Flexible Flat Research Articles

Effect of Body Mass Index on Pedobarographic and Patient-Reported Outcome Measures in Adolescent Flexible Flat Feet.

Although adolescent flexible flatfoot deformity (FFD) is common, little is known regarding the effect of weight on associated symptomatology. This study uses pedobarography and patient-reported outcome measures (PROs) to determine if overweight adolescents with FFD have more severe alterations in dynamic plantar pressures than normal body mass index percentiles (wnBMI) with FFD and if such alterations correlate with pain and activity. A retrospective review of patients aged 10 to 18 years with nonsyndromic symptomatic FFD was performed. Overweight (BMI percentile ≥ 85%) patients were compared with wnBMI patients with regard to dynamic plantar pressure measures and PRO scores. Pedobarographic data were subdivided into regions: medial/lateral hindfoot and midfoot, and first, second, and third to fifth metatarsals. Plantar pressure variables were normalized to account for differences in foot size, body weight, and walking speed. Contact area (CA%), maximum force by body weight (MF%), and contact time as a percentage of the rollover process (CT%) were calculated. Two foot-specific PROs were assessed, including the Foot and Ankle Outcome Score and the Oxford Ankle Foot Measure for Children. Of the 48 adolescents studied, 27 (56%) were overweight and 21 (44%) were wnBMI. After normalization of the data, overweight patients had significantly greater medial midfoot MF%, whereas CT% was increased across the medial and lateral midfoot and hindfoot regions. Correlations showed positive trends: as BMI percentile increases, so will CA and MF in the medial midfoot, as well as CT in the medial and lateral midfoot and hindfoot. Significant differences were seen between groups, with the overweight group reporting lower sports and recreation subscores than the wnBMI group. No significant differences were seen in the pain and disability subscores. Although overweight adolescents with FFD exhibit greater forces and more time spent during the rollover process in the medial midfoot than normal-weight patients, they did not report worse pain or disability associated with their flat foot deformity. Therapeutic level 3.

Effects of Instrument Assisted Soft Tissue Mobilization and Foot Strengthening Exercise on Navicular Height and Ankle Range of Motion in College Students with Flexible Flat Feet: A Comparative Study

Background: The medial longitudinal arch (MLA) plays a major role in maintaining the biomechanics of the foot and is maintained with the help of active and passive systems. Dysfunction of active and passive support system can lead to a reduction of navicular height, leading to excessive pronation of the foot known as pes planus. Pes planus is caused by injury, prolonged stress on the foot, obesity, and faulty biomechanics which will result in posterior tibial tendon dysfunction, collapse of the foot archand flat foot.The patients with posterior tibial tendon dysfunction and pesplanus have reduced dorsiflexion and increased eversion.So, the aim was to study the effects of instrument assisted soft tissue mobilization and foot strengthening exercise on navicular height and ankle range of motion in college students with flexible flat feet. Method: Total 40 students were recruited for the study as per selection criteria and were divided into two groups (20 in each group). Group A was treated with Instrument Assisted Soft Tissue Mobilization(IASTM)and group B was treated with Foot Strengthening Exercise for five days a week for 4 weeks. Inter-group analysis by Mann Whitney U-test showed statistically significant improvement in navicular height and ankle range of motion (P value ≤ 0.001). Conclusion: This study showed statistically significant improvement in navicular height and ankle ROM with the use of IASTM and foot strengthening exercise. However, IASTM was found to be more effective in improving ankle ROM and foot strengthening exercise was found to be more effective inincreasingnavicular height.

Assessment of Motor Control in Chronic Mechanical Low Back Pain Patients with Flexible Flat Foot

Assessment of Motor Control in Chronic Mechanical Low Back Pain Patients with Flexible Flat Foot

On Robust Assembly of Flexible Flat Cables Combining CAD and Image Based Multiview Pose Estimation and a Multimodal Robotic Gripper

On Robust Assembly of Flexible Flat Cables Combining CAD and Image Based Multiview Pose Estimation and a Multimodal Robotic Gripper

