Exercise programmes incorporating proximal kinetic-chain components in flexible flatfoot: a systematic review and meta-analysis of foot posture, neuromuscular, and dynamic outcomes
- 1School of Sports and Health Engineering, Hebei University of Engineering, Handan, Hebei, China
- 2School of Physical Education and Health Science, Guangxi Minzu University, Nanning, Guangxi, China
Abstract
Purpose: To evaluate the effects of exercise programmes incorporating proximal kinetic-chain components versus local or basic foot–ankle exercise in individuals with study-defined flexible flatfoot or low-arch/pronated-foot phenotypes.
Methods: PubMed, Web of Science, Scopus, and SPORTDiscus were searched from inception through 19 July 2026. Randomised controlled trials comparing exercise programmes incorporating proximal kinetic-chain components with local or basic foot–ankle exercise programmes were included. Random-effects meta-analyses used restricted maximum likelihood estimation. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE.
Results: Fourteen randomised trials reported in 15 publications were included; 13 trials (14 reports) contributed to at least one meta-analysis. Programmes containing proximal or kinetic-chain components were associated with lower navicular-drop values (11 trials, 410 participants; mean difference −2.34 mm, 95% CI −3.30 to −1.37; I²=84.6%; low-certainty evidence). The Foot Posture Index estimate was uncertain (4 trials, 157 participants; mean difference −1.67 points, 95% CI −3.36 to 0.01; I²=89.1%; very-low-certainty evidence). The exploratory Plantar Arch Index and all three exploratory Y-Balance estimates had confidence intervals including the null and very-low-certainty evidence. Evidence for muscle, plantar-pressure, gait, kinematic, patient-reported, adherence, and adverse-event outcomes was limited and mainly derived from individual trials.
Conclusion: Programmes incorporating proximal kinetic-chain components may reduce short-term navicular drop compared with local or basic foot–ankle exercise programmes, but substantial heterogeneity limits confidence in the magnitude of this response; effects on FPI-6 remain uncertain. Evidence for dynamic, functional, and patient-reported outcomes remains insufficient.
Systematic review registration: identifier CRD420261455079.
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BibTeX
@article{xiong2026exercise,
title = {{Exercise programmes incorporating proximal kinetic-chain components in flexible flatfoot: a systematic review and meta-analysis of foot posture, neuromuscular, and dynamic outcomes}},
author = {Zheyu Xiong and Jiguo Liang and Guanghua Li},
journal = {Frontiers in Physiology},
year = {2026},
month = oct,
doi = {10.3389/fphys.2026.1959545},
url = {https://doi.org/10.3389/fphys.2026.1959545},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Exercise programmes incorporating proximal kinetic-chain components in flexible flatfoot: a systematic review and meta-analysis of foot posture, neuromuscular, and dynamic outcomes
AU - Zheyu Xiong
AU - Jiguo Liang
AU - Guanghua Li
PY - 2026
DA - 2026/10/12
JO - Frontiers in Physiology
DO - 10.3389/fphys.2026.1959545
UR - https://doi.org/10.3389/fphys.2026.1959545
AB - Purpose: To evaluate the effects of exercise programmes incorporating proximal kinetic-chain components versus local or basic foot–ankle exercise in individuals with study-defined flexible flatfoot or low-arch/pronated-foot phenotypes. Methods: PubMed, Web of Science, Scopus, and SPORTDiscus were searched from inception through 19 July 2026. Randomised controlled trials comparing exercise programmes incorporating proximal kinetic-chain components with local or basic foot–ankle exercise programmes were included. Random-effects meta-analyses used restricted maximum likelihood estimation. Risk of bias was assessed with RoB 2 and certainty of evidence with GRADE. Results: Fourteen randomised trials reported in 15 publications were included; 13 trials (14 reports) contributed to at least one meta-analysis. Programmes containing proximal or kinetic-chain components were associated with lower navicular-drop values (11 trials, 410 participants; mean difference −2.34 mm, 95% CI −3.30 to −1.37; I²=84.6%; low-certainty evidence). The Foot Posture Index estimate was uncertain (4 trials, 157 participants; mean difference −1.67 points, 95% CI −3.36 to 0.01; I²=89.1%; very-low-certainty evidence). The exploratory Plantar Arch Index and all three exploratory Y-Balance estimates had confidence intervals including the null and very-low-certainty evidence. Evidence for muscle, plantar-pressure, gait, kinematic, patient-reported, adherence, and adverse-event outcomes was limited and mainly derived from individual trials. Conclusion: Programmes incorporating proximal kinetic-chain components may reduce short-term navicular drop compared with local or basic foot–ankle exercise programmes, but substantial heterogeneity limits confidence in the magnitude of this response; effects on FPI-6 remain uncertain. Evidence for dynamic, functional, and patient-reported outcomes remains insufficient. Systematic review registration: identifier CRD420261455079.
SN - 1664-042X
ER -