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Effect of arch support on balance performance in individual with flat foot 1


“Effect of arch support on balance performance in individuals with flatfoot”

Submitted by:

Goriya Hetal

(Enrolment no.: 12SPTPT11032)

Gohil Nirupa

(Enrolment no.: 12SPTPT11031)

6th semester, JUNE-2015

Guided by:

NAME: Dr. Niraj Karamchandani

Degree: MPT Sports Rehabilitation

Designation: Lecturer, R K University


CERTIFICATE

This is to certify that the project work entitled “Title of study effect of arch support on

balance performance in individuals with flatfoot” has been undertaken and written

under my supervision and it describes the original research work carried out by Ms.

Goriya Hetal & Gohil Nirupa registered at RK University in 6th semester Bachelors of

Physiotherapy.

Signature of Guide: Name: Dr. Niraj Karamchandani Degree: MPT Sports Rehabilitation Designation: Lecturer, R K University


DECLARATION

We hereby certify that we are the authors of this project work. We certify to the best of

our knowledge, our project does not infringe upon anyone’s copyright nor violate any

proprietary rights and that any ideas, techniques, quotations, or any other material from

the work of other people included in our project published or otherwise, are fully

acknowledged in accordance with the standard referencing practices. We declare that

this is a true copy of our project, including any final revisions, as approved by my project

review committee.

Signature.of candidate Signature.of candidate

Goriya Hetal Gohil Nirupa

Enrolment no.: 12SPTPT11032 Enrolment no.: 12SPTPT11031

Date: 2-6-2015 Date: 2-6-2015

Place: RK University Place: RK University


ACKNOWLEGEMENT

First and foremost we would like to thank my parents Goriya Jentibhai & Goriya Vasanben

and Gohil Manubhai & Gohil Babitaben who are my living Gods and my brother Goriya

Kishan & Gohil Dhaval for their valuable support and encouragement, blessing and love

which has always been a source of inspiration and strength in accomplishing this academic task.

My heartfelt gratitude to almighty God who has guided me this far and to whom goes all the

honor and glory for the successful completion of this study.

We wish to express my regards to my Director School of Physiothera Dr.Priyanshu Rathod

py, R.K.University for her whole hearted guidance and meticulous suggestions in the completion

of this work and for all the facilities and support extended to me during this study. We are

extremely thankful for her constant encouragement and inspiration during the course of this

study.

With due respect, we would like to express my sincere thanks to my guide Dr. Niraj

Karamchandani Senior lecturer of Schoolof Physiotherapy, R.K.University, for his judicious

information, expert suggestions, valuable guidance, continuous support, incessant reassurance

during every stage of this work and interest shown in this dissertation without which this work

would not have been possible.

We would like to extend my heartfelt thanks to assistant lecturer, Dr. Kajal mam for their

valuable guidance, constant help and support throughout this study and all the lecturers of my

college who have taught me and gave their valuable suggestions during the course of the study.


My sincere thanks to Dr. Niraj Karamchandani for taking keen interest in my study, guiding

me through the path, giving me support and motivation during the course of study.

We wish to express my thanks to Harshal sir our librarian for their timely help in lending me

books and journals for my reference all the time..

We shall fail my duties if I don’t acknowledge my Colleagues and Friends for their suggestions

and criticism while assisting me in this study.

Last but not the least I would like to thanks all the Individuals in my study without whom this

task would not have been possible.

My sincere thanks to all the contributors whose names we might have missed but who truly

deserve my gratitude.

We would like to thank once again to all who have helped me all the while.

