TF and MFR on Calf Muscles in Patients With Pes Planus

NCT ID: NCT06707844

Last Updated: 2025-09-03

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 44 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2024-01-21
• Study Completion Date: 2025-08-29

Brief Summary

Pes planus, commonly known as flat feet, is a condition characterized by a reduced or absent arch in the foot, which often leads to pain and functional limitations. This study aims to evaluate the effectiveness of two therapeutic interventions-tissue flossing and myofascial release-in improving balance, arch height, and range of motion (ROM) in patients with flexible flatfoot. The research will be conducted at the Margalla Rehabilitation Center over a duration of six months, involving a total of 44 participants divided into two equal groups. One group will receive tissue flossing as the intervention, while the other group will undergo myofascial release. Participants will be selected using non-probability convenience sampling. Eligible individuals will be adults aged 18-25 years with flexible pes planus and limited ankle dorsiflexion. The study seeks to provide valuable insights into the comparative effectiveness of these interventions for managing symptoms associated with flat feet. Data was be analyzed through SPSS version 25.

Detailed Description

Pes planus, or flat feet, is characterized by a reduced or absent arch, causing the entire sole to contact the ground. It is categorized into flexible and rigid types, with flexible pes planus being more common. In this form, the arch is visible in non-weight-bearing positions but flattens during standing or walking, while rigid pes planus remains flat irrespective of weight-bearing. The condition often results in foot instability, excessive eversion, and midfoot abduction, leading to pain, fatigue, and reduced shock absorption during activities.

Flexible flatfoot is prevalent in children but can persist into adulthood, affecting 2% to 23% of adults in the U.S. and 13.6% in India. It disrupts gait mechanics, shifting weight medially, impairing balance, and increasing injury risk. Management ranges from conservative treatments like physical therapy to surgical interventions in severe cases.

Emerging therapies include tissue flossing and myofascial release (MFR). Tissue flossing uses compression bands to improve blood flow, reduce pain, and enhance range of motion (ROM). In contrast, MFR applies sustained pressure to relieve fascial tension, promoting flexibility and reducing discomfort. Both techniques show promise for addressing the biomechanical and functional impairments associated with pes planus.

Literature review: According to literature, Galis et al. (2022) performed a study that aimed to examine the effects of applying tissue flossing band at different pressure levels on ankle ROM, strength and power performance in university students. The results showed an increase in dorsiflexion ROM and power. Furthermore, the author concluded that this can aid injury prevention, performance enhancement, and functional ability.

In another study, Driller et al. (2016) conducted a study on the effects of tissue flossing on ankle ROM and jump performance in recreational athletes. The study concluded that applying floss bands to the ankle effectively increased both dorsiflexion and plantarflexion ROM and enhances single-leg jump performance in recreational athletes.

Similarly, Choi et al. (2022) conducted a study aimed at investigating the impact of myofascial release of the peroneus longus muscle on the activity of the abductor hallucis muscle and the medial longitudinal arch in individuals with flexible pes planus. The results showed an increase in abductor hallucis muscle activity and elevation of the medial longitudinal arch.

A study conducted by Chang et al. (2021) examined the effect of a single session of tissue flossing on the knee joint in female college students. The results showed a significant improvement with a medium-to-large effect in the Y-Balance test assessment immediately postintervention. He concluded that tissue flossing can indeed enhance dynamic balance.

Conditions

Pes Planus

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Tissue flossing

• Tissue flossing involves wrapping a latex band around the calf muscles with 50-75% elongation, followed by active ankle movements (dorsiflexion, plantarflexion, circles, heel raises).
• Protocol: 4 sets of 8 repetitions, 10-second rest between sets
• Performed twice weekly for 3 weeks.

Conventional Treatment

Group Type: EXPERIMENTAL

Conventional treatment

Intervention Type: OTHER

Conventional treatment will include:

• Stretching exercises (5Reps with 15sec hold): Gastrocnemius-soleus stretch, TA stretch.
• Strengthening exercises (5Sets, 5Reps, 5sec hold): Weight-bearing lunges, Short-foot exercise.
• Maitland mobilization Grade 2 & 3 (3 Sets, 20Reps) at Talonavicular joint.

