Immediate and long-term effects of anti-pronation insoles on spatiotemporal gait parameters in individuals with flat feet

Purpose of the study: This study examined the immediate and long-term effects of anti-pronation insoles on gait characteristics in young adults with flexible flatfoot compared with healthy controls.

Methods: Twenty-four participants (12 flatfoot, 12 controls) underwent gait analysis under barefoot and shod conditions using a 3D motion system. The flatfoot group wore custom anti-pronation insoles during testing and continued daily use for six weeks. Spatiotemporal gait parameters were analyzed using repeated measures ANOVA and MANOVA.

Results: At baseline, the flatfoot group showed significant temporal differences, including prolonged opposite foot off and reduced single support duration (p < 0.05). Short-term insole use led to partial improvements, while post-intervention assessments demonstrated significant increases in step and stride length and normalization of stance-phase timing (p < 0.05). Cadence, walking speed, and step time remained unchanged.

Conclusion: Anti-pronation insoles produced both immediate and sustained improvements in gait timing and spatial characteristics in individuals with flexible flatfoot. Importantly, these benefits emerged not only after a single session but also following six weeks of use, underscoring the adaptive potential of long-term intervention. While gait velocity and cadence were unaffected, improvements in step and stride length and stance-phase dynamics suggest enhanced stability and efficiency. These findings support anti-pronation insoles as a conservative and clinically relevant strategy for restoring gait mechanics in individuals with flatfoot.

1. Deconinck F.J., De Clercq D., Savelsbergh G.J., Van Coster R., Oostra A., Dewitte G., Lenoir M. Differences in gait between children with and without developmental coordination disorder. Motor Control. 2006;10(2):125–142. https://doi.org/10.1123/mcj.10.2.125

2. Sorsdahl A.B., Moe‐Nilssen R., Strand L.I. Observer reliability of the Gross Motor Performance Measure and the Quality of Upper Extremity Skills Test, based on video recordings. Dev. Med. Child Neurol. 2008;50(2):146–151. https://doi.org/10.1111/j.1469-8749.2007.02023.x

3. Yoshino K., Motoshige T., Araki T., Matsuoka K. Effect of prolonged free-walking fatigue on gait and physiological rhythm. J. Biomech. 2004;37(8):1271–1280. https://doi.org/10.1016/j.jbiomech.2003.11.031

4. Lee M.S., Vanore J.V., Thomas J.L., Catanzariti A.R., Kogler G., Kravitz S.R., Miller S.J., Gassen S.C. Diagnosis and treatment of adult flatfoot. J. Foot Ankle Surg. 2005;44(2):78–113. https://doi.org/10.1053/j.jfas.2004.12.001

5. Chen Y.-C., Lou S.-Z., Huang C.-Y., Su F.-C. Effects of foot orthoses on gait patterns of flat feet patients. Clin. Biomech. 2010;25(3):265–270. https://doi.org/10.1016/j.clinbiomech.2009.11.007

6. Grasso R., Bianchi L., Lacquaniti F. Motor patterns for human gait: backward versus forward locomotion. J. Neurophysiol. 1998;80(4):1868–1885. https://doi.org/10.1152/jn.1998.80.4.1868

7. Levinger P., Murley G.S., Barton C.J., Cotchett M.P., McSweeney S.R., Menz H.B. A comparison of foot kinematics in people with normal-and flat-arched feet using the Oxford Foot Model. Gait Posture. 2010;32(4):519–523. https://doi.org/10.1016/j.gaitpost.2010.07.013

8. Patterson K.K., Mansfield A., Biasin L., Brunton K., Inness E.L., McIlroy W.E. Longitudinal changes in poststroke spatiotemporal gait asymmetry over inpatient rehabilitation. Neurorehabil. Neural Repair. 2015;29(2):153–162. https://doi.org/10.1177/1545968314533614

9. Zakharov S.N., Kuryshev B.B., Pigolkin Y.I. Development of a new orthopedic insole design for the correction of walking disorders. Sports medicine: research and practice. 2025. (In Russ.). https://doi.org/10.47529/2223-2524.2025.4.1

10. Barton C.J., Menz H.B., Levinger P., Webster K.E., Crossley K.M. Greater peak rearfoot eversion predicts foot orthoses efficacy in individuals with patellofemoral pain syndrome. Br. J. Sports Med. 2011;45(9):697–701. https://doi.org/10.1136/bjsm.2010.077644

11. Jafarnezhadgero A., Shad M.M., Ferber R. The effect of foot orthoses on joint moment asymmetry in male children with flexible flat feet. J. Bodyw. Mov. Ther. 2018;22(1):83–89. https://doi.org/10.1016/j.jbmt.2017.04.007

12. Hausdorff J.M., Yogev G., Springer S., Simon E.S., Giladi N. Walking is more like catching than tapping: gait in the elderly as a complex cognitive task. Exp. Brain Res. 2005;164(4):541–548. https://doi.org/10.1007/s00221-005-2280-3

13. Tsai L.-C., Yu B., Mercer V.S., Gross M.T. Comparison of different structural foot types for measures of standing postural control. J. Orthop. Sports Phys. Ther. 2006;36(12):942–953. https://doi.org/10.2519/jospt.2006.2336

14. Fattahi A., Koreili Z., Ameli M. Instantaneous effect of insole on the balance of adolescents with flat foot and pes cavus. J. Sport Biomech. 2020;6(1):44–53. https://doi.org/10.32598/biomechanics.6.1.6

15. Arachchige S.N.K., Chander H., Knight A. Flatfeet: Biomechanical implications, assessment and management. Foot. 2019;38:81–85. https://doi.org/10.1016/j.foot.2019.02.004

