The Effect of Systematic Corrective Exercises on the Ankle Proprioception in People with Functional Pronation Distortion Syndrome: A Randomized Controlled Clinical Trial Study

Document Type : Original Articles


1 PhD Candidate, Department of Sport Pathology and Corrective Exercise, School of Sports Sciences, University of Isfahan, Isfahan, Iran

2 Professor, Department of Sport Pathology and Corrective Exercise, School of Sports Sciences, Isfahan University, Isfahan, Iran



Introduction: Pronation distortion syndrome is one of the most common abnormalities in the lower extremity that causes distortions in the structures of the skeletal parts of the foot. The purpose of this study was to determine the effect of systematic corrective exercises on the ankle proprioception in people with functional pronation distortion syndrome.Materials and Methods: In this randomized controlled clinical trial study, 30 volunteers who had pronation distortion syndrome were selected and randomly divided in to control and experimental groups. The experimental group performed corrective exercises for 12 weeks (3 sessions per week for one hour), while control group performed the routine exercises. Ankle proprioception (using electrogoniometer) was evaluated before and after the interventions. Data were analysed using independent and paired t tests.Results: Following 12 weeks of corrective exercises, the experimental group showed significant improvement in ankle proprioception (P = 0.001); however, there was no significant change in control group (P > 0.050). In addition, there was a significant improvement in ankle proprioception in the experimental group compared to control group (P < 0.001).Conclusion: It can be concluded that systematic corrective exercises improve ankle proprioception in patients with pronation distortion syndrome, and it may be recommended for these people.


