TR2024003197A2 - A TREATMENT METHOD USED THROUGH AN EXERCISE SYSTEM FOR THE TREATMENT OF FLAT FEET - Google Patents

Abstract

This invention; It is related to a treatment method applied through an exercise system containing at least one balance device that can be used for all age groups in orthopedic rehabilitation, technological rehabilitation, pes planus (flat feet) rehabilitation. In flatfoot patients, activating the intrinsic (inner) muscles of the foot by transferring weight on the balance device at the tip of the toe and preferably to the lateral (outer part) of the foot, thus reducing navicular drop, reducing the load on the medial part of the foot, neutralizing the subtalar angle that decreases due to pronation and plantar pressure. The aim is to provide a normal walking pattern by correcting the distribution.

Description

DESCRIPTION A TREATMENT METHOD APPLIED THROUGH AN EXERCISE SYSTEM FOR THE TREATMENT OF FLAT FOOT Technical Field This invention relates to a treatment method applied through an exercise system including at least one balance device that can be used for all age groups in orthopedic rehabilitation, technological rehabilitation, and pes planus (flatfoot) rehabilitation. Known Status of the Technique The foot is a functional structure that enables the body to move and has important functions such as balance, shock absorption, and weight transfer. Pes planus (flatfoot), one of the common foot deformities seen in all age groups, describes conditions in which the medial longitudinal arch of the foot (MLA, inner arch of the foot) chronically loses its height. Flat feet, which can develop due to congenital (born) or acquired (acquired) causes, have a reported prevalence of between 2% and 23% in the general population. Flat feet have two clinical forms: flexible and rigid. Clinical evaluation allows for the distinction between flexible and rigid forms, depending on the dynamic load transfer to the foot. Flexible flat feet are usually bilateral (on both feet) in adults, but can also be unilateral (on one foot). The most significant problem associated with flat feet is excessive pronation (inward turning) of the foot during standing and walking. Increased pronation of the subtalar joint causes the tibia (shinbone) to remain internally rotated (turned inward) for a longer period than normal during gait. Consequently, valgus stress occurs in the knees, increased internal rotation occurs in the hips, and an increase in anterior tilt (decrease in the angle of the front of the hip bone and femur) and lumbar lordosis (inward curvature of the lumbar spine located just above the hips) is observed in the pelvis. It is thought that malalignment resulting from flat feet negatively affects foot function and physical performance. Back, leg, and foot pain, fatigue, and weakness that occur with walking and standing may also accompany the symptoms. Additionally, studies have shown that; Studies have shown that flatfoot affects the mobility of the medial longitudinal arch, increases stress on the foot, causes impaired load distribution, posterior tibial tendon insufficiency, patellofemoral pain syndrome (kneecap pain), and compensatory internal hip rotation, thus negatively impacting performance and balance. Flatfoot deformities can present with pain, instability, and various functional limitations, and clinical symptoms can be very mild. However, it is thought that the biomechanical changes caused by this deformity in the foot and proximal joints can increase over time, leading to clinical symptoms and functional problems. Therefore, flatfoot in young adults, even when asymptomatic, should be treated with consideration for potential future biomechanical and functional problems. Flatfoot is a pathology that requires long-term rehabilitation. Individuals with flat feet have a strong belief in the incurable nature of this deformity. Even those who have previously received exercise therapy experience a lack of motivation to continue with conventional exercise programs. This lack of adherence often leads to treatments being discontinued and ineffective outcomes. Rehabilitation protocols that foster high levels of motivation and participation from an early stage are essential, particularly considering the secondary pathologies and functional limitations that the deformity can cause. In this regard, video-based game exercise therapies, which have become increasingly popular in healthcare and rehabilitation in recent years with the advancement of technology, come to mind. The need for technological rehabilitation protocols is increasing daily due to the lack of motivation, tediousness of exercises, and the inability to achieve long-term adherence in conventional rehabilitation methods for many conditions. One technological rehabilitation method that can be used in flatfoot rehabilitation is video-based games. Games specifically designed to improve balance are played on a Balance Board. In common practice, games are performed by transferring weight forward, backward, right, and left, with the feet in full contact on the balance beam. A review of the literature shows that practices used in the rehabilitation of various diseases are always carried out in this manner. However, in flatfoot deformity, exercising the intrinsic muscles of the foot is particularly important in the treatment. Performing exercises with the feet in full contact on the balance beam does not produce the desired effect. The flatfoot treatment protocol can be surgical or conservative, depending on