[논문]The Effects of Foot Intrinsic Muscle and Tibialis Posterior Strengthening Exercise on Plantar Pressure and Dynamic Balance in Adults Flexible Pes Planus

Lee, Da-bee; Choi, Jong-duk

doi:10.12674/ptk.2016.23.4.027

The Effects of Foot Intrinsic Muscle and Tibialis Posterior Strengthening Exercise on Plantar Pressure and Dynamic Balance in Adults Flexible Pes Planus 원문보기

한국전문물리치료학회지 = Physical Therapy Korea, v.23 no.4, 2016년, pp.27 - 37

Lee, Da-bee (Rehabilitation Center, Chungnam University Hospital) , Choi, Jong-duk (Dept. of Physical Therapy, College of Health & Medical Science, Daejeon University)

Abstract ▼ AI-Helper

Background: In previous studies regarding flexible pes planus, Foot orthosis, special shoes have been used as interventions for correcting malalignment and intrinsic muscles strengthening exercise have been regarded as interventions for foot function and supporting medial longitudinal arch during walking. However, some recent studies reported that strengthening extrinsic muscles as well as intrinsic muscles is more effective and active intervention for flexible pes planus. In particular, the tibialis posterior muscle of foot extrinsic muscles plays essential roles in maintaining the medial longitudinal arch during dynamic weight bearing and balance. In addition this muscle acts longer than other supination muscles during the stance phase in the gait cycle. Objects: This study aimed to investigate the effect of foot intrinsic muscle and tibialis posterior muscle strengthening exercise for plantar pressure and dynamic balance in adults with flexible pes planus. Methods: 16 young flexible pes planus adults (7 males, 9 females) were recruited and were randomized into two groups. The experimental group performed foot intrinsic muscle and tibialis posterior muscle strengthening training, the control group performed only foot intrinsic muscle strengthening training. All groups received strengthening training for 30 minutes five times a week for six weeks. Results: The experimental group had significantly lower plantar pressure of medial heel area than the control group in stand (p<.05). The experimental group had significantly higher dynamic balance ability than control group (p<.05). Conclusion: The results of this study provide evidence to suggest that foot intrinsic muscle and tibialis posterior muscle of extrinsic muscle strengthening exercises may improve plantar pressure distribution and dynamic balance ability in adults with flexible pes planus.

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가설 설정

Therefore, the present study includes an examination of the effects of strengthening the tibialis posterior muscle, which maintains foot supination for the longest time among the extrinsic muscles that maintain the MLA, as well as effects on intrinsic muscles related to foot arch height, dynamic balance, and foot plantar pressure distribution in young adults with flexible pes planus. The hypothesis states that intervention methods combining foot intrinsic muscle strengthening exercise and tibialis posterior muscle strengthening exercise will affect flexible pes planus by decreasing foot arch height differences before and after weight bearing, increasing dynamic balance, and decreasing plantar medial column pressure.

