Effect of hip-focused exercises on medial longitudinal arch height in individuals with pes planus: A systematic review

BACKGROUND: Traditional exercise approaches focusing on the foot and ankle are generally preferred for pes planus treatment. However, given that the lower extremity functions as a kinetic chain with its segmental connections, the relationship of this deformity beyond local musculature to more proximal segments is becoming increasingly important. This study aimed to evaluate the effects of hip-focused exercise approaches on medial longitudinal arch (MLA) height in individuals with pes planus. METHODS: This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in International Prospective Register of Systematic Reviews (PROSPERO). PubMed, Web of Science, Scopus, and Cochrane Library databases were searched from inception to November 2025. Randomized controlled trials (RCTs) involving individuals with pes planus that included hip-focused exercises and reported MLA height outcomes were included. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2 (RoB2) tool. RESULTS: Eleven RCTs with a total of 478 participants were included. All studies reported significant improvements in MLA height following interventions that incorporated hip-focused exercises. In most studies, hip exercises were combined with traditional foot-focused protocols, resulting in superior improvements compared to control groups. Several studies also reported improvements in balance and foot posture. CONCLUSION: Hip-focused exercise approaches may significantly enhance MLA height in individuals with pes planus, especially when integrated into comprehensive lower extremity exercise protocols. These results suggest that targeting the proximal kinetic chain particularly the hip musculature may provide additional benefits beyond local foot and ankle interventions.