Signature Signature

Name: Goriya Hetal Name: Gohil Nirupa


TABLE OF CONTENTS

Sr. No. Title Page No.

| List of Figures |

| List of Tables ||

| List of Graphs |||

| Structured Abstract IV

1 Introduction 1

2 Need of the Study 3

3 Aim & Objectives of the study 5

4 Hypothesis 7

5 Review of literature 9

6 Methodology 11

6.1 Criteria for selection 13

6.2 Materials used in the study 14

6.3 Method 15

7 Results 20

8 Discussion 25

9 Summary and Conclusion 28

10 References 32

11 Appendices 34

12 Certificate A

13 Certificate B


List of Figures

Sr. no. Figure no. Subject Page no. 1 6.1 Arch support 15

2 6.2 Star Excursion Balance Test

16

3 6.3 Single Limb Stance Time

18


LIST OF TABLES

Sr. no Tables no. Subject Page no.

1 7.1 Star Excursion

Balance Test 22

2 7.2 Single Limb Stance

Time 23

Effect of arch support on balance performance in individual with flat foot

10

LIST OF GRAPHS

Sr. no. Graphs no. Subject Page no.

1 7.1 Star Excursion Balance Test

23

2 7.2 Single Limb Stance Time

24


11

ABSTRACT

Title: “Effect of arch support on balance performa nce in individuals

with Flatfoot”

Author: Goriya Hetal (12SPTPT11032) and Gohil Nirupa (12SPTPT11031)

Guided by: Dr.Niraj Karamchandani

BACKGROUND: Pes planus or flatfoot is defined as a condition in which the arch of the foot is abnormally flattened down so that the entire sole makes contact with the ground. Several studies have shown that flat foot reduces the lower limb balance performance in compare to normal arched foot. Arch support is used to increase arch height thus it might increase the balance performance of an individual. Very few studies are available which has directly measure the effects of arch support on balance performance in flatfeet.

AIM: The aim of the study was to assess the effect of arch support on balance performance in individuals with flatfoot.

METHODOLOGY: Study design: experimental study, Inclusion criteria: 18-25 years of individuals male and female) having bilateral flexible flat foot, Positive Feiss line (i.e. Navicular drop) present, Exclusion criteria: any recent lower limb injury, any foot deformity other than flat foot that may hinder the performance , any neurological disorder that may affect the balance of an individual, Sample size : 20 subjects, Sampling : convenient sampling method, Study setting: school of physiotherapy, RK University, Rajkot.

RESULTS: The results showed that static and dynamic balance with shoes and insoles increases in individuals with bilateral flat feet.

CONCLUSION: Present study suggests that the balance performance is improved with the use of arch support.

KEY WORDS: flatfoot, star excursion balance test (SEBT), single limb stance time (SLST), arch support


12

INTRODUCTION


13

INTRODUCTION

Pes planus or flatfoot is defined as a condition in which the arch of the foot

is abnormally flattened down so that the entire sole makes contact with the ground. (1)

Causes of flat foot includes: Congenital flat foot, weakened muscles due to aging or

heavy strain placed on the feet, Standing or walking for long periods in high heels and

wearing shoes that don’t provide proper arch support.

Symptoms of flat foot includes: Feet tire easily, feeling of instability

walking on uneven surface, painful or achy feet especially in the areas of the arches

and heels, foot movement such as standing on your toes is difficult. Flat foot can also

cause back and leg pain. Risk factors of flat foot includes: traumatic injury to foot or

ankle, Rheumatoid arthritis, obesity, Obesity, diabetes, neuromuscular disease. eg.

Hemiplegic, polio.

Treatment of flatfoot involves: Rest and ice to relieve pain and reduce

swelling if present, Physical therapy such as stretching exercises, intrinsic muscle

strengthening exercises, orthotic devices, shoe modifications, braces or casts. Arch

support is used to increase arch height thus it might increase the balance performance

of an individual.

Several studies have shown that flat foot reduces the lower limb balance

performance in compare to normal arched foot. One of the study supports the use of a

custommade flexible orthotic for the improvement of pedal structural alignment.(5)

Study done by Yu-Chi Chen,at all The results showed that walking with shoes and

insoles and walking with shoes conditions increased the peak ankle dorsiflexion angle

and moment , and also reduced the peak ankle plantarflexion angle and moment.(6)

Therefore there are Very few studies that have directly evaluated effect of arch support

on balance performance in individuals with bilateral flatfeet.


