Plyometric vs. Intrinsic Foot Muscle Training in Pediatric Flatfoot

NCT07884162 — Not applicable, Completed, 36 participants, Faculty of Medicine, Sousse

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Plyometric-First Versus Intrinsic Foot Muscle-First Training in Children With Flexible Flatfoot: Effects on Plantar Loading and Athletic Performance

Registry	NCT07884162
Status	Completed
Phase	Not applicable
Study type	Interventional; randomized, single group, masking: single, treatment
Enrollment	36 (Actual)
Sponsor	Faculty of Medicine, Sousse (Other)
Conditions	Flatfoot, Flexible
Interventions	Plyometric Training (Behavioral)
Dates	start 2025-11-15, primary completion 2026-01-26, completion 2026-05-15, first posted 2026-10-20, last updated 2026-10-20
Locations	1 site in Tunisia

-Summary

The purpose of this study is to investigate how the order of exercises in a training program affects foot mechanics and physical performance in children with flexible flatfoot. Flexible flatfoot is common in children and can affect how weight is distributed on the foot, balance, and athletic abilities. While both foot-strengthening exercises and jump training (plyometrics) are helpful, it is not known which one should be done first to get the best results.

In this study, thirty-six young male football players with flexible flatfoot were divided into three groups. The first group performed jump training followed by foot muscle strengthening. The second group did the foot muscle strengthening first, followed by jump training. The third group served as a control group and did not change their usual training. The researchers measured changes in foot pressure, balance, jumping height, muscle force, and sprint speed before and after the training to find out which exercise order is most effective for improving athletic performance and foot loading.

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+Detailed description

This study evaluates the impact of exercise sequencing within a combined training program for young athletes with flexible flatfoot. Participants are block-randomized into three distinct parallel arms to compare different training structures over the intervention period:

* Group P1-R2: Participants undergo plyometric training in the first phase, followed by intrinsic foot muscle (IFM) strengthening in the second phase.
* Group R1-P2: Participants undergo intrinsic foot muscle (IFM) strengthening in the first phase, followed by plyometric training in the second phase.
* Control Group (CG): Participants maintain their habitual football training schedule without any additional specific foot or plyometric interventions.

All participants undergo a comprehensive testing battery at baseline (pre-intervention) and immediately following the completion of the training protocol (post-intervention). The assessments include static and dynamic baropodometric analyses to measure peak plantar pressure, postural tracking to evaluate balance, countermovement jump (CMJ) tests for neuromuscular mechanics, eccentric rate of force development (RFD) evaluations, and 20-meter timed sprints to quantify locomotor performance.

+Arms and interventions

Arm	Type	Interventions	Description
Group P1-R2	Experimental	Behavioral: Plyometric Training	Pediatric football players with flexible flatfoot who undergo a combined training program consisting of 4 weeks of plyometric training (Phase 1) followed by 4 weeks of intrinsic foot muscle strengthening (Phase 2), performed 3 times per week for a total of 8 weeks.
Group R1-P2	Experimental	Behavioral: Plyometric Training	A separate group of pediatric football players with flexible flatfoot who undergo the inverse sequence: 4 weeks of intrinsic foot muscle strengthening (Phase 1) followed by 4 weeks of plyometric training (Phase 2), performed 3 times per week for a total of 8 weeks.
Control Group	No intervention		A third separate group of pediatric football players with flexible flatfoot who maintain their habitual football training schedule without participating in any specific plyometric or foot muscle strengthening protocols during the 8-week study period.

Plyometric Training (Behavioral): Jump and plyometric exercises performed 3 times per week for a total duration of 4 weeks. This intervention is implemented during Phase 1 for Group P1-R2 and during Phase 2 for Group R1-P2.

+Outcome measures

Primary outcomes

Peak Plantar Pressure [Baseline (before the intervention) and post-intervention (after 8 weeks of training).]: Static and dynamic peak plantar pressure assessed using baropodometric analysis to evaluate changes in plantar loading.

Secondary outcomes

Postural Balance Tracking [Baseline (before the intervention) and post-intervention (after 8 weeks of training).]: Postural stability tracking parameters evaluated under static and dynamic conditions.

Other outcomes

Countermovement Jump (CMJ) Height [Baseline (before the intervention) and post-intervention (after 8 weeks of training).]: Vertical jump performance measured in centimeters using countermovement jump mechanics.
Eccentric Rate of Force Development (RFD) [Baseline (before the intervention) and post-intervention (after 8 weeks of training).]: Neuromuscular force production capacity during the eccentric phase of movement.
20-Meter Sprint Time [Baseline (before the intervention) and post-intervention (after 8 weeks of training).]: Locomotor and acceleration performance measured in seconds.

+Eligibility

Sex: Male, ages: 9 Years to 12 Years

Inclusion Criteria:

* Participants were required to be actively practising youth football players aged between 9 and 12 years with a clinically and podographically confirmed diagnosis of bilateral flexible flatfoot according to the study's predefined diagnostic criteria.

Exclusion Criteria:

* Participants were excluded if they presented any history of lower limb orthopaedic surgery, a musculoskeletal injury within the preceding six months, or a diagnosed neurological disorder.

+Locations (1)

Facility	City	Country	Status
Research Laboratory (LR19ES09), Exercise Physiology and Pathophysiology, Faculty of Medicine of Sousse, University of Sousse	Sousse	Tunisia

+Investigators

Mounir Landolsi, PhD, Principal investigator, Faculty of Medecice of Sousse, University of Sousse

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