  1. Hertling D, Kessler RM. Management of common musculoskeletal disorders: Physical therapy principles and methods. Philadelphia, PA: Lippincott Williams and Wilkins; 2006. p. 606-12.
  2. Clark MA, Lucett SL. NASM essentials of corrective exercise training. 1st ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2011.
  3. Rees JD, Maffulli N, Cook J. Management of tendinopathy. Am J Sports Med 2009; 37(9): 1855-67.
  4. Irving DB, Cook JL, Menz HB. Factors associated with chronic plantar heel pain: A systematic review. J Sci Med Sport 2006; 9(1-2): 11-22.
  5. Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC. Medial tibial stress syndrome: A critical review. Sports Med 2009; 39(7): 523-46.
  6. Holmes A, Delahunt E. Treatment of common deficits associated with chronic ankle instability. Sports Med 2009; 39(3): 207-24.
  7. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther 2003; 33(11): 639-46.
  8. Cote KP, Brunet ME, Gansneder BM, Shultz SJ. Effects of pronated and supinated foot postures on static and dynamic postural stability. J Athl Train 2005; 40(1): 41-6.
  9. Sahrmann S. Movement system impairment syndromes of the extremities, cervical and thoracic spines. St Louis, MI: Mosby; 2011.
  10. Riemann BL, Lephart SM. The sensorimotor system, part I: The physiologic basis of functional joint stability. J Athl Train 2002; 37(1): 71-9.
  11. Lephart SM, Pincivero DM, Giraldo JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med 1997; 25(1): 130-7.
  12. Chung K, Lee E, Lee S. The effect of intrinsic foot muscle training on medial longitudinal arch and ankle stability in patients with chronic ankle sprain accompanied by foot pronation. Phys Ther Rehabil Sci 2016; 5: 78-83.
  13. Moon DC, Kim K, Lee SK. Immediate effect of short-foot exercise on dynamic balance of subjects with excessively pronated feet. J Phys Ther Sci 2014; 26(1): 117-9.
  14. Najafi M, Shojaedin S, Haddadnejad M, Barati AH. Effect of eight-week corrective exercises on the activity of involved muscles in ankle balance strategies in girls with lower limb pronation syndrome. J Rehab Med. 2018; 7(1): 77-87. [In Persian].
  15. Goo YM, Kim DY, Kim TH. The effects of hip external rotator exercises and toe-spread exercises on lower extremity muscle activities during stair-walking in subjects with pronated foot. J Phys Ther Sci 2016; 28(3): 816-9.
  16. Snyder KR, Earl JE, O'Connor KM, Ebersole KT. Resistance training is accompanied by increases in hip strength and changes in lower extremity biomechanics during running. Clin Biomech (Bristol, Avon) 2009; 24(1): 26-34.
  17. Nejati P, Forugh B, Kuhpayezade J, Moeineddin R, Nejati M. Effects of foot orthoses on knee pain and function of female athletes with patellofemoral pain syndrome. J Adv Med Biomed Res 2009; 17(66): 49-60. [In Persian].
  18. Holmes CF, Wilcox D, Fletcher JP. Effect of a modified, low-dye medial longitudinal arch taping procedure on the subtalar joint neutral position before and after light exercise. J Orthop Sports Phys Ther 2002; 32(5): 194-201.
  19. Feltner ME, MacRae HS, MacRae PG, Turner NS, Hartman CA, Summers ML, et al. Strength training effects on rearfoot motion in running. Med Sci Sports Exerc 1994; 26(8): 1021-7.
  20. Sadeghi Dehcheshme H, Tasoujian E, Omidi AR. The effect of eight weeks foot reflexology massage on balance and ankle joint proprioception error in elderly men. Journal of Practical Studies of Biosciences in Sport 2016; 4(8): 123-35. [In Persian].
  21. Hatami M, Shojaedin SS, Letafatkar A. Effect of six weeks of balance exercise protocol, taping, and mixed protocol on proprioception and functional performance in teenager boys' Volleyball players with chronic ankle instability. J Rehab Med 2018; 7(2): 23-32. [In Persian].
  22. Khosravi Kaviz M, Rahnama N, Sahebalzamani M. The effect of eight weeks of training with balance board on neuromuscular variables of karate girls` ankle. Paramedical Sciences and Rehabilitation 2016; 6(2): 27-37. [In Persian].
  23. Chougala A, Phanse V, Khanna E. Screening of body mass index and functional flatfoot in adult: An observational study. Int J Physiother Res 2015; 3(3): 1037-41.
  24. Culik J, Marik I, Cerny EP. Biomechanics of leg deformity treatment. J Musculoskelet Neuronal Interact 2008; 8(1): 58-63.
  25. Youdas JW, Hollman JH, Krause DA. The effects of gender, age, and body mass index on standing lumbar curvature in persons without current low back pain. Physiother Theory Pract 2006; 22(5): 229-37.
  26. Saidi F, Rajabi R, Ebrahimi Takamejani E, Mosavi SJ. Reliability and validity of Iranian flexible ruler in lumbar spine curvature measurement. Journal of Movement Science and Sports 2010; 7(14): 31-8. [In Persian].
  27. Ahmad Ali Dokht F. Effect of NASM corrective exercise on functional tests and Foot Posture Index (FPI) in children with flat foot [MSc Thesis]. Urmia, Iran: Urmia University; 2015. [In Persian].
  28. Nobakht S, Seidi F, Rajabi R. A comparison of ankle joint position sense in female students with and without pronated and supinated foot. Journal of Sport Medicine 2016; 8(1): 99-113. [In Persian].
  29. Musavi SH, Ghasemi B, Faramarzi M. The relationship between internal longitudinal foot arch with static and dynamic balance of 12-14 years male students. Sport Medicine 2009; 1(2): 107-25. [In Persian].
  30. Dahle LK, Mueller MJ, Delitto A, Diamond JE. Visual assessment of foot type and relationship of foot type to lower extremity injury. J Orthop Sports Phys Ther 1991; 14(2): 70-4.
  31. Barrett JR, Tanji JL, Drake C, Fuller D, Kawasaki RI, Fenton RM. High-versus low-top shoes for the prevention of ankle sprains in basketball players. A prospective randomized study. Am J Sports Med 1993; 21(4): 582-5.
  32. Beynnon BD, Renstrom PA, Alosa DM, Baumhauer JF, Vacek PM. Ankle ligament injury risk factors: A prospective study of college athletes. J Orthop Res 2001; 19(2): 213-20.
  33. O'Neill DB. Arthroscopically assisted reconstruction of the anterior cruciate ligament. A prospective randomized analysis of three techniques. J Bone Joint Surg Am 1996; 78(6): 803-13.
  34. Demeritt KM, Shultz SJ, Docherty CL, Gansneder BM, Perrin DH. Chronic ankle instability does not affect lower extremity functional performance. J Athl Train 2002; 37(4): 507-11.
  35. Thomas JR, Nelson JK, Silverman SJ. Research Methods in Physical Activity. Champaign, IL: Human Kinetics; 2001. p. 164-175.
  36. Sholukha V, Salvia P, Hilal I, Feipel V, Rooze M, Jan SVS. Calibration and validation of 6 DOFs instrumented spatial linkage for biomechanical applications. A practical approach. Med Eng Phys 2004; 26(3): 251-60.
  37. Karimizadeh Ardakani M, Alizade M, EbrahimiTakamjani E. The effect of 6-week hopping exercises program on joint position sense in athletes with functional ankle instability. J Res Rehabil Sci 2013; 9(3): 540-52. [In Persian].
  38. Spanos S, Brunswic M, Billis E. The effect of taping on the proprioception of the ankle in a non-weight bearing position, amongst injured athletes. The Foot 2008; 18(1): 25-33.
  39. Riemann BL, Myers JB, Lephart SM. Sensorimotor system measurement techniques. J Athl Train 2002; 37(1): 85-98.
  40. Morrison KE, Kaminski TW. Foot characteristics in association with inversion ankle injury. J Athl Train 2007; 42(1): 135-42.
  41. Mahdavi A, Hadadnezhad M, Eftekhari F. Effect of 6 week stretching training of Gastrocnemius-Soleus complex on dorsiflexion range of motion, ankle proprioception, knee valgus and function in athletes with limited dorsiflexion. Journal for Research in Sport Rehabilitation 2018; 6(11): 21-32. [In Persian].
  42. Daneshmandi H, Saki F, Shahheidari S, Khoori A. Lower extremity Malalignment and its linear relation with Q angle in female athletes. Procedia Soc Behav Sc 2011; 15: 3349-54.
  43. Akbari M, Mohammadi M, Saeedi H. Effects of rigid and soft foot orthoses on dynamic balance in females with flatfoot. Med J Islam Repub Iran 2007; 21(2): 91-7.
  44. Wang D, Linn G. Structure of proprioceptive mechanisms in the regulation of stance. Progress in Brain Research. 2008: 41-8.
  45. Sekir U, Yildiz Y, Hazneci B, Ors F, Aydin T. Effect of isokinetic training on strength, functionality and proprioception in athletes with functional ankle instability. Knee Surg Sports Traumatol Arthrosc 2007; 15(5): 654-64.