (home practice encouraged), 1-2 sets of 5-15 reps (hold 5-10 sec), 1-2 min rest, session 30-45 min. 1. Short-Foot: Lift arch without toe curling (5-15 reps) 2. Heel Raises: Tip-toe, hold 2 sec (15 reps) 3. Towel Scrunch: Toe curl (\~1 min) 4. Marble Pickup: Pick/place objects (\~1 min) 5. Arch Lift: Standing arch raise (15 reps) 6. Plantar Roll + Stretch: Ball roll + calf stretch (15-30 sec ×2-3) 7. Toe Spread/Squeeze: Improves foot stability
Locations(1)
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NCT07578974