the individual's symptoms and clinical evaluation. Surgical approaches are more commonly considered in the presence of rigid flatfoot. Conservative treatment consists of physiotherapy and orthotic (insole) approaches. In orthotic approaches; Various insoles are used to support the collapsed medial arch of the foot and prevent the ankle from pronating, positioning the foot in a neutral position. These insoles can be either factory-made or custom-made. People must constantly wear insoles inside their shoes in daily life. However, due to the materials used, they don't last very long; they can only be used for about a year. When they wear out, they must be replaced. There is evidence in the literature that various insole shapes improve the foot's subtalar angles and regulate plantar pressure distribution. However, insole supports are passive applications. Whenever a person walks barefoot or without shoes, the foot returns to its original position. Therefore, it's a well-known fact that insole supports are not only quite costly but also don't provide as long-lasting and lasting effects as exercises. To permanently correct the deformity, it's crucial to actively contract the muscles supporting the medial arch of the foot, bringing it back to its neutral position and permanently treating the pronation process. Treatments applied within the scope of a physiotherapy program can be divided into two categories: conventional exercise methods and technological methods (virtual reality). Conventional exercise methods include intrinsic foot exercises, stretching, strengthening, and balance exercises for the ankle and lower extremity muscles; while technological rehabilitation includes video-based game exercise programs. Studies in the literature on the effects of conventional exercise practices, such as short-foot exercises, towel pick-ups, toe raises, and gastrocsoleus stretching, on the medial longitudinal arch, foot biomechanics, and balance in flatfoot rehabilitation. For example, short foot exercises performed three days a week for five weeks have been reported to improve balance and navicular drop in individuals with flexible flat feet. However, difficulties in maintaining adherence are observed due to the perceived tediousness of traditional rehabilitation protocols and lack of motivation, which limits treatment outcomes and prevents effective results. At this point, the importance of technological methods that allow individuals to exercise with high motivation and enjoyment without getting bored is increasing. One technological method increasingly used in rehabilitation is virtual reality. Virtual reality is a three-dimensional simulation model that provides participants with a realistic feeling and allows for interaction with a dynamic, computer-generated environment. Virtual rehabilitation has advantages over traditional methods in terms of increasing active participation, allowing for repetition without repetition, and providing high motivation, performance, and feedback. The patient's ability to fulfill the game's commands within specific timeframes creates a competitive environment, increasing interest and excitement. Subsequently, the game's visual and auditory feedback makes the experience interactive and increases the patient's motivation to exercise. More specifically, with virtual reality rehabilitation, the patient simultaneously receives treatment while having fun. This simplifies the process for both the patient and the therapist. One of the most commonly used virtual reality applications is video-based game exercise therapy. The purpose of using video-based games is to guide patients through exercise by performing tasks assigned to the computer while simultaneously providing visual or auditory feedback from the therapist. In recent years, the literature has shown frequent use of video-based game applications in the rehabilitation of various patient groups. Cerebral palsy, hemiplegia, Parkinson's disease, multiple sclerosis, brachial plexus injuries, knee osteoarthritis, cruciate ligament injuries, meniscus pathologies, and rotator cuff injuries are some of these. The number of studies on the application of such applications to flatfoot is quite limited. Currently, there is only one known study using video-based games in flatfoot rehabilitation. The study, titled "Comparison of short-term effects of virtual reality and short foot exercises in pes planus," used Microsoft Xbox Kinect equipment. The study, which involved playing Microsoft Xbox games, found that the application improved balance and navicular drop in individuals with flatfoot. An examination of balance device applications in the rehabilitation of many other conditions also reveals that games are played using a full-foot contact technique. The full-contact technique is not effective in treating flatfoot. The main problem here is that flatfoot patients place increased load on the medial (inner) aspect of the foot during standing and walking, resulting in excessive pronation of the foot. Therefore, performing games using the full-contact technique is not recommended. Conversely, if this is not taken into account during games that involve shifting weight from side to side, symptoms can worsen. A platform is mentioned on which the foot can perform movements. The surface of the platform responds to foot movements and flexes up and down, like a trampoline. Although it addresses the problem of flatfoot, it lacks any game content, and the user is seen resting their heels on this platform when standing