14

NEED OF THE STUDY


15

NEED OF THE STUDY

Very few studies are available which has directly measure the effects of arch support on

balance performance in flatfeet. So there is a need to analyze the effect of arch support

on dynamic and static balance in individuals with flat feet


16

AIM AND OBJECTIVES


17

AIM & OBJECTIVES

AIM:

The aim of the study was to assess the effect of arch support on balance performance

in individuals with flatfoot.

Objective:

• To study the effect of arch support on dynamic balance in individuals with

flatfoot using Star Excursion Balance Test ( SEBT)

• To study the effect of arch support on static balance in individuals with flatfoot

using Single Limb Stance Time (SLST)


18

HYPOTHESIS


19

HYPOTHESIS

Null hypothesis:

There is no significant different in all the directions of SEBT for the

both before and after application of arch support. There is increase in the distance of

SEBT after arch support.

Alternative hypothesis:

There is significant different in all the directions of SEBT for the both

before and after application of arch support. There is increase in the distance of SEBT

after arch support.


20

REVIEW OF LITERATURE


21

REVIEW OF LITERATURE

1. Munro GA, Herrington et al 2010 have checked the between session

reliability of Star Excursion Balance Test (SEBT). 22 healthy recreational

athletes (11 males, 11 females) were included and test –retest reliability of

SEBT was measured. They found 0.84 to 0.92 reliability of SEBT.

2. D.Robert Kuhn DC, Nofa j. shibley DC, 1999 et al. To determine whether

any positive change in the alignment of the bones of the feet occur with the

use of custom-made flexible orthotics, cast by weight bearing, in individuals

having flexible pes planus. Biomechanical faults in the pedal foundation can

adversely affect any of the joints and structures of the foot/ankle complex,

lower extremities, pelvis and spine. This study supports the use of a

custommade flexible orthotic for the improvement of pedal structural

alignment. (5)

3. Yu-chi Chen, shu- zon Lou, 2010 et al. Although foot orthotics is widely

prescribed for the treatment of flatfoot, the biomechanical effects of such

devices are not yet fully clear. Accordingly, this study conducted an

experimental investigation to evaluate the effects of orthoses on the gait

patterns of patients with flatfoot during level walking. The results suggested

that the foot insoles and shoes developed in this study might benefit the

ankle joint in patients with flatfeet. (6)


22

METHODOLOGY


23

METHODOLOGY

Study design: experimental study

Study setting : school of physiotherapy, RK University, Rajkot.

Sampling technique: convenient sampling method.

Study Population: 18-25 years of individuals with bilateral flat feet

Study Sample: 20 subjects.

Study Duration: Total Study duration – 14 weeks

Training duration – single session study


24

CRITERIA FOR SELECTION

Inclusion criteria: 18-25 years of individuals (male and female) having bilateral

Flexible flatfoot, positive Feiss line (i.e. Navicular drop) present.

Exclusion criteria: Any recent lower limb injury, any foot deformity other than flat foot

That may hinder the performance, any neurological disorder that

May affect the balance of an individual.


25

MATERIALS USED IN THE STUDY

(1) Chalk

(2) Pen

(3) Arch support

(4) Star excursion balance test grid

(5) Stopwatch

(6) Measure tape

(7) Weighting machine


26

METHOD

Procedure :

We have identified subject having flatfoot from Rk university. Subjects were selected

between the age 18-25 years (male and female) having bilateral flexible flatfeet.

Subjects were informed with details of study. Interested subjects were included as per

the inclusion criteria. Then for further investigation to continue with the study we

performed Feiss line (i.e. Navicular drop) present. After finding the test positive we

asked their consent for the further investigation and written informed consent was taken.

After asking their consent we performed Star Excursion Balance Test and Single limb

stance time on subjects as a baseline reading of dynamic as well as static balance.

