COMPENSATORY EXERCISES AS FLATFOOT PREVENTION IN TEAMGYM

The topic of this article is the issue of flat feet and the effect of compensatory exercises in TeamGym gymnasts. The aim of our study was to investigate and document the effect of specific compensatory exercises on the flatfoot condition in five selected gymnasts competing in TeamGym. The research questions were based on our practical observations and practice sessions with TeamGym gymnasts. Foot arch examination methods were used for the research part. Each athlete underwent initial testing, which included a standing examination, and each proband had her foot imprinted using Footdisc and Podoscope devices, all documented by taking photographs which were compared and evaluated before and after the intervention exercise. The results of the initial examination confirmed a flat foot and uneven foot loading in all gymnasts. Subsequently, interventional compensatory exercise was performed and lasted for three months. Output examination showed that after regular compensatory exercise, most probands showed some improvement in flat foot loading. This work suggests that compensatory exercise should be incorporated into routine training to have a preventive effect on the undesirable development of flatfoot.


INTRODUCTION
TeamGym is a team sport that uses elements of gymnastics and acrobatics.It competes in three disciplines -a set for movement composition, acrobatics and jumping from a small trampoline.The large number of jumps and hard impacts that gymnasts perform barefoot is one of the reasons why, in our experience, flat-footedness problems are more prevalent in this sport.With the constant jumping, skipping and landing, the feet are subjected to excessive forces and the disparity between the load and the strength of the muscles and ligaments is one of the causes of flat feet in gymnasts.Changes caused by poor pressure distribution of the flat foot can create dysfunction of the foot and other upper body segments, but can also increase the risk of other serious lower extremity injuries.Targeted compensatory exercises to affect the flatfoot should be an important part of the training process in these types of gymnastic sports.TeamGym is a team sport that uses elements of gymnastics and acrobatics.It is competed in three events -tumbling routines, acrobatics and jumping from a small trampoline.The large number of jumps and hard impacts that gymnasts perform barefoot is one of the reasons why, in our experience, flat-footedness problems are more prevalent in this sport.With the constant jumping, skipping and landing, the feet are subjected to excessive forces and the disparity between the load and the strength of the muscles and ligaments is one of the causes of flat feet in gymnasts.Changes caused by poor pressure distribution of the flat foot can create dysfunction of the foot and other upper body segments, but can also increase the risk of other serious lower extremity injuries.Targeted compensatory exercises to affect the flatfoot should be an important part of the training process in these types of gymnastic sports.

AIM AND RESEARCH QUESTIONS
The aim of our study was to verify and document the effect of a specific compensatory exercise on plantarflexion in five female athletes competing in Teamgym.The research questions were based on our practical observations and practice sessions with the team gymnasts.We were interested in whether a flatfoot disorder would be found in all the gymnasts examined and whether there would be an improvement in the overall weight distribution on the gymnasts' feet after the three-month exercise program.

METHODOLOGY
Five young female gymnasts aged between 10 and 12 years old who have been involved in TeamGym for at least 6 years and train 4 times a week were selected for the study.The girls' parents agreed to participate in the research.Initial testing included standing and gait aspect testing, and each proband's feet were imprinted using Footdisc and Podoscope devices.The standing examination and foot impression on both devices were documented by taking photographs, which were compared and evaluated after three months.Based on the input examination, a compensatory exercise program was developed to improve plantar foot position.The exercise program was carried out over a period of three months.The probands exercised 4 to 5 times a week, for 15 minutes.In addition to continuous quality control of exercise execution during the training, the gymnasts had a recorded video with individual exercises and detailed descriptions and could also consult their possible problems regarding the exercises with the supervising coachco-author of the paper.According to the Footdisk scale, the proband is in category C and according to our visual scaling, she is a first-degree flatfoot.This is the principle of the visual scaling method (Kapanji, 1987), which consists of comparing the shape of the plantogram of the healthy foot with the examined one (Riegerová, Přidalová, Ulbrichová, 2006).