on their toes. Furthermore, the platform moves in conjunction with the user's movements. In these respects, it differs from the inventive method and is much more advantageous in terms of its therapeutic efficacy and motivating users for treatment. Considering the disadvantages of existing practices, there is a need for a treatment method that increases user motivation for treatment, is more fun, faster, and more effective, has a higher therapeutic efficacy, and is easy to use. Brief Description of the Invention The purpose of this invention is to eliminate the aforementioned disadvantages of the current state of the art by developing a treatment method through an exercise system that increases patient motivation for exercise, uses video games to enable them to practice foot positions effective for the treatment of flat feet during exercise, and includes at least one balance device. In patients with flatfoot, it is aimed to activate the intrinsic (inner) muscles of the foot by transferring weight to the toes and preferably to the lateral (outer part) of the foot on the balance device and thus reduce navicular drop, reduce the load on the medial side of the foot, neutralize the decreased subtalar angle due to pronation and provide a normal gait pattern by correcting the plantar pressure distribution. Detailed Description of the Invention The exercise system in which the treatment method which is the subject of the invention is applied comprises at least one balance device and at least one first communication unit that provides communication with the balance device, at least one user interface, a control unit which stores the data received from the balance device and transmits it to the user interface and includes at least one memory unit that stores the inputs from the user interface. The balance device; It is a device that the patient stands on, shaped like a scale, and has a dotted upper surface. This device includes at least one second communication unit that transmits the user's foot movements to the control unit and enables communication; at least one button that, when pressed by the user, activates the balance device and connects to the control unit; at least one energy storage unit that provides the energy required for operation; and at least one sensing unit that detects the patient's foot movements. The first communication unit and the second communication unit communicate preferably wirelessly, such as via Bluetooth. Through the user interface, the user can adjust game parameters, view video game images, and access information about the duration of the exercise performed, the length of each movement, foot positions, and postures via the memory unit where they are stored. The control unit within the exercise system can connect to the internet within an application. This connection allows access to video games and the storage within the system can also be loaded. The treatment method which is the subject of the invention and is applied with the exercise system in question includes the following steps: - The user selects a predetermined video game for the exercise system which is in the memory unit or accessed via internet connection through the user interface and determines the game parameters in a way that the user will need to stand on the tiptoes for predetermined time intervals in line with his needs and will not fully contact the bottom surface of his foot with the surface of the balance device. - Storing these parameters determined through the user interface in the memory unit. - The user presses the button on the balance device to activate it and steps on the balance device. - The foot movements made by the user during the game are detected by the detection unit contained in the balance device and are instantly transmitted by the second communication unit to the first communication unit contained in the control unit. - Storing the data received by the first communication unit in the memory. - Transmitting to the unit and storing it there, - Processing these data via the control unit and producing a report, - Storing the report in the memory unit and displaying it to the user and/or therapist/doctor via the user interface when necessary. The order of the steps in this method is not as specified and can vary depending on the situation. The game parameters in the first step include game time, target score, difficulty level, weight transfer (right-left), and weight transfer (forward-backward). If the weight transfer (right-left) parameter is adjusted to the right, for example, the user must step more on the outside of their right foot. On the other hand, if the weight transfer (forward-backward) parameter is adjusted forward, the user must step more on the toes. These weight transfer parameters also have difficulty levels. As the difficulty level increases, that movement needs to be done more often. For patients with flat feet, adjusting the forward-backward weight transfer parameter to a higher difficulty level is essential for performing the game by enabling toe-lifts. Preferably, when setting the parameters in the first method step, the parameters are set to require the user to stand on the outer parts of the foot for predetermined periods of time. In one application, two games within the exercise system, "Balance Surf and Balance Adventure," are opened by changing the parameters. The reason for changing the parameters is to adapt the game to the patient's pathology. Our goal is to have patients with flat feet play the games by standing on their