PREPARATION METHOD AND THERMAL PERFORMANCE OF A NEW ULTRA-THIN FLEXIBLE FLAT PLATE HEAT PIPE

Ultra-thin flat plate heat pipes must provide a degree of flexibility to meet foldable electronics heat dissipation requirements. In this paper, a new flexible ultra-thin flat plate heat pipe with a thickness of 0.75 mm has been designed and fabricated. Compared with the traditional flexible ultra-thin flat heat pipes, the innovation lies in the flexible insulation section formed by epoxy resin pouring of the shell. The design of the shell ensures that the flexible ultra-thin plate heat pipe can respond quickly to the external temperature change, and also has good flexibility, which provides a new choice for the material and structure design of the flexible ultra-thin plate heat pipe shell. The gas-liquid coplanar type mesh is used as the capillary wick to reduce the flow resistance of steam inside the heat pipe, and the wick is hydrophilically modified to improve its capillary pumping performance; a sandwich support structure is used to prevent the steam chamber from collapsing. The thermal performance of the three liquid filling ratios of 0.3, 0.4, and 0.5 was tested at different tilt angles and bending angles. The results show that in the cases of filling ratios of 0.3, 0.4, and 0.5, the ultra-thin flexible flat plate heat pipe with the liquid filling ratio of 0.3 has the best heat transfer performance under different working conditions; the tilt angle has different effects on the heat transfer performance and starting speed of the ultra-thin flexible flat plate heat pipe with different filling ratios, and the bending angle changes the steam condensation position inside the ultra-thin flexible flat plate heat pipe and increases the thermal resistance.

Using Goal-Conditioned Reinforcement Learning With Deep Imitation to Control Robot Arm in Flexible Flat Cable Assembly Task

Using Goal-Conditioned Reinforcement Learning With Deep Imitation to Control Robot Arm in Flexible Flat Cable Assembly Task

Efficacy of Personalized Foot Orthoses in Children with Flexible Flat Foot: Protocol for a Randomized Controlled Trial.

Pediatric flat foot (PFF) is a very frequent entity and a common concern for parents and health professionals. There is no established definition, diagnostic method, or clear treatment approach. There are multiple conservative and surgical treatments, the implantation of foot orthoses (FO) being the most used treatment. The evidence supporting FO is very thin. It is not clearly known what the effect of these is, nor when it is convenient to recommend them. The main objective of this protocol is to design a randomized controlled trial to determine if personalized FO, together with a specific exercise regimen, produce the same or better results regarding the signs and symptoms of PFF, compared to only specific exercises. In order to respond to the stated objectives, we have proposed a randomized controlled clinical trial, in which we intend to evaluate the efficacy of FO together with strengthening exercises, compared to a control group in which placebos will be implanted as FO treatment along with the same exercises as the experimental group. For this, four measurements will be taken throughout 18 months (pre-treatment, two during treatment and finally another post-treatment measurement). The combination of FO plus exercise is expected to improve the signs and symptoms (if present) of PFF compared to exercise alone and the placebo FO group. In addition, it is expected that in both conditions the biomechanics of the foot will improve compared to the initial measurements.

Effect of Custom-Made Orthotic Insoles on Lower Limb Biomechanics in Children with Flexible Flat Feet

This study aimed to investigate the effect of custom-made orthotic insoles on the lower limb biomechanics in children with flexible flat feet. A sample of 27 children (19 boys and eight girls) aged 7 to 13 years old with flexible flat feet participated in the study. Each custom-made orthotic insole was individually designed based on the foot of each subject, using ethylene-vinyl acetate (EVA) material with medium density. The study was conducted using a gait analysis laboratory, and participants were required to walk randomly at a self-selected speed with one of three insole conditions (custom-made orthotic insole, flat insole, and barefoot). The data was processed using Visual 3D software and analyzed by SPSS software. The results showed that using custom-made orthotic insoles resulted in a significant reduction in the maximum ankle inversion angle and ankle inversion moment while increasing the knee adduction moment during the stance phase when compared to wearing either flat insoles or being barefoot (p<0.05). This study found that custom-made orthotic insoles significantly altered the biomechanical characteristics of the lower limbs of children with flexible flat feet, reducing the movement of the ankle joint in the frontal plane, thereby enhancing ankle joint stability, but may increase knee joint load.