Proband no. 1 before intervention
After the exercise, the proband's pinkies loading improved, the foot arches flattened and there was a change in the Footdisc rating scale to grade B, and according to visual scaling, we determined that this was a normal foot .After a three-month intervention, the proband felt progress on her left foot, which was also better exercised.There was no visible progress in terms of the instrumented examination compared to the initial examination.There is still bilateral unloaded body weight distribution to the foot and 4th and 5th toes of the left foot, and bilateral reduction of the internal longitudinal plantar arch persists.Exit examination using Podoscope assesses the left little toe still in reduced load and bilateral minor V metatarsal loading.We diagnose the assessment by visual scaling as I. grade flatfoot.According to Footdisc, we grade the flatfoot as grade C (Figures 33-35).

DISCUSSION
Pes planovalgus meaning pediatric flatfoot, is one of the most common orthopaedic defects in children, occurring as they grow.López (2014) reports that up to 30% of all children suffer from foot arch disorders.Dungl (2005) describes typical signs indicative of flatfoot problems as the tibia dropping medially and walking with the toes turned inward.In contrast, a study by Vergillos, et al. (2023) mentions that flatfoot is a common finding in children under 10 years of age and is somewhat normal during development.Therefore, pediatric flatfoot should not be considered pathological unless stiffness or functional limitation is present.
Our initial examination revealed a problem with flatfoot in all the gymnasts tested, to varying degrees.All girls were also found to have valgus of the calcaneus, Achilles tendon pointing medially bilaterally, and drop of the tibia medially.Toe-in gait was not seen in any of the girls.On the contrary, one of the gymnasts showed the opposite feature manifested by standing and walking with the toes outwards, which, in our opinion, may lead to additional unwanted loading in running or in jumping from challenging elements, which may subsequently negatively affect the upper body segments.
The postural function of the foot is also a source of proprioceptive and exteroceptive information for the central nervous system (Vařeka, 2009).It follows that pathological foot position or impaired foot function is associated with impaired motor stereotype.This in turn can affect the posture and function of the entire lower limbs and the whole body's axial system (Toppischová and Šnoplová, 2008).Using various physiotherapeutic techniques and targeted compensatory exercises for the plantar foot, it is then possible to influence the associated problems associated with faulty posture.(Buchtelová and Vaníková, 2010).
Since we had the opportunity to observe the gymnasts during the training program, we can state that even there, the consequences of incorrect loading of the plantar foot are evident in individual elements (e.g., one-legged stand on the balance beam or precision push-ups).
It is clear that after three months of regular compensatory exercises, there was some improvement in the loading of the footplate in most of the probands, so it is certainly appropriate to recommend adding compensatory exercises focusing on the correct function of the footplate to the training plan of gymnasts.
One of the basic compensatory exercises that has been applied to gymnasts is the "four-point foot support" exercise, which is the essence of full body support.Dylevský (2009), describes that the foot has three points for proper and even loading, Kapandji (1987)  This included a final interview to subjectively assess the effect of the threemonth therapy.Three of the tested gymnasts reported that the compensatory exercises helped to relieve their leg pain, while others became more aware of the alignment of their entire lower limb.All probands were aware of the possible consequences of poor loading of the plantar surface of the foot after the programme.A study by Knappová, Charvátová and Stackeová (2022) showed that the effects of a movement intervention and regimen can be corrected without the need for orthotic insoles or other special footwear modifications.If exercise is not regularly performed and regimen measures are not followed, the effect of the intervention diminishes.Other influences, such as inappropriate sporting activity or inappropriate footwear, may also negate the positive effect of the intervention.

CONCLUSIONS
The issue of flat feet in gymnasts competing in TeamGym is often a neglected topic.However, due to the demanding nature of the sport and the heavy load placed on the lower limbs, it is a topic of utmost importance, especially in the prevention of injury and the development of any chronic pain conditions occurring in the sport.Compensatory exercises targeting the plantar region of the foot, according to our observation, appear to be a suitable tool for maintaining the functionality not only of the lower limbs but of the entire musculoskeletal system.
The output examination again included a standing examination, and a foot examination on the Podoscope and Footdisc devices, along with photo documentation for final comparison of results.Compensatory exercises included five exercises to activate the longitudinal and transverse arches along with stimulation of the small muscles of the foot.All exercises were performed barefoot, on a hard mat, and, when possible, in front of a mirror.The selected exercises are shown in Figures1-5(stimulation of the plantar surface of the foot using a rehabilitation hedgehog, training of the four-point foot support, activation of the transverse arch of the foot, training of the 'small foot' and toe abduction).

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Fig. 2: Training the four-point foot support

Fig 4 :FigFigFig
Fig 4: Abduction training of the big toe