Background: The longitudinal arch is important for individuals with pes planus. The toe spread out exercise (TSO) has been widely used to continuously support the longitudinal arch by increasing the abductor hallucis (AbdH) muscle activation. However, the AbdH muscle is commonly lack of the sufficient activation during the TSO especially in individuals with pes planus. Objects: This study was performed to investigate the effect of arch support on the muscle activity and strength of the AbdH during TSO in standing position in individuals with pes planus. Methods: Twenty subjects with pes planus between 20 and 30 years of age participated in this study. The muscle activity and strength of the AbdH were measured using surface EMG system and the Smart KEMA tensiometer system. The AbdH muscle was evaluated during TSO between individuals with and without longitudinal arch support in standing position. The longitudinal arch was supported by using the insole. The paired t-test was used. The level of statistical significance was set at α = 0.05. Results: The muscle activity and strength of the AbdH during TSO with arch support in standing position was significantly greater than that without arch support. Conclusion: The muscle activity and strength of the AbdH during TSO in standing position can be influenced by the longitudinal arch support in individuals with pes planus. The AbdH strengthening during TSO in standing with arch support can be recommended especially in individuals with pes planus in the clinical settings.

Background: The toe-spread-out (TSO) exercise has been introduced as a strengthening exercise for the abductor hallucis muscle in subjects with hallux valgus. Visual biofeedback using ultrasound imaging during exercise, may increase the ability to selectively contract the abductor hallucis muscle, compared with exercise alone. Objects: The aim of this study was to investigate the effects of ultrasound imaging visual feedback during the TSO exercise with respect to its influence on the angle of the first metatarsophalangeal joint (1st MPJ) and the cross-sectional area (CSA) of the abductor hallucis muscle in subjects with hallux valgus. Methods: Twenty-five healthy young subjects with a mean average age of 22.5 years, and a standard deviation of 2.3 years, were recruited for this study. Hallux valgus was defined as an angles greater than 15° angle of 1st MPJ. Goniometric measurement was used to determine the angle of 1st MPJ. In addition, an ultrasound system was used to collect the CSA of the abductor hallucis muscle in each foot. The angle of the 1st MPJ and CSA of the abductor hallucis were measured in three positions; the resting position, during TSO exercise, and during TSO exercise in conjunction with real-time ultrasound imaging feedback. All data analyzed using a repeated analysis of variance with Bonferroni correction in order to compare the dependent variables in all three positions. Statistical level of significance was set up as p<.05. Results: The angle of the 1st MPJ was noted to be significantly reduced and the CSA of the abductor hallucis to be significantly greater during TSO exercise used in conjunction with ultrasound imaging visual feedback, compared to when the values were recorded during TSO exercise alone (p<.05). Conclusion: Based on these findings, it can be concluded that the application of ultrasound imaging visual feedback during TSO exercise is more effective in contracting selectively the abductor hallucis than the use of exercise alone.