The Comparision of the Static Balance, Contact Area, and Plantar Pressure of Flexible Flat Foot According to Elastic Taping

The Comparision of the Static Balance, Contact Area, and Plantar Pressure of Flexible Flat Foot According to Elastic Taping

The Effect of Insole to Flexible Flat Foot on Dynamic Balance and Ankle Muscle Activity during the Y-Balance Test

The Effect of Insole to Flexible Flat Foot on Dynamic Balance and Ankle Muscle Activity during the Y-Balance Test

Mosca's Technique in Surgical Treatment of Symptomatic Flexible Flat Foot in Children and Adolescents

Mosca's Technique in Surgical Treatment of Symptomatic Flexible Flat Foot in Children and Adolescents

Treatment of Symptomatic Flexible Flat Foot in Pediatrics with A Modified Mosca's Lateral Column Lengthening.

Background: The optimal treatment of flat foot is still controversial. In this study, we evaluated the outcome the Mosca's lateral column lengthening with the advancement of the tibialis posterior. Methods: In a retrospective study . fifty symptomatic pediatric flexible flat feet with or without hindfoot valgus were ‎included in this study. Lateral column lengthening was done as described by Mosca. ‎The tibialis posterior advancement was made on the navicular bone instead of the medial cuneiform. Radiographic measures of outcome were evaluated before the surgery and immediately ‎after the surgery and included Calcaneal Inclination (Pitch) Angle, Talonavicular Coverage ‎Angle, Talo-1st metatarsal Angle (Meary's Angle), Lateral Talocalcaneal Angle, Anteroposterior ‎Talocalcaneal Angle (kite's angle), and Talar Declination Angle (Talo-Horizontal Angle).‎ A paired t-test or its nonparametric counterpart (Wilcoxon T-test) was used to compare the mean value of preoperative and postoperative measures. A chi-square test was used to compare qualitative variables Results: The mean age of the patients was ‎9.2±2.2‎‏ years‎. ‎The mean follow‎-‎up of the patients was ‏‎2.6±1.1‎‏ ‏years‎. All radiographic measures were significantly improved after the surgery. According to the radiographic measures, under-correction was seen in seven feet. Overcorrection was seen in one of the patients. Union of the osteotomy site was observed in all feet. No patients had postoperative pain or limited ankle range of motion. One superficial infection occurred that was managed with oral antibiotics. Conclusion: Lateral column lengthening and advancement of tibials posterior on navicular bone is a safe and effective procedure in the treatment of the symptomatic pediatric flexible flat foot.

Immediate Effects of Silicone Arch Support Insoles on Postural Balance in Children with Flexible Flat Feet

Immediate Effects of Silicone Arch Support Insoles on Postural Balance in Children with Flexible Flat Feet

Subtalar arthroereisis in pediatric flexible flat foot: Functional and radiographic results with 5 years of average follow-up

The aim of this retrospective study is to evaluate the clinical-functional and radiographic results in pediatric patients with painful and disabling Flexible Flat Foot (FFF) refractory to conservative treatment who underwent percutaneous subtalar arthroereisis with a Maxwell Brancheau Arthroereisis® (MBA) implant. Patients aged 8–14 years old with a minimum follow-up of 24 months were included. A pre and postoperative radiographic evaluation was carried out analyzing Meary's angle, internal Moreau-Costa-Bartani´s angle, Talar declination angle, Calcaneal Pitch, Kite's angle, Talar-1st metatarsal angle, and Talonavicular coverage angle. In those patients with more than 5 years of follow-up, the development of subtalar osteoarthritis was evaluated. A clinical-functional evaluation was carried out using the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot rating scale. Pre and postoperative pain was evaluated using the visual analog scale (VAS). Postoperative complications were described. Fourteen patients (19 feet) met the inclusion criteria. The mean age at surgery was 12 years old with a mean follow-up of 68.26 months. All radiographic angles improved significantly. No signs of subtalar osteoarthritis were identified. The mean pre and postoperative pain according to VAS was 7.05 and 0.77 respectively. The mean pre and postoperative AOFAS was 75.42 and 97.05 respectively. One female patient had persistent pain in both feet (VAS = 4). However, she was able to do sports and daily life activities without restrictions. None of the implants needed to be removed due to intolerance or pain. Subtalar arthroereisis seems to be effective to improve the clinical-functional and radiographic parameters in moderate pediatric FFF.

