Monitoring the Role of Physical Activity in Children with Flat Feet by Assessing Subtalar Flexibility and Plantar Arch Index

Round 1

Reviewer 1 Report

It would be advisable to put the validity and reliability data of the RSscan.

Author Response

Dear reviewer,

Thank you very much for suggestion and evaluation of our paper.

Dr Rusu Ligia

Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for study.    The number of subjects in the article is quite small, but I think it will be useful to evaluate two parameters-plantar index arch and subtalar flexibility - before and after physiotherapy and orthoses interventions.

In the introduction, What is the hypothesis of the study?

There are a few points that should be added in the Method section.

The effect of orthosis during walking is quite high. In the study, no explanation was written about the orthosis. What were the arch supports in the insoles? A picture of the orthosis can be added. I think it should be added.

In the study, no classification was made regarding the degree of low arch in children with FF. A classification of two groups can be given.

Thank you for study.    The number of subjects in the article is quite small, but I think it will be useful to evaluate two parameters-plantar index arch and subtalar flexibility - before and after physiotherapy and orthoses interventions.

In the introduction, What is the hypothesis of the study?

There are a few points that should be added in the Method section.

The effect of orthosis during walking is quite high. In the study, no explanation was written about the orthosis. What were the arch supports in the insoles? A picture of the orthosis can be added. I think it should be added.

In the study, no classification was made regarding the degree of low arch in children with FF. A classification of two groups can be given.

Thank you for study.    The number of subjects in the article is quite small, but I think it will be useful to evaluate two parameters-plantar index arch and subtalar flexibility - before and after physiotherapy and orthoses interventions.

In the introduction, What is the hypothesis of the study?

There are a few points that should be added in the Method section.

The effect of orthosis during walking is quite high. In the study, no explanation was written about the orthosis. What were the arch supports in the insoles? A picture of the orthosis can be added. I think it should be added.

In the study, no classification was made regarding the degree of low arch in children with FF. A classification of two groups can be given.

Thank you for study.    The number of subjects in the article is quite small, but I think it will be useful to evaluate two parameters-plantar index arch and subtalar flexibility - before and after physiotherapy and orthoses interventions.

In the introduction, What is the hypothesis of the study?

There are a few points that should be added in the Method section.

The effect of orthosis during walking is quite high. In the study, no explanation was written about the orthosis. What were the arch supports in the insoles? A picture of the orthosis can be added. I think it should be added.

In the study, no classification was made regarding the degree of low arch in children with FF. A classification of two groups can be given.

Thank you for study.    The number of subjects in the article is quite small, but I think it will be useful to evaluate two parameters-plantar index arch and subtalar flexibility - before and after physiotherapy and orthoses interventions.

In the introduction, What is the hypothesis of the study?

There are a few points that should be added in the Method section.

The effect of orthosis during walking is quite high. In the study, no explanation was written about the orthosis. What were the arch supports in the insoles? A picture of the orthosis can be added. I think it should be added.

In the study, no classification was made regarding the degree of low arch in children with FF. A classification of two groups can be given.

Author Response

Dear reviewer,

Thank you very much for your effort and time spent for evaluation our paper. 

Dr Rusu Ligia

Author Response File: Author Response.docx

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

In this study authors assessed the relationship between plantar arch index and subtalar flexibility in static and dynamic situations. They studied two groups of children with bilateral flat foot using two therapeutic interventions. They found inverse correlation between arch index and subtalar flexibility.

The whole script is not well-written. There are a lot of typos and grammar mistakes. The whole script is not readable and thus comprehensible. It seems to me that authors just submitted their draft version. I highly recommended to rewrite with the help of an English native speaker, and re-arrange the figures and tables

 

Keywords: please avoid using general keywords such as ‘assessment’, ‘physiotherapy’.

 

1. Introduction

“Flat foot means flat of medial longitudinal arch (MLA) of the foot which is visible on the standing position but also during the gait. Hyperpronation or excessive pronation of the foot refers to medial deviation of the talus during gait, which is more visible in stance phase. Both aspects open the discussion about the subtalar angle behavior which could have the expressed on subtalar flexibility in functional activities.”

You need proper citations here.

 

“Subtalar joint is a multijoints structure with many movements because of three joints facetes. These allow antero-posterior movement and lateral movement. Thes facetes  definy three components of subtalar joint anterior, medial and posterior components [1]. About the subtalar joint mobility are a lot of controverses and the majority of the authors consider that is 42° in sagittal plan and 23° medial deviation if we report to long 45 foot axis [2].”

This paragraph is not understandable.

 

“Gait analysis is used for design physiotherapy program in flat foot (FF) due to the necesity to understand its behavior during gait which involves three actions: rollover of foot from supination to pronation on the floor, dorsal and plantar flexibility, rotations .”

Only one of the applications of gait analysis could be design physiotherapy plans. What do you mean by rotations?

 

“Flat foot defined by collapse of MLA and overpronation, could generates pain syndrome, gait disorders, static and balance disorders and affects the entire lower limb.”

Please add proper references.

 

“Many of the evaluations included measure the indexes like: valgus index, arch 70 index, Staheli index, Chippaux-Smirak index, Foot posture index and Clarke angle [5].”

Please cite original papers not the review.

 

“One common foot structure measurement is the MLA-angle, based on three points: medial malleolus, tuberositas ossis navicularis and caput metatarsale [16],”

What do you mean by ‘caput metatarsale’? the definition of MLA-angle is not right. It is not based on medial malleolus rather medial calcaneus. Also, I don’t find the ref 16 as proper ref since nothing is mentioned about the MLA-angle definition.

