الفهرس 
Effect of adding arch support insole to foot strengthening exercise in patients with bilateral Flexible flatfoot
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Abstract
Flexible flatfoot (FFF) has been considered a risk factor for many lower limb injuries. Custom-made arch support insoles (ASI) are commonly described for patients with FFF. The efficacy of custom-made ASI compared to standard foot insoles needs to be explored. Objective: the study was conducted to compare custom-made ASIefficacy added to strengthening exercise of foot muscles versus standard insole efficacy addedto strengthening exercise of foot muscles on dynamic balance, foot function, and foot muscle strength (intrinsic and extrinsic) in patients with bilateral FFF. Methods: Thirty-four patients with bilateral FFF participated in the study. Their ages ranged from 18 to 30 years old. All patients were evaluated by dynamic balance (star excursion balance test (SEBT), intrinsic foot muscle strength (intrinsic foot muscle test (IFMT), extrinsic foot muscle strength (hand-held dynamometer (HHD), and foot function (the Arabic version of foot and ankle ability measure questionnaire (FAAM). They were randomized into two groups, A and B. group A received custom-made arch support insole (ASI) in addition to strengthening exercises of foot muscles both intrinsic and extrinsic. group Breceived standard insole in addition to the same strengthening exercises of foot muscles applied in group A.Results: Before treatment, there was no significant differences between the groups. After completion of the study, there was significant improvement in all measured variables within groups. There was a significant improvement in means of SEBT and FAAM values in comparing groups in favor of group Ain both limbs. No significant differences were observed between the two groups in terms of IFMT. No significant differences were observed in reported means of muscle strength between groups in dorsiflexion, plantar flexion, and inversion in both limbs. Evertors were the only muscle group showing astatistically significant difference in muscle strength between groups in both limbs in favor of group A (P=0.048).Conclusion: In the present study it could be seen that custom-made ASI was more effective than standard insole in terms of dynamic balance and foot function and foot evertors’ strength.