Short-term Effects of Using Arch Supporting Insoles on Balance and Symptoms of Flexible Flat Foot in Children

Background and Aims One of the treatment methods for Pediatric Flexible Flat Foot (PFFF) is to use medical insoles. The current study aimed to investigate the Short-term effects of arch supporting insoles on balance and symptoms of flexible flat foot in children. Methods Twenty children aged 6-11 years with a flexible flatfoot complication were purposefully selected after applying Inclusion and exclusion criteria. Participants were randomly assigned to two intervention (n=10) and control groups (n=10). The intervention group used insoles supporting the longitudinal arch of the foot in their shoes for 12 weeks, but the control group did not use them. To measure the balance and symptoms of flexible flat foot in children, a sensory organization test of dynamic posturography apparatus, medial longitudinal arch height, and footprint were used in the pre-posttest. The intervention group used insoles supporting the longitudinal arch of the foot in their shoes for 12 weeks, but the control group did not. Data analysis was performed in two descriptive (mean and standard deviation) and inferential (covariance analysis) sections using SPSS software v. 25 at a significance level of α<0.05. Results The results showed that short-term use of medical insoles led to improved balance in conditions of normal vision and fixed support (P=0.047), absent vision and fixed support (P=0.1010), sway referenced vision and fixed support (P=0.004), normal vision and fixed support (P=0.004), absent vision and sway referenced support (P=0.001) and sway referenced vision and sway referenced support (P=0.001). The results also showed that medical insoles improved the medial longitudinal arch of the foot (P=0.001) and footprint (P=0.001). Conclusion According to the results of the present study, educators and parents of children with flexible flat foot are advised to use supportive medical insoles to improve children’s motor function, balance, and symptoms of flexible flat foot.

Calcaneal Stop Procedure for Treatment of Pediatric Flexible Flat Foot

Calcaneal Stop Procedure for Treatment of Pediatric Flexible Flat Foot

17-in. × 17-in. Flexible Flat Panel X-Ray Detectors with High Image Quality and Light Weight

17-in. × 17-in. Flexible Flat Panel X-Ray Detectors with High Image Quality and Light Weight

Comprehensive Physiotherapy Program Improves the Medial Longitudinal Arch of a Male Adolescent with Bilateral Flexible Flat Foot: A Case Report

Introduction: Flat foot is a common foot deformity marked by the absence of the medial longitudinal arch of the foot. Flexible flat foot is usually symptomless but can affect the biomechanics of the lower extremity and lumbar spine, possibly increasing the risk of pain and injury. Conservative management, including physiotherapy, is important in flat foot management, yet the number of reports regarding physiotherapy for flat foot is scarce. Therefore, this case report aimed to describe a case of bilateral flexible flat foot in a male adolescent who was treated with a comprehensive physiotherapy program.
 Case Description: A 17-year-old male presented to the physiotherapy clinic with flat foot deformity on both feet. The patient received an hour of comprehensive physiotherapy program per session, twice per week, which included lower extremity stretching, various foot and leg strengthening exercises, proprioception exercises, and an educational aspect. The footprint test was conducted and the patient was evaluated using the Arch Index. The Arch Index measurements according to Cavanagh and Rodgers decreased from 0.38 to 0.32 (left foot) and 0.35 to 0.28 (right foot). Likewise, Staheli’s Arch Index measurements also decreased from 1.54 to 1.02 (left foot) and 1.5 to 0.7 (right foot).
 Conclusion: Following 20 physiotherapy sessions, the patient’s Arch Index measurements demonstrated an overall reduction, indicating noteworthy improvements in the medial longitudinal arch height. Hence, it can be concluded that a comprehensive physiotherapy program can help improve the medial longitudinal arch height, and thereby foot posture, of an adolescent with bilateral flexible flat foot.