toes and on the lateral (outer) edges of the foot on the balance beam. In both games, the most advanced (X5) mode of the forward-backward weight transfer parameter is selected. This modified parameter prevents the user from progressing on their toes if they do not reach the target, making toe-lifts mandatory. This method aims to induce contraction of the intrinsic muscles of the foot, thereby elevating the medial longitudinal arch of the foot. Playing games by stepping on the lateral aspect of the foot also helps correct the subtalar angle. The balance device, thanks to its punctuated structure, has a more textured surface compared to a flat surface. This provides additional sensory input to the sole of the foot, which is rich in proprioceptors (sensory receptors). Therefore, the increased sensory stimulation of the lateral aspect of the foot and the forefoot should be considered effective in both improving balance and correcting the subtalar angle. Designed for use with different patient groups, the automatic mode allows the target to advance even if the subject does not rise on their toes. When the manual mode is selected for patients with flat feet, the target advances when the subject rises on their toes, and not otherwise. Parameters are adjusted in this way to ensure proper exercise performance. Using the method in question, positive changes are observed in the ankle subtalar angles of the same patient before and after treatment. The subtalar angle should be 180 degrees in healthy individuals. This angle decreases in individuals with flat feet (pronation). An increase in the angle (approaching 180 degrees) is interpreted as improvement. Correction of pronation also reduces the load on the medial aspect of the foot, improving plantar pressure distribution and gait. The decrease in the load on the medial aspects of the foot was objectively assessed, and significant reductions were observed after treatment. The advantages of the invention can be listed as follows: - Normalizes the ankle subtalar angles. - Improves balance. -It increases the strength of the intrinsic and extrinsic muscles of the foot (especially the inverter muscle). -The balance device provides sensory input thanks to its dotted structure. -It normalizes the plantar pressure distribution on the sole of the foot. -It enables the creation of a normal walking pattern. -It is anticipated that it will significantly reduce the use of insoles, which are quite costly. -It is thought that participation and user motivation will be higher due to its application through video-based games. -The therapist can access all the information such as how many minutes the patient has exercised, their reports, etc. through the system, allowing them to follow more patients simultaneously. -It is also thought that it will reduce the treatment time thanks to its entertaining content and the fast and effective results it provides compared to classical exercise methods, which can take months. -Because it is applied through video-based games, patients can exercise remotely from home. and they will be able to exercise in work environments, which will reduce hospital transportation and treatment costs. Forty-five flatfoot patients were divided into three groups for a comparative test of the inventive method. The first group performed exercises with the foot in full contact on the balance beam. The classical method of using the device is to play games with the foot in full contact on the device. The second group played games using the treatment method used with the inventive exercise system. The third group performed some classical exercises such as walking on tiptoe for a hundred meters and collecting towels. When the results of the study were examined, it was found that the group that exercised on tiptoe and on the outer edge of the foot on the balance beam included in the exercise system had significantly more improvements in the foot subtalar angles compared to the other two groups. It was found that the inventive method reduced navicular drop compared to other protocols and significantly improved balance and muscle strength. It has been determined that our method meets all treatment objectives and reduces plantar pressure in the medial (inner) region of the foot. This is very important in terms of revealing that our method meets all treatment goals and can be used especially in the treatment of a chronic disease that requires long-term treatment such as flatfoot. The method in question is important in terms of being applied for the first time and yielding positive results. It is also anticipated that it will have a potentially widespread effect in terms of providing superior results compared to classical methods in the treatment of flatfoot deformity, which can be seen in all age groups at quite high rates (25% - 33%) in society. Applicability of the Invention to Industry This invention relates to a treatment method applied by means of an exercise system including at least one balance device that can be used for all age groups in orthopedic rehabilitation, technological rehabilitation, flatfoot rehabilitation and is of industrial applicability. The invention is not only the method mentioned above but also the method mentioned above. It is not limited to the explanations; a person skilled in the art can easily reveal different applications of the invention. These should be evaluated within the scope of the protection claimed by the invention's claims.

Claims (1)

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