16. Dunn J., Link C., Felson D., Crincoli M., Keysor J., McKinlay J. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am. J. Epidemiol. 2004;159(5):491–498. https://doi.org/10.1093/aje/kwh071

17. Mousavi Nodoshan S.M., Taheri A.R. The effect of foot orthosis on the vertical component of the ground reaction force while walking: a review study. J. Rehabilitation. 2021;22(1):10–27. https://doi.org/10.32598/rj.22.1.3212.1

18. Murley G.S., Landorf K.B., Menz H.B., Bird A.R. Effect of foot posture, foot orthoses and footwear on lower limb muscle activity during walking and running: a systematic review. Gait Posture. 2009;29(2):172–187. https://doi.org/10.1016/j.gaitpost.2008.08.015

19. Murley G.S., Menz H.B., Landorf K.B. A protocol for classifying normal-and flat-arched foot posture for research studies using clinical and radiographic measurements. J. Foot Ankle Res. 2009;2:22. https://doi.org/10.1186/1757-1146-2-22

20. Hamacher D., Singh N., Van Dieën J.H., Heller M., Taylor W.R. Kinematic measures for assessing gait stability in elderly individuals: a systematic review. J. R. Soc. Interface. 2011;8(65):1682–1698. https://doi.org/10.1098/rsif.2011.0416

21. Lange B., Chipchase L., Evans A. The effect of low-Dye taping on plantar pressures, during gait, in subjects with navicular drop exceeding 10 mm. J. Orthop. Sports Phys. Ther. 2004;34(4):201–209. https://doi.org/10.2519/jospt.2004.34.4.201

22. Slivin A.V., Parastaev S.A. Plantar fasciitis in athletes: current state of the problem. Sports medicine: research and practice. 2024;14(1):50–64. (In Russ.). https://doi.org/10.47529/2223-2524.2024.1.6

23. Gvozdareva M., Shpagin L., Kareva N., Kuropatova E., Rerikh V. The influence of walking in an exoskeleton on rehabilitation of patients with spinal cord injury consequences. Sports medicine: research and practice. 2023;13(3):58–66. (In Russ.). https://doi.org/10.47529/2223-2524.2023.3.2

24. Jafarnezhadgero A.A., Shad M.M., Majlesi M. Effect of foot orthoses on the medial longitudinal arch in children with flexible flatfoot deformity: A three-dimensional moment analysis. Gait Posture. 2017;55:75–80. https://doi.org/10.1016/j.gaitpost.2017.04.011

25. Majlesi M., Farahpour N., Robertson G.E. Comparisons of spatiotemporal and ground reaction force components of gait between individuals with congenital vision loss and sighted individuals. Journal of Visual Impairment & Blindness. 2020;114(4):277–288. https://doi.org/10.1177/0145482x20940429

26. Majlesi M., Azadian E., Zaheri R.M. Kinematic assessment of the dominant and non-dominant legs at initial contact: Implications for lower limb injury risk during spike and block landings in professional volleyball players. Sports medicine: research and practice. 2025;15(2):67–75. https://doi.org/10.47529/2223-2524.2025.2.2

27. Brown G.P., Donatelli R., Catlin P.A., Wooden M.J. The effect of two types of foot orthoses on rearfoot mechanics. J. Orthop. Sports Phys. Ther. 1995;21(5):258–267. https://doi.org/10.2519/jospt.1995.21.5.258

28. Hamlyn C., Docherty C.L., Klossner J. Orthotic intervention and postural stability in participants with functional ankle instability after an accommodation period. J. Athl. Train. 2012;47(2):130–135. https://doi.org/10.4085/1062-6050-47.2.130

29. Kaulmann D., Saveriano M., Lee D., Hermsdörfer J., Johannsen L. Stabilization of body balance with Light Touch following a mechanical perturbation: Adaption of sway and disruption of right posterior parietal cortex by cTBS. PLoS One. 2020;15(7):e0233988. https://doi.org/10.1371/journal.pone.0233988

30. Zwicker J.G., Missiuna C., Harris S.R., Boyd L.A. Brain activation associated with motor skill practice in children with developmental coordination disorder: an fMRI study. Int. J. Dev. Neurosci. 2011;29(2):145–152. https://doi.org/10.1016/j.ijdevneu.2010.12.002

31. Hebert J.R., Manago M.M. Reliability and validity of the computerized dynamic posturography sensory organization test in people with multiple sclerosis. Int. J MS Care. 2017;19(3):151–157. https://doi.org/10.7224/1537-2073.2016-027

32. Jang O.-J., Lee B.-D., Chung Y.-I. A study on factors related to long-term hospitalization in patients with chronic schizophrenia. J. Korean Neuropsychiatr. Assoc. 2015;54(1):76–83. https://doi.org/10.4306/jknpa.2015.54.1.76

33. Peng H.-T., Lin C.-H., Kuo Y.-C., Song C.-Y. Effects of arch support insoles on single-and dual-task gait performance among community-dwelling older adults. Clin. Interv. Aging. 2020;15:1325–1332. https://doi.org/10.2147/CIA.S254474

34. Zifchock R.A., Davis I. A comparison of semi-custom and custom foot orthotic devices in high-and low-arched individuals during walking. Clin. Biomech. 2008;23(10):1287–1293. https://doi.org/10.1016/j.clinbiomech.2008.07.008

35. Majlesi M., Farahpour N. Kinematic and spatio-temporal characteristics of gait in blind individuals. Journal of Research in Rehabilitation Sciences. 2015;11(4):292–300. (In Persian). https://doi.org/10.22122/jrrs.v11i4.2415