The Long-Term Wearing of Foot Orthoses Can Change the Frequency Domain of Ground Reaction Forces in Children with Flexible Flat Feet

ABSTRACT Introduction Analyzing the frequency content of ground reaction forces (GRFs) might be helpful when assessing gait abnormalities in children with flexible flatfeet. The aims of this study were therefore to evaluate 1) differences in GRF frequency content between children with and without flatfeet; and 2) whether the long-term wearing of foot orthoses changes the GRF frequency contents in children with flatfeet. Materials and Methods This is a pre-post study design. GRFs were collected at baseline for boys both with and without flatfeet. Boys with flatfeet wore custom-made foot orthoses with unique shoes for 4 months; GRFs were collected for the flatfeet group after 4 months too. Data were collected while participants wore shoes without foot orthoses in the pretest and shoes with foot orthoses in the posttest. GRFs were collected during walking by two Kistler force platforms (each force plate was used for each leg). Multivariate analysis of variance (MANOVA) test and a separate 2 (side: dominant vs. nondominant) × 2 (time: pretest vs. posttest) ANOVA with repeated measures were used for statistical analysis. Results The flatfeet group indicated lower vertical GRF frequency (P = 0.003; d = 1.21; 95% confidence interval [CI], 7.12–7.59) and greater vertical amplitude of harmonic 16 for the nondominant limb (P = 0.030; d = 0.71; 95% CI, 0.0001–0.0022) than the normal feet group. No significant differences in GRF frequency content were found for the dominant limb between pretest and posttest (P > 0.05; d = 0.01–039). However, for nondominant limb, vertical GRF frequency content (P < 0.001; d = 0.85; 95% CI, 6.21–7.36) was diminished at posttest compared with pretest. In the nondominant limb, the anteroposterior GRF frequency with a power of 99.5% showed a significant increase at posttest compared with pretest (P = 0.025; d = 0.50; 95% CI, 13.30–16.20). For both limbs, amplitudes of three-dimensional GRF components were lower at posttest than at pretest (P < 0.05; d = 0.0.14–1.20; 95% CI, −0.0005 to −0.0083). Conclusions The results indicated lower GRF frequency content and amplitudes after long-term wearing of foot orthoses. Therefore, long-term wearing of foot orthoses may be applied to obtain functional improvements in children with flatfeet. Clinical Relevance Clinicians are advised to apply foot orthoses to improve functions in children with flatfeet.

Effect of UCBL and Medial Longitudinal Arch Support in Balance and Functional Performance in Bilateral Flexible Flat Feet in Patients Aged Between 16 And 20 Years

Purpose: Moulded foot orthoses have been shown to be successful in treating such injuries and reducing the symptoms by realigning the foot anatomy, controlling excessive pronation and reducing internal tibial rotation. Numerous prophylactics or therapeutic devices, such as motion control shoe, orthoses, orthotic devices, inserts and others, have emerged to limit the pronation range during running. In evaluating the effect of these devices to control pronation during running, orthopaedics and biomechanics researchers often investigate the rearfoot kinematics, or to be specific, the calcaneal motion in respect to the talus bone. Previous researches showed that the effects are still unclear however some orthotic inserts are useful in relieving heel and plantar fasciitis pain. The purpose of this study is to identify among UCBL and Medial Arch Support which is a better prescription option for Pes planus. Materials and Method: An incidental simple randomised sample of 30 participants (30 Bilateral Flexible Flat Feet) were recruited for the study with age range from 16 to 20 years. There were 21 male and 9 female patients in the study. There was no drop out during the study. Participants were allocated to two groups by random allocation based on the fitment of UCBL and arch support (UCBL prescribed for Group A and Medial arch support prescribed for Group B). Pre and post interventional tests- balance and functional parameters was taken before the fitment of orthosis and after four-week of usage of the prescribed orthotic treatment and the said pre and post interventional data was analysed for statistical significance. Result: One-way ANOVA test shows a significant difference between groups at p<0.000. Posttest between the parameters (Berg balance and TUG) shows that UCBL has a high statistical significance than medial arch support in improving balance and functional parameters at p<0.000 at t value -6.942. Conclusion: A comparison of balance and functional parameter results in the tested orthoses indicated that the UCBL orthosis significantly increased the stability of people with flexible flatfoot, and it has improved balance and functional parameters in total among those with flatfeet. It seems that creating mobility in the midfoot area of the foot orthosis may cause a balance disturbance in patients with flatfoot. It is recommended that other balance parameters such as sway of the center of pressure and the long-term effects of orthoses may also be investigated.