 

 “Even if majority of the researchers and physicians consider that approach of …

and orthoses interventions. Also the study includes the analysis of the correlation between these two parameters.”

this part of introduction is not readable.

 

2. Materials and Methods

 

Please remove term ‘flat-footed participants’ and use participants with flat-foot instead.

What do you mean by ‘more expresed to the left side’  ? please give proper information or remove this.

• Evaluation

Please give the definition of MLA index.

Please mention the statistical tests you performed in the Materials and Methods section not in the Results.

How the author measured the Subtalar Flexibility? Nothing mentioned in the Materials and Methods. Please clear this out.

 

3. Results

This section is mess. The result section is just presenting the most important findings not describing statistical method (it belongs to the Materials and Methods) and not discussion about the results (it belong to the Discussion). In the way you present the chaotic results with the high number of tables and figures (14 tables and 6 figures), makes it almost impossible to follow the results. Please r-arrange this section.

 

 Since the participants have bilateral flat foot, it is not clear why the results have been divided to the left and right sides. Though the authors mentioned ‘more expresed to the left side’ but as the authors have not provided more information about left side tendencies, I suggest to combine left and right sides. In this way, the results would be much more understandable and very easy to follow.

Where is Fig 2?

I suggest to use Figs instead of Tables 2, 3, 4, and 5. I suggest to merge left and right sides and I suggest put all statistical findings in maximum two tables.

Author Response

Dear reviewer, thank you very much for effort to read and assess our paper. Your comments are very useful for us and we try to do the best for answer.Hope that this will be well done and you will accept our paper.Thank you again

Author Response File: Author Response.docx

Reviewer 2 Report

The authors compared the treatment between physiotherapy and physiotherapy + foot orthosis, before and after the treatment. I found no relationship between the manuscript title and the work done in the paper. The English level is terribly unacceptable and unreadable; with much non-compliance to format. The introduction is full of scattered short sentences without any coherence, and the presentation of data results and statistics could merely be understood. The statistical analysis did not seem to be correct and was not described in the abstract.

Line 31: I believed that this is overclaimed that flatfoot is one of the frequent pathologies. Instead, it could be one common type of paediatric foot deformity.  

Line 31: the author stated that flatfoot is where the foot arch is visible when standing but also during gait. Firstly, the foot arch naturally collapses during weight-bearing, and it really depends on the type of flatfoot, flexible or rigid.

Line 32: This is not how hyperpronation be defined.

Line 54: Gait analysis is used to design physiotherapy program in flatfoot. This is simply incorrect.

Line 41: Subtalar had a particular set of movements. The joint did not have many movements.

Line 130: Since this is a clinical intervention with outcomes related to health, please include the information of clinical trial registration according to the ICMJE guidelines.

Line 131: Please justify the sample size

Line 131: Please include information on body weight and height in-text.

Line 139: How do the authors assign participants into groups?

Line 152: How do the authors justify which dataset is the “best” ? Will this induce bias to the study because they select the data that best align with their hypothesis?

Line 155: The authors mentioned that they applied a statistical test to evaluate significant differences. However, they did not mention what kind of test they had conducted.

Line 192: The authors prescribed insoles to group 2 as an essential measure. However, there was no information on the insole.

The words in the tables are overlapped.

There was no discussion on the limitation of the study

Author Response

Dear reviewer, thank you very much for effort to read and assess our paper. Your comments are very useful for us and we try to do the best for answer.Hope that this will be well done and you will accept our paper.Thank you again

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

Thanks to the authors for the respond. Unfortunately, my main concerns have not been addressed properly.

1. The text language, including typos and errors, still is remained intact.
2. Apparently, authors misunderstood the term re-write with Copy and Paste form one section to another section. I wish the authors, instead of providing quick response, took their time and properly went through the critics since I still think there is some decent material and research work there.

Unfortunately, I don’t see a way to see this manuscript could be published.  

Reviewer 2 Report

I believed that the authors had no intention to improve the manuscript quality. Not only that the authors did not settle the problems on coherence between sentences issues and format compliance of the journal, but the number of typos and grammatical mistakes is also yet countless, which could kindly be resolved by a spelling check in Microsoft Word., E.g.
Line 42: "Flat foot is one these pathology"
Line 56: "Gait analysis is one of the method" 
A lot of the "previous actions" and “methods/outcomes of existing literature” shall be past tense.
Line 102: “This is just a hypothesis because are not consistent”
Line 283: "we obser average" 
I could not name it all but this shall be the author’s role to work on that. 
The authors mentioned that the sample size was originally 64 and dropped to 30 because of some issues. This shall not be the justification of sample size. If the original is 64, why 64?
I also raised the issue of the flatfoot type (i.e. flexible, and rigid). While the authors simply repeated my words. My particular concern was that participants with different classes of flatfoot shall receive different treatments and the research was not valid without such consideration. 
For the statistical part, I kindly advise the authors to head help from biostatistician. The test shall name “student’s t-test”, while Cohen’s D is the effect measure of the test. Also, family-wise error was not considered. There was a comparison between EV1 and EV2, and also Group 1 and Group 2. If the statistics is to compare two groups, there will be only one set of statistical analysis for the group comparison. I do not understand why there are different p-values and Cohen’s d value for each group. 
I cannot find the clinical registry in the EU system and I believed that this is not a proper code format for the EudraCT Number.