To evaluate whether combining proprioceptive neuromuscular facilitation (PNF) therapy with customized orthotic insoles leads to greater improvements in gait parameters, ankle range of motion, and lower-limb function than either intervention alone in pediatric foot drop and inversion deformity.

Ninety-seven children (aged 5–14 years) with foot drop and inversion deformity were randomized into three groups: (1) PNF plus insole, (2) insole only, and (3) PNF only. All interventions lasted 12 weeks. Gait parameters, the Gross Motor Function Measure (GMFM), ankle range of motion, muscle strength, and functional balance were assessed at baseline, immediately post-intervention, and at 1- and 3-month follow-ups.

Children receiving the combined PNF plus insole intervention demonstrated significantly greater increases in gait velocity (18.5 % vs. 9.2 % and 8.7 % for insole-only and PNF-only groups, respectively) and higher improvements in GMFM scores (12-point increase vs. 6 and 5 points). Ankle dorsiflexion improved by a mean of 6.1° in the combined group (p < 0.05). Approximately 85 % of these gains were maintained at the 1-month follow-up, which exceeded the modest regression observed in the single-intervention groups.

Combining PNF therapy with customized orthotic insoles offers superior and more durable improvements in gait and lower-limb function compared to single interventions, suggesting a more effective rehabilitative strategy for pediatric patients with foot drop and inversion deformity.

Foot drop

Inversion deformity

Proprioceptive neuromuscular facilitation

Orthotic insole

Gait analysis

© 2025 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.