Then arch support was inserted in each limb. After insert of arch support, we again

checked the balance of subject using SEBT and SLST. Data was collected in for each

subject in similar way.

Star excursion balance test:

The subject was guided to perform SEBT and the following readings for both the limbs

were taken, with and without arch support. (2) (3) (4)

(Arch support)


27

(Star Excursion Balance Test)


28


29

Single limb stance time:

The subjects were asked to stand on one leg with his/her eyes closed so that the

sensory feedback is inhibited. The time up to which the subject can maintain the

balance was noted. Test was performed with and without arch support.

(Single limb stance time)

Pre and post results will be compared.


30

Pre and post results will be compared.

The time up to which the subject can maintain the balance was noted. Test was performed with and without arch support.

The subjects were asked to stand on one leg with his/her eyes closed so that the sensory feedback is inhibited.

The subject were guided to perform SEBT and the following readings for both the limbs were taken , with and without arch support.

Baseline assessment will be taken before arch insert and post insert reading of SEBT and SLST will be taken.

Signing of consent form.

Making subject understand the procedure.

Selecting subject as per inclusion criteria.


31

RESULTS


32

RESULT ANALYSIS

A comparative study was performed in SEBT and SLST was assessed in taken subject.

The pre and post values for SEBT and SLST values were collected for taken subject

Statistic was performed using paired t test for both SEBT and SLST.

• Paired t test taken subject

• Calculate t value

• Paired t test two tailed p value for SEBT is < 0.0001

• Paired t test two tailed p value for SLST IS < 0.0001

• The data analyze by using paired t test result were result obtained

• There is significant difference between pre and post in subjects with taken

subjects.


33

RESULT ANALYSIS

There is significant different in all the directions of SEBT for the both before and after

application of arch support. There is increase in the distance of SEBT after arch insert.

Side & Direction

Pre (x ± SD)

Post (X ± SD)

Mean (X ± SD)

t value

P value

RA 86.74±10.78 93.08±12.02 6.34±5.57 -5.094

<0.00 RPL 67.00±13.94 74.97±12.79 7.97±4.99 -7.136

RPM 73.54±9.07 81.46±10.89 7.92±5.94 -5.959

LA 88.32±8.39 93.42±10.09 5.09±4.32 -5.274

LPL 67.95±8.75 76.68±11.68 8.72±9.60 -4.061

LPM 75.99±7.61 83.74±8.85 7.75±4.66 -7.437

*(RA = Right Anterior, RPL = Right Poster lateral, RPM = Right Posteromedial , LA = Left Anterior , LPL = Left Posterolateral , LPM = Left Posteromedial)

The result is shown in given chart:


34

(RA = Right anterior, RPL = Right Posterolateral, RPM = Right Poster medial, LA = Left anterior, LPL = Left Posterolateral, LPM =Left Poster medial)

There is significant different in both the legs of SLST for the both side before and after

application of arch support. There is increase in the time of SLST after arch insert.

Side & Direction

Pre (X ± SD)

Post (X ± SD)

Mean (X ± SD)

t value P value

RSLS 7.34±2.47 12.72±3.89 5.38±2.76 -8.696 0.000

LSLS 8.30±2.29 13.70±4.58 5.40±4.29 -5.616 0.000

(RSLS = Right single limb stance, LSLS = Left single limb stance)

The result is shown in given chart:

86.74

67

73.54

88.32

67.95

75.99

93.08

74.97

81.46

93.42

76.68

83.74

0

10

20

30

40

50

60

70

80

90

100

Right Anterior Right PL right PM left anterior left PL left pm

pre

post


35

( RSLS = Right single limb stance , LSLS = Left single limb stance )

7.34

8.3

12.72

13.7

0

2

4

6

8

10

12

14

16

RSLS LSLS

pre

post


36

DISCUSSION


37

DISCUSSION

Aim of our study was to see the effect of arch support on balance performance in

individuals with flatfoot in 18 – 25 age groups.

