Health TrialsbyHealthPanel

Foot-Core Training With/Without Visual Feedback in Pediatric FPP

ConditionFlexible Flatfoot
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age7-12
SponsorRiphah International University

About this trial

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 criteria

This trial does not accept healthy volunteers

Qualifiers

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)

Disqualifiers

Children with tarsal coalitions

Congenital defects of lower limbs

Previous foot surgery

Foot/ankle trauma within the last six (6) months

Trial design

Design model

Parallel

Treatments tested in this trial

  • Foot Core Training

    Other intervention

    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

  • Foot Core Training with Visual Feedback

    Other intervention

    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

Treatment groups

24 Participants
are divided into 2 treatment groups
Group A: Group A: Experiment Group 1: Foot-Core Training groupActive comparator 1 intervention
Group B: Group B: Experiment Group 2: Foot-Core Training with Visual Feedback groupActive comparator 1 intervention

Trial outcomes

Primary outcomes

1

Foot Posture Index

The Foot Posture Index-6 (FPI-6) is a reliable and valid tool for pediatric foot assessment, with excellent inter-rater (ICC 0.92-0.97) and test-retest reliability (ICC 0.93-0.95). It shows good validity through correlations with radiographic measures (r = 0.37-0.77) and demonstrates strong diagnostic accuracy for flexible flatfoot (AUC 0.82, sensitivity 83.7%, specificity 80.4), supporting its clinical and research use.

Time frame
Baseline, 8 weeks
2

Temporal Distance Gait Analysis:

Temporal-distance gait analysis using footprint methods is a valid and reliable tool for assessing pediatric gait. It measures parameters like step length, stride width, and cadence via footprints on a marked walkway. Studies show good test-retest reliability (ICCs 0.52-0.98), supporting its use in children with gait abnormalities, including flexible pes planus.

Time frame
Baseline, 8 weeks
3

Arch Height Index

The Arch Height Index (AHI) is a reliable and valid measure of pediatric foot structure. It shows strong intra- and inter-rater reliability (ICC ≥ 0.76-0.90) in both sitting and standing positions. Evidence supports its precision and consistency for assessing foot posture in children.

Time frame
Baseline, 8 weeks
4

Medial Longitudinal Arch Angle

The Medial Longitudinal Arch (MLA) angle is a reliable and valid clinical measure for assessing pediatric foot posture. It shows excellent intra-rater (ICC 0.88-0.90) and inter-rater (ICC 0.80-0.85) reliability in children aged 6-12 years. It is a simple, non-invasive tool that accurately reflects arch structure and is useful for evaluating flexible flatfoot.

Time frame
Baseline, 8 weeks

Secondary outcomes

Other outcomes

1

Tiptoe standing test

The Tiptoe Standing Test is a valid clinical tool for differentiating flexible from rigid pes planus, based on reformation of the medial longitudinal arch during tiptoe stance. It shows good reliability, with intra-rater ICC 0.80-0.90 and inter-rater ICC 0.70-0.85. Despite some observer variability, it remains a practical and efficient pediatric screening method.

Time frame
Baseline
2

Jack's test

Jack's Test (Hubscher Maneuver) assesses medial arch flexibility and windlass mechanism function for diagnosing flexible flatfoot. It shows excellent intra-rater reliability (ICC 0.85-0.92) and moderate to high inter-rater reliability (ICC 0.75-0.88), especially with trained examiners. It also correlates well with radiographic measures, making it a valid tool for distinguishing structural vs functional deformities in children.

Time frame
Baseline
3

Navicular Drop Test

The Navicular Drop (ND) Test is used to assess medial arch flexibility and confirm flexible flatfoot. It measures the change in navicular height from non-weight bearing to weight bearing, with \>10 mm indicating flexible flatfoot. It shows acceptable reliability (ICC 0.61-0.79) and is a valid measure of medial arch function.

Time frame
Baseline
4

Mini-Mental State Examination

The Mini-Mental State Examination (MMSE) is a well-established cognitive screening tool with strong validity and reliability. It shows good construct and criterion validity, correlating well with full neuropsychological assessments. It also demonstrates high test-retest reliability (r = 0.80-0.89) and strong inter-rater reliability (ICC ≈ 0.75).

Time frame
Baseline

Sponsors and contacts

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Riphah International University

Lead sponsor

Source ClinicalTrials.gov
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