제안 방법

For TC and SF exercises in a sitting position, the subject sat on a chair to support the hip, knee, and ankle joints at 90° angles.
All exercises were performed in a sequence from a sitting position, to a standing position, and finally a one-legged standing position (Jung et al, 2011). In addition, the researcher instructed the subjects to perform all exercises with maximum efforts.
05). NDTs were conducted to select subjects and measure foot arch heights. Both groups showed significant decreases in foot arch height differences before and after weight bearing after interventions (p[.
The Gaitview is a pressure pad in the form of a footboard consisting of 2,304 (48×48 ㎟) sensors placed in an area of 410×410 ㎜, and it is highly reliable (Kim and Lee, 2012). The foot plantar pressure measurements were divided into eight zones: hallux, the second through fifth toes, first metatarsal (M1), second through fourth metatarsals (M24), fifth metatarsal, midfoot (MF), medial heel (MH), and lateral heel. To measure the foot plantar pressure distributions, the subjects were instructed to stand upright on the Gaitview for 30 seconds in a comfortable posture with eyes open and looking forward.
The general characteristics of the study subjects are provided in Table 1, and selection criteria included foot arch height differences before and after weight bearing exceeding 10 ㎜ (Cote et al, 2005), normal weight with a body mass index ranging from 18.5∼23.0 (Chang et al, 2010), and no use of insoles or orthoses.
The subjects in the experimental group performed selective tibialis posterior muscle strengthening exercises along with the intrinsic foot muscle strengthening exercise, while the subjects in the control group performed only the intrinsic foot muscle strengthening exercise. The interventions were implemented for 30 minutes per time, 5 times per week for 6 weeks.
The purpose of the present study was to examine the effects of exercise to strengthen the tibialis posterior muscle, which is an extrinsic muscle, as well as intrinsic foot muscles on foot arch height, foot plantar pressure distribution and dynamic balance among young adults with flexible pes planus. According to the results, the FTST group, which combined strengthening exercises of the tibialis posterior muscle and intrinsic foot muscles, showed decreased foot arch height differences before and after weight bearing, improved dynamic balance, and significantly decreased foot plantar pressure in the M1 bone, M24 bones, and MH after intervention.
For the foot supination resistance exercise, each subject placed one leg on and stood at the lateral end of the footboard with the knee joint of placed on the footboard maintained a bend. The subject placed the medial part of the heel and foot at the base of the third metatarsal bones on the edge of the footboard to perform foot supination (Figure 1).
After hearing sufficient explanations of the study, three participants were excluded during the selection process. The subjects were divided into an experimental group (foot intrinsic muscle and tibialis posterior muscle strengthening training; FTST) that performed intrinsic foot muscle and tibialis posterior muscle strengthening exercises and a control group that performed intrinsic foot muscle strengthening exercise (foot intrinsic muscle strengthening training; FST). The subjects were randomly assigned to the groups by having them draw a card indicating one of the two groups.
This study included 16 male and female adults with flexible pes planus divided into an intrinsic foot muscle and tibialis posterior muscle strengthening exercise group and a intrinsic foot muscle strengthening exercise group to examine the effects of the exercises on foot arch height, foot plantar pressure distribution, and dynamic balance. According to the results, the combined exercise group showed decreases in arch height differences before and after weight bearing, improvement of dynamic balance, and significant decreases in foot plantar pressure in the M1 bone, M24 bones, and MH after intervention.

대상 데이터

This study included 16 young adults (7 males and 9 females) with flexible pes planus residing in Daejeon City of Korea. After hearing sufficient explanations of the study, three participants were excluded during the selection process.

성능/효과

According to the results of the present study, the FTST group showed significant increases in stretching distances in all directions, including SEBT-L (foot supination), SEBT-A (forward movement of the center of gravity similar to the propulsion stage in gait cycles), and SEBT-AM and SEBT-M directions (moving the center of gravity toward the medial side of the foot; p<.05).
The purpose of the present study was to examine the effects of exercise to strengthen the tibialis posterior muscle, which is an extrinsic muscle, as well as intrinsic foot muscles on foot arch height, foot plantar pressure distribution and dynamic balance among young adults with flexible pes planus. According to the results, the FTST group, which combined strengthening exercises of the tibialis posterior muscle and intrinsic foot muscles, showed decreased foot arch height differences before and after weight bearing, improved dynamic balance, and significantly decreased foot plantar pressure in the M1 bone, M24 bones, and MH after intervention. In addition, this group showed significant decreases in MH pressure and significant increases in medial, lateral, and anterior-lateral SEBT stretching distances compared to the FST group, which performed only intrinsic foot muscle strengthening exercises (p<.
This study included 16 male and female adults with flexible pes planus divided into an intrinsic foot muscle and tibialis posterior muscle strengthening exercise group and a intrinsic foot muscle strengthening exercise group to examine the effects of the exercises on foot arch height, foot plantar pressure distribution, and dynamic balance. According to the results, the combined exercise group showed decreases in arch height differences before and after weight bearing, improvement of dynamic balance, and significant decreases in foot plantar pressure in the M1 bone, M24 bones, and MH after intervention. This group also showed decreases in MH pressure and significant increases in stretching distances during medial and lateral SEBTs, but as the center of gravity moving toward the medial side of the foot during the anterior-lateral SEBT, forward movement of the center of gravity was similar to the propulsion stage of the gait cycle and caused foot supination (p<.

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