There is significant different in all the direction of SEBT for the both before and after

application of arch support. There is increase in the distance of SEBT after arch insert.

This shows that arch support has increased the foot stability and thus improved the

balance performance. (2)

There is significant different in both the legs for SLST for the both side before and after

application of arch support. There is increase in the time of SLST after arch insert.

Thus, static balance has also improved following arch insert.

Study done by Yu-Chi Chen, at all the results showed that walking with shoes and

insoles and walking with shoes conditions increased the peak ankle dorsiflexion angle

and moment, and also reduced the peak ankle plantarflexion angle and moment.

Study done by D.Robert Kuhn DC at all the t test values and p values derived from the

analysis indicated statistically significant improvements in both dynamic and static

balance. This study supports the use of a readymade flexible arch support for the

improvement of pedal balance.

The results showed that static and dynamic balance with shoes and insoles increases in

individuals with bilateral flat feet.


38

LIMITATIONS OF THE STUDY

• Small sample size

• Ready made one sized arch support was used

• Specific age is included

FURTHER RECOMMENDATION:

• Use of custom made arch support

• Sample size can be larger

• can use wider age group


39

CONCLUSION


40

CONCLUSION

Present study suggests that the balance performance is improved with the use of arch

support in individuals with flatfoot.


41

SUMMARY


42

SUMMARY

Pes planus or flatfoot is defined as a condition in which the arch of the foot is

abnormally flattened down so that the entire sole makes contact with the ground.

Several studies have shown that flat foot reduces the lower limb balance performance in

compare to normal arched foot. Arch support is used to increase arch height thus it

might increase the balance performance of an individual. Researcher’s aim was finding

the effect of arch support on balance performance in individuals with flatfoot so

researcher’s 1) select the age18-25 year 2) select the subject 3) measure all collages

student’s height and weight 4) measure BMI 5) find out flat feet in only student 6)

measure limb length. The following reading for both the limbs were taken, with or

without arch support .Pre and post results will be compared. There is significant

different in all the direction of SEBT for the both before and after application of arch

support. There is increase in the distance of SEBT after arch insert. There is significant

different in both the legs for SLST for the both side before and after application of arch

support. There is increase in the time of SLST after arch insert. Present study suggests

that the balance performance is improved with the use of arch support.


43

BIBLOGRAPHY


44

BIBLOGRAPHY

1. website: http://www.nlm.nih.gov/medlineplus/ency/article/001262.htm

2. Heyward V. Human kinetics, Star Excursion Balance Test 6th edition:303 (5)

3. Plisky P et al. Am J Sports Phys Ther. The Reliability of an Instrumented Device for Measuring

Components of the Star Excursion Balance Test. 2009 May; 4(2): 92-99. (2B)

4. Olmsted L., Caria C., Hertel J., Shultz S. Efficacy of the Star Excursion Balance Tests in Detecting

Reach Deficits in Subjects with Chronic Ankle Instability. Journal of Athletic Training

2002;37(4):501-506 (1B)

5. Journal of Manipulative and Physiological Therapeutics May 1999, Vol.22 (4):221-226, doi:

10.1016/…..

6. Clinical Biomechanics March 2010, Vol.25(3):265-270, doi:10.101…


45

ANNEXURES


46

ANNEXURE 10.1

CONSENT FORM Study title: “EFFECT OF ARCH SUPPORT ON BALANCE PERFORMANCE IN

INDIVIDUAL WITH FLATFOOT”

Subject’s Name: _______________________________________________________

Age : ____________Years Sex:__________

Occupation: ____________________

Address of the Subject ____________________________________________

I have been explained in details about the various questions/tests that will be

asked/performed is to assess my functional capacity & health status etc. I have also

been explained that all the tests are non-invasive and without any side effect.

I understand that my participation in the study is voluntary and that I am free to withdraw

at any time, without giving any reason, without my medical care or legal right being

affected.

