Foot Muscle Exercise: A Novel Approach to Improve Motor Functions in Children with Down Syndrome Having Pes Planus - A Randomized Controlled Trial.

Children with Down syndrome often have flat feet, or pes planus, alongside broader motor delays, and clinicians have long relied on arch support insoles paired with balance exercises to help. This trial asked whether a different approach, exercises targeting the small muscles of the foot, could improve motor function as well or better than the standard insole-plus-balance-exercise routine. Forty-seven children were randomly assigned to one of the two approaches, training three times weekly for twelve weeks, then following a home program, with motor skills reassessed at 24 weeks from the start. Both groups showed statistically significant improvement in motor function over the study period.

The foot muscle exercise group maintained gains at the later follow-up on both measures used, while the insole and balance group lost its advantage on one of the two motor scales by that later point, though it kept improvement on the other. The foot muscle group performed significantly better than the control group overall. This is an interesting early signal for a simple, low-cost intervention, but the trial was small and the abstract does not detail blinding or long-term durability beyond 24 weeks.

If your child has Down syndrome and flat feet, you may already be familiar with arch support insoles and balance exercises as a common approach to help with movement skills. This study tested something different, exercises aimed at strengthening the small muscles of the foot, comparing it against the standard insole and balance exercise routine over twelve weeks, with a check-in at six months. Both groups of children improved their motor skills during the program.

What stood out is that the group doing foot muscle exercises kept their improvements at the six month follow-up on both movement measures used, while the insole and balance group lost their gains on one measure, even though they kept gains on the other. Children doing foot muscle exercises also ended up with better overall results than those using insoles and balance training. This is a promising early finding, but it comes from a fairly small study of forty-seven children, so it's not yet clear how consistently these results would hold up in larger groups or over longer periods of time.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This randomised controlled trial compared foot muscle exercises against an arch support insole combined with one-leg balance exercises in 47 children with Down syndrome and pes planus, delivered three times weekly for 12 weeks followed by a home programme, with outcomes reassessed at 24 weeks to gauge residual effect. Motor function was measured using the Gross Motor Function Measure (GMFM-88) and the Pediatric Balance Scale (PBS), both showing statistically significant within-group improvement (p = 0.00) in both arms during the intervention phase. The more informative finding concerns durability: the foot muscle exercise group retained a positive residual effect on both GMFM-88 and PBS at 24 weeks, whereas the control group failed to sustain gains on GMFM-88, retaining benefit only on PBS.

Between-group comparison favoured the foot muscle exercise group overall. This suggests foot muscle training may offer more durable motor benefits than the conventional insole and balance approach, though the abstract gives no detail on blinding, allocation concealment, or effect sizes beyond significance testing. Given the small sample size and limited methodological detail available, these results should be regarded as preliminary.

They support foot muscle exercise as a plausible alternative therapeutic avenue worth further investigation rather than an established superior treatment.