Tissue flossing

Intervention Type: OTHER

Tissue flossing involves wrapping a latex band around the calf muscles with 50-75% elongation, followed by active ankle movements (dorsiflexion, plantarflexion, circles, heel raises).

Protocol: 4 sets of 8 repetitions, 10-second rest between sets Performed twice weekly for 3 weeks.

Myofascial release

• Myofascial release is a manual therapy applying sustained pressure on the calf muscles to release fascial restrictions.
• Protocol: 3 sets of 2-minute pressure applications with a 1-minute break between sets
• Performed twice weekly for 3 weeks

Conventional Treatment

Group Type: ACTIVE_COMPARATOR

Conventional treatment

Intervention Type: OTHER

Conventional treatment will include:

• Stretching exercises (5Reps with 15sec hold): Gastrocnemius-soleus stretch, TA stretch.
• Strengthening exercises (5Sets, 5Reps, 5sec hold): Weight-bearing lunges, Short-foot exercise.
• Maitland mobilization Grade 2 & 3 (3 Sets, 20Reps) at Talonavicular joint.

Myofascial release

Intervention Type: OTHER

• Myofascial release is a manual therapy applying sustained pressure on the calf muscles to release fascial restrictions.
• Protocol: 3 sets of 2-minute pressure applications with a 1-minute break between sets
• Performed twice weekly for 3 weeks

Interventions

Conventional treatment

Conventional treatment will include:

• Stretching exercises (5Reps with 15sec hold): Gastrocnemius-soleus stretch, TA stretch.
• Strengthening exercises (5Sets, 5Reps, 5sec hold): Weight-bearing lunges, Short-foot exercise.
• Maitland mobilization Grade 2 & 3 (3 Sets, 20Reps) at Talonavicular joint.

Intervention Type: OTHER

Myofascial release

• Myofascial release is a manual therapy applying sustained pressure on the calf muscles to release fascial restrictions.
• Protocol: 3 sets of 2-minute pressure applications with a 1-minute break between sets
• Performed twice weekly for 3 weeks

Intervention Type: OTHER

Tissue flossing

Tissue flossing involves wrapping a latex band around the calf muscles with 50-75% elongation, followed by active ankle movements (dorsiflexion, plantarflexion, circles, heel raises).

Protocol: 4 sets of 8 repetitions, 10-second rest between sets Performed twice weekly for 3 weeks.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Age 18-25 years.
• Having normal BMI ranging from 18.5 to 24.9 kg/m²
• Having flexible flat feet, defined as a navicular drop test value of ≥10 mm
• Must have pain in the calf muscles or ankle joint, with a NPRS score of ≥3
• Must have limited ankle dorsiflexion ROM, defined as ≤10° of dorsiflexion

Exclusion Criteria

• Patients with rigid flatfoot
• History of ankle or calf muscle injury or surgery within the last 6 months
• Individuals with latex allergy
• Individuals having any lumbo-pelvic, hip, knee and ankle pathologies such as fractures, dislocations, degenerative diseases etc.
• Any neurological disease
• Pregnant females
• Individuals with BMI greater than or equal to 25.0 kg/m²
• Ongoing use of medications such as muscle relaxants or anti-inflammatory drugs
• Involved in athletic training

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 25 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Aneela Zia, MsOMPT

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

Margalla Rehabilitation Center

Rawalpindi, Punjab Province, Pakistan

Countries

Pakistan

References

1. R A, Malar A, J H, G S. The cause and frequency of PES Planus (Flat Foot) problems among young adults. Asian Journal of Medical Sciences. 2021;12(7):107-11.

Reference Type: BACKGROUND

Other Identifiers

REC/MS-PT/02019 Arfa Zafar

Identifier Type: -

Identifier Source: org_study_id