This study was a clinical trial to investigate the effects of Short Foot Exercise (SFE) and standard physical therapy on knee muscle tone, knee pain and function, balance ability, and quality of life in adults with flexible flat feet and knee pain.
BMI (Body Mass Index): If between 18 and 25 kg/m²
Litigation period: If knee pain lasted for more than 6 weeks
Navicular drop test: If it was 10 mm or more
Numerical assessment scale: If knee pain was 4 or more
History of knee surgery: If you have had knee surgery
Treatment history: If you have received physical therapy for knee pain in the 4 weeks before the start of the study
Mental status: If you have a psychological disorder that may interfere with your participation in the study
Injury status: If you have a current serious injury affecting the lower extremity joints and foot
Parallel
Short Foot Exercise
Behavioral* Description: Short Foot Exercise is a therapeutic exercise designed to strengthen intrinsic foot muscles and improve medial longitudinal arch stability. * Procedure: Participants will perform Short Foot Exercise twice daily, five times per week for four weeks. The exercise consists of progressive phases, starting with basic foot activation and advancing to resistance-based strengthening using bands. * Purpose: To determine if strengthening the foot's intrinsic muscles positively impacts knee pain, muscle function, and balance in individuals with flexible flatfoot.
Conventional Physical Therapy
Behavioral* Description: Standard non-invasive physical therapy aimed at reducing knee pain, improving muscle relaxation, and enhancing lower limb function. * Procedure: Participants will receive twice-weekly conventional physical therapy for ten minutes per session over four weeks. Treatment includes soft tissue mobilization, muscle relaxation techniques, and neuromuscular stimulation, as appropriate for knee pain relief. * Purpose: To evaluate its effectiveness as a standalone treatment compared to the addition of Short Foot Exercise.
Change in Knee Muscle Tension from Baseline to 4 Weeks (Measured by Myoton Pro - Frequency in Hz)
* Description: This outcome measure assesses changes in muscle tension (tone) in the knee region before and after the intervention. * Measurement Tool: Myoton Pro * Unit of Measure: Frequency (Hz) * Assessment Method: Myoton Pro applies a gentle mechanical impulse to the skin overlying the Vastus Medialis, Biceps Femoris, Gastrocnemius Medialis, and Tibialis Anterior muscles, recording oscillation frequency as an indicator of muscle tone.
Change in Knee Muscle Stiffness from Baseline to 4 Weeks (Measured by Myoton Pro - Stiffness in N/m)
* Description: This measure evaluates changes in muscle stiffness, reflecting muscle resistance to external force. * Measurement Tool: Myoton Pro * Unit of Measure: Newton per meter (N/m) * Assessment Method: Stiffness is quantified by Myoton Pro by applying a controlled impulse and measuring the muscle's resistance to deformation.
Change in Knee Muscle Elasticity from Baseline to 4 Weeks (Measured by Myoton Pro - Logarithmic Decrement)
* Description: This measure evaluates changes in muscle elasticity, which indicates the muscle's ability to return to its original shape after deformation. * Measurement Tool: Myoton Pro * Unit of Measure: Logarithmic decrement * Assessment Method: The Myoton Pro records how quickly oscillations in the muscle dampen after a mechanical impulse, representing its elasticity.
Change in Dynamic Balance from Baseline to 4 Weeks (Measured by Y-Balance Test - Reach Distance in cm)
* Description: This measure assesses changes in lower limb balance and stability using the Y-Balance Test (YBT). * Measurement Tool: Y-Balance Test (YBT) * Unit of Measure: Reach distance (cm) * Assessment Method: Participants will perform three reach directions (anterior, posteromedial, posterolateral) while maintaining single-leg stance. The maximum reach distance for each direction is recorded and averaged.
Change in Quality of Life from Baseline to 4 Weeks (Measured by EQ-5D-5L - Score on a 5-Dimension Scale)
* Description: This outcome measure evaluates self-reported quality of life in five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. * Measurement Tool: EQ-5D-5L * Unit of Measure: Score on a 5-Dimension Scale * Assessment Method: Participants rate their health status on a 5-level Likert scale (1 = No problems, 5 = Extreme problems). A total EQ-5D-5L index score is calculated using a weighted algorithm.
Change in Knee Pain from Baseline to 4 Weeks (Measured by WOMAC Pain Subscale - Score on a 5-Point Likert Scale)
* Description: This measure evaluates knee pain severity before and after treatment. * Measurement Tool: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) - Pain Subscale * Unit of Measure: Score on a 5-Point Likert Scale * Assessment Method: Participants rate pain intensity across five activities (e.g., walking, climbing stairs) using a 0-4 scale (0 = No pain, 4 = Extreme pain).
Change in Knee Function from Baseline to 4 Weeks (Measured by WOMAC Function Subscale - Score on a 5-Point Likert Scale)
* Description: This measure assesses changes in functional ability and movement limitations. * Measurement Tool: WOMAC - Function Subscale * Unit of Measure: Score on a 5-Point Likert Scale * Assessment Method: Participants rate functional difficulty in 17 daily activities (e.g., rising from a chair, bending) on a 0-4 scale (0 = No difficulty, 4 = Extreme difficulty).
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