I understand that the data obtained through the study may be used for research paper

publication and I also understand that my identity will not be revealed at any cost. I

agree to give my consent for taking my photograph and have no objection against it.

I agree to take part in the above study

Signature of the subject:

Date:

Name of Witness:

Signature of the Witness:

Signature of Investigator:

Date:


47

ANNEXURE 10.2

DATA COLLECTION FORM

Name: ____________________________________

Age: ____ Gender: ______ Height: ______ Weight: _________ BMI: ________

Address: _______________________________________________________

Occupation: ____________________________________________________

Chief complaints: ________________________________________________

History: history of ankle sprain, history of any other previous lower limb injury__________________________________________________________________________________________________________________________________

On observation:

Posture:-

Deformity:-

Attitude of lower limb:-

On examination:

Vitals:

HR: - _____________________________

BP: - ______________________________

Temperature: ________________________

PR: ________________________________


48

MMT:-

Muscle Grade Right Left Planter flexor Dorsi flexor Evator Inviter

Tightness: ____________________________

Gait: _________________________________

Balance examination:-

Start exclusion balance test

Pre Post Right Left Right Left A P

L P M

A

P L

P M

A P L

P M

A P L

P M

Single limb stance time

Pre Post Right Left Right Left

Functional examination:-


49

ANNEXURE 10.3

MEASUREMENT TOOL

Measure tap


50

ANNEXURE 10.4

SCALES USED IN OUTCOME MEASURES

� Star excursion balance test

� Single limb stance time


51

ANNEXURE 10.5

MASTER CHART

NO

Name Age Sex Limb length

measurement

Star excursion balance test

Pre Post

Right Left Right Left

Right Left A

P

L

P

M

A

P

L

P

M

A

P

L

P

M

A

P

L

P

M

1 Virali bhansali 21 F 94 94 90 61 75 95 64 71 93 64 78 99 74 78

2 VrundaVadera 18 F 90 90 82 53 70 85 54 66 88 56 87 88 61 78

3 Charmi mehta 18 F 94 94 68 87 59 76 59 70 79 90 63 80 70 72

4 Heena pandya 20 F 96 96 76 54 68 84 68 75 87 65 82 89 71 82

5 Grishma vasani 21 F 98 98 67 55 60 80 63 65 70 65 63 82 80 77

6 Rinkal nakarani 18 F 97 97 80 60 64 82 67 72 78 73 84 78 75 77

7 Mansi kakadiya 21 F 90 90 79 87 79 85 77 82 98 89 93 90 89 98

8 Pooja popat 19 F 99 99 88 59 68 91 57 71 91 62 72 93 62 78

9 Disha namera 18 F 94 94 87 52 61 79 52 60 89 64 66 87 57 65

10 Khushbu

raladiya

18 F 96 96 84 65 73 88 58 77 94 69 75 97 83 86

11 Shreya patel 19 F 90 90 85 48 69 90 50 71 88 61 77 93 53 72


52

12 Gamdha hiral 21 F 104 104 10

0

91 10

0

94 84 99 11

5

104 103 110 105 10

6

13 Mayuri vghasiya 21 F 91 91 97 66 72 87 71 68 98 80 81 100 73 80

14 Nidhi prajapati 21 F 98 98 88 57 72 86 61 74 95 68 76 93 68 75

15 Pooja kalaria 21 F 92 92 87 51 62 87 54 66 98 66 77 90 86 76

16 Kishan goriya 19 M 98 98 10

2

67 75 97 67 79 10

5

71 80 100 72 84

17 Ankit sardhara 21 M 96 96 79 68 81 68 60 72 82 71 85 73 64 75

18 Swati savaliya 20 F 94 94 69 85 60 76 62 72 71 88 64 80 68 78

19 Pooja mishara 22 F 94 94 66 50 52 70 75 60 72 55 65 72 78 74

20 Riddhi vyas 20 F 88 88 69 54 64 72 60 70 72 60 71 75 65 75

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