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ORIGINAL ARTICLE
Year : 2022  |  Volume : 25  |  Issue : 1  |  Page : 21-26

Effectiveness of Kinesio Taping and Exercises for Pronated Feet in Children with Neurodevelopmental Disorders: A Cross Over Study


Department of Paediatric Physiotherapy, SDM College of Physiotherapy, Karnataka, India

Date of Submission03-Feb-2021
Date of Acceptance24-May-2021
Date of Web Publication19-Jan-2022

Correspondence Address:
Dr. S T Parmar
Department of Paediatric Physiotherapy, SDM College of Physiotherapy, Dharwad, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_62_21

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   Abstract 


Background: Taping is widely used intervention in various conditions treated by physiotherapist. Neurodevelopmental disorders in children leading to foot abnormality is one of the major concen. As taping is one of the intervention in same the study is focusing taping on pronated feet in the selected age group. Aim: The aim of this study was to investigate whether the kinesiotaping and exercise improve pronated feet in neurodevelopmental disordered (NDD) children. Patients and Methods: This was a cross over study, within subjects study evaluating two treatments, kinesio tape, and exercise. Thirty subjects with age group 6–12 years diagnosed with NDD having pronated feet. Subjects were allocated in the two groups. Group 1 included subjects for taping and Group 2 included subjects for exercise. Taping was applied for two consecutive weeks for 5 days per week and then 2 weeks of the window period, which was followed by two consecutive weeks of exercise sessions for 5 days per week. The navicular drop test and Foot Posture Index were measured pre and post treatment. Foot posture index used to examine the posture of foot and navicular drop test. Results and Conclusion: Group 1 (taping) and Group 2 (exercises) showed no significant results as a single entity, whereas there was a small effect seen of the intervention.

Keywords: Children, exercise, kinesio taping, neurodevelopmental disorders, pronated feet


How to cite this article:
Parmar S T, Dhanuka H R, Shetty D R. Effectiveness of Kinesio Taping and Exercises for Pronated Feet in Children with Neurodevelopmental Disorders: A Cross Over Study. Niger J Clin Pract 2022;25:21-6

How to cite this URL:
Parmar S T, Dhanuka H R, Shetty D R. Effectiveness of Kinesio Taping and Exercises for Pronated Feet in Children with Neurodevelopmental Disorders: A Cross Over Study. Niger J Clin Pract [serial online] 2022 [cited 2022 Nov 30];25:21-6. Available from: https://www.njcponline.com/text.asp?2022/25/1/21/335990




   Introduction Top


Neurodevelopmental disorder (NDD) is a result of atypical central nervous system development which can occur in utero throughout the early to 5years of age[1] these may include complex conditions like genetic syndromes, cerebral palsy, mental retardation, epilepsy and autism. The causes can be varying for those disorders. Estimated NDDs were 9.2% and 13.6% in children aged 2-6years and above respectively and almost one-fifth of the children had more than one NDD.[2]

Pesplano valgus has been defined as a flattening or loss of the medial longitudinal arch.[3] Pesplano valgus is a combination of movement that is seen at the ankle joint, which is eversion, ankle dorsiflexion, and abduction of the foot. This condition is generally seen in patients who have no support for the medial longitudinal arch.

Many tools have been developed to assess the degree of foot pronation, including navicular drop test (NDT) > 10mm,[4] radiographs,[5] foot posture index(FPI)[6],[7], footprints, staheli's plantar index,[8] and clarke's angle.[9] Several interventions are used to correct excessive foot pronation in children and adults like kinesiotaping[10], faradic foot bath[11], short foot strengthening exercises[12], low dye taping[13], elastic band exercises for foot muscle strengthening[14], foot orthosis[15], custom-made medial arch support[4],[16], sham taping[6].

Exercises for foot muscles give sensory-motor training that activates the intrinsic muscles of the foot and also helps in achieving the longitudinal arch and the horizontal arch.[16] Kinesiotaping becomes increasingly popular for the conservative management of musculoskeletal impairments like foot pronation.

As seen in earlier studies, most of them had a long duration of intervention and was done for pronated feet's in normal children but as the prevalence quoted above of NDD, we intended to study pronated feet in children with NDD to see whether there is any effect of taping and exercises on pronated feet.

On review, the effect of above-mentioned interventions are in children with foot problems which include pronated feet, of all these interventions most of the studies are done in normal school-going children aging from 5 to 12 years of age and above. Also, it is feasible that kinesiotaping may be effective in correctin excessive pronation despite lacking the rigid properties of traditional tape.[4],[5],[6],[17]

And studies also had proven that exercise for short foot muscle was more effective than any other medial arch support and insoles for correcting the pronated foot.[4],[16],[18],[19], Kinesiotaping does not improve pronated feet when compared to sham taping and kinesiotaping in the age group between 18 to 40 years.[6] Studies are also done on the combined effect of kinesiotaping with exercise for pronated foot in school-going children population.[4] Considering NDD in children aged 6-12 years using kinesiotape and exercise on pronated feet, we intend to see the effect of kinesiotape in correcting pronated feet and also crossing over the subjects to see the effect of exercise to see if it is a simple alternative intervention for pronated feet in NDD.


   Method Top


Ethics

Ethical clearance was obtained from the institutional ethical committee, informed written consent and assent were obtained from all children and parents of the subjects before enrolment, and all rights of the participants were protected.

