Toe Spread Out Exercise With and Without Walking Surface Training in Children With Autism

Summary

Flatfoot is a common postural deformity in children, characterized by the collapse of the medial longitudinal arch, leading to abnormal foot posture, gait disturbances, and postural instability. Arch collapse in flatfoot is also due to navicular drop a condition where the navicular bone, located in the midfoot, shifts downward excessively when bearing weight.

This excessive drop reflects poor structural support in the foot and is often linked to weakness in the intrinsic foot muscles. The intrinsic and extrinsic muscles of the foot, particularly the abductor hallucis (AbdH), play a vital role in maintaining arch stability.

Strengthening exercises like toe spread out movements are specifically designed to target these muscles by abducting and flexing the toes, helping to support and elevate the medial arch. This study aims to investigate the combined effect of toe spread out exercises and walking surface training on navicular drop and jumping performance in children with ASD, focusing on muscle strength and sensory-motor integration to support functional movement and postural control. This randomized controlled trial will be conducted over ten months at Step Up Autism Center and Rehab Care, Lahore, following ethical approval from the Research Ethical Committee of Riphah International University Islamabad (Lahore Campus). Children aged 7 to 12 years, clinically diagnosed with autism spectrum disorder, navicular drop, and poor locomotor skills will be recruited through non-probability convenient sampling. After obtaining informed consent from guardians, eligible participants will be randomly allocated into two groups. Group A will perform toe spread out exercises only, while Group B will perform toe spread out exercises combined with walking surface training. Both interventions will be carried out three times a week for eight weeks. This will be a single-blinded study, where the assessor will remain unaware of the group allocations. Data collection will involve pre- and post intervention assessment using the Navicular Drop Test, Wet Footprint Test (Clarke's Angle), Horizontal Jump Test, and the Test of Gross Motor Development-Second Edition (TGMD-2) to evaluate changes in foot posture, arch structure, lower limb power, and locomotor skills in participating children.

Conditions

• Autism

Interventions

OTHER

Toe spread out exercise

Partcipant will sit on the edge of chair with hips and knees at 90 degree flexion, with foot flat on the floor. This position makes sure that there is equal weight distibution across the calcaneus, metatarsals and phalanges. It is also made sure that the feet are hip width apart.Then the participant is asked to lift the toes off the ground(dorsiflexion) , keeping the heel and ball(metarsals) of foot on the ground. While maintaining dorsiflexion of toes, the participant will be asked to flex the first toe medially (bending downward and toward the midline), similarly the fifth toe will be flexed laterally (bending downward and away from the midline) .The position will be held for 3 to 5 seconds with 10 repetiotns.

OTHER

Toe spread out exercises with walking surface training

Walking Surface • The participant will be barefoot and will be asked to walk in their usual manner and speed. • There will be three different surfaces i.e pile carpet (18mm thickness) for soft sensation, vinyl tile for flat smooth and loose gravel (average height of 14mm) for uneven sensation respectively. • The participant will be asked to walk on the 4 meter walking surface, taking 10 rounds on each

Sponsors & Collaborators

• Riphah International University

  lead OTHER

Principal Investigators

• Fareeha Kausar, PPDPT · Riphah International University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

7 Years

Max Age

12 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-02-04

Primary Completion

2026-07-30

Completion

2026-08-30

Countries

• Pakistan

Study Locations