Study design

Selection and description of participants

Inclusion criteria for subjects were diagnosed cases of non-progressive NDD by a pediatrician, FPI score >6,[20],[21] NDT = >10 mm,[4] both male and female, age 6-12 years, patient should be able to stand without support or with minimum support. All the subjects were assessed on FPI, and NDT.

Sample size calculated at, 0.05% significance level, 2 sided, 1.17 standard deviation, 0.9 power, 1.5 the minimal detectable difference in means, sample for each group calculated was 15.

A total of 30 subjects was enrolled in the study, subjects were divided into two groups of 15 each, by using simple random sampling Group 1(taping)––15 subjects and Group 2 (exercise)––15 subjects all even number were taken in Group 1 and odd number in Group 2 and further cross over was done.[10],[22],[23]

Intervention

Subjects were evaluated and examined by the principal investigator at baseline on scales FPI and NDT and scorings were recorded in the respective data collection sheet. Subjects who fit the inclusion criteria were allocated according to even and odd simple randomization in their respective groups. The intervention was given for 2 weeks and then was a washout period of 2 weeks, and then the same subjects were crossed over to the next treatment for 2 weeks. Before the application of the tape, the area was evaluated for skin texture, skin allergy, and irritation of the skin.[4] First, the tape was applied longitudinally [Image 1], second diagonally [Image 2] Third transverse [Image 3] as per the clinical decision.[10] The same group of subjects was given exercises in the form of strengthening for ankle dorsiflexion on tilt board, lateral weight-bearing, standing on the vestibular ball, lateral shift of weight on the lateral border. All these exercises were performed by the therapist for successive 5 days and consecutive 2 weeks. Each exercise was repeated 10 times.



Outcome measures

For the administration of FPI guide to the item, Scoring criteria for FPI: Neutral foot = zero value, pronated posture = '+' value, supinated posture = '-' value.[7],[20] Scoring criteria for NDT, under 10mm = normal, more than 10mm = abnormal.

Data analysis

[Diagram 1]-see CONSORT for allocation of participants.




   Discussion Top


[Table 1],[Table 2],[Table 3],[Table 4],[Table 5] are discussed below.
Table 1: Distribution of Age and BMI in two study groups (Kinesiotaping and Exercise)

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Table 2: Within group comparison of Group 1 (Taping)

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Table 3: Within group comparison of Group 2(Exercise)

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Table 4: Between group comparison of taping (Group 1 and group 2)

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Table 5: Comparison of baseline values with Crossover values

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Study demographic data of study groups (kinesiotaping and exercise) with mean age and BMI. Our sample of subjects showed a BMI of 9.20 kg/m2 to 20.80 kg/m2. It shows that the BMI was non-significant in both the groups showing baseline values were similar in both the groups (P = 0.247). Mean age of male 8(17) ±1.73 and female 8.5(12) ± 2.50. BMI 15.04 ± 1.08. The intragroup (within) comparison of group 1 (taping) with pre-post values using paired Sample Wilcoxon test. This shows non-significant results in FPI and NDT scores since the effect size in Group 1(taping) showed 0.08-0.06 which is a small effect. Within-group comparison of group 2 (exercise) with pre-post values using paired Sample Wilcoxon test. This shows non-significant results in FPI and NDT scores while effect size showed 0-0.10 which is a small effect. The inter-group comparison using the independent samples Mann–Whitney U test. In our study, we have found nonsignificant results in FPI from baseline to post-intervention. Whereas in NDT from baseline to post-intervention there were significant results with the P = 0.006. Crossover values from baseline taping to post crossover exercise values using independent samples Mann–Whitney U test. In our study baseline values of taping with post crossover values of exercise showed significant results with P = 0.003 since baseline values of exercise with post crossover as taping also showed significant results with P = 0.014 and effect size for crossover was 0.08–0.16 which was a small effect. A study on interpretation on effect size shows that effect size small with d = 0.20 or r = 0.10, while medium-sized effect were placed d = 0.50 or r = 0.30 whereas large size of effect were d = 0.80 or r = 0.50.[24]

A single study on NDD was done in which Kinesio taping and exercises were taken as an intervention in hemiplegic cerebral palsy with a mean age of 6.2 ± 0.79 years, Biodex system was used to measure dynamic stability indexes. In this study, they showed improvement in the posture of hemiparetic CP after applying the tape for 12 consecutive weeks.[10] While other studies are on normal children considering flat foot.

Limitations and further scope of study

In the study, there was no control group, and gait was not assessed using any outcome measures. In the study, the long-term intervention effect was limited whereas the washout period was given 2 weeks, the sufficiency of it was not known.

Further studies can be carried out including three groups, long-term intervention, and effects to be studied. Studies to be carried in the multicenter. Post-intervention gait can also be assessed as the outcome measure.


   Conclusion Top


A total of 30 subjects of age group 6–12 years old with mean age 8.20 ± 2.05 were treated in which group 1 (taping) and group 2 (exercise) showed no changes within the group whereas the statistical difference was found between the groups and post crossover except in the FPI. We conclude that a combination of kinesiotaping and exercise may be used as part of the intervention in this age group. Further studies need to be carried out to study in the early age group as a part of therapy.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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[PUBMED]  [Full text]  
24.
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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