3D-Printed Arch Supports Combined with Toe Spreaders Modulate Phase-Specific Ankle Alignment and Muscle Activity in Young Adults with Functional Flat Foot.

Background/Objectives: Functional flat foot (FF) is associated with altered lower limb biomechanics, leading to inefficient load transfer and potential overuse injuries. Customized orthoses, such as 3D-printed insoles and toe spreaders, may mitigate these deficits, but their combined biomechanical and neuromuscular effects remain unclear. The current study investigated the immediate effects of 3D-printed arch support insoles (SI) and toe spreaders (Toe) and their combination (SI+Toe) on gait pattern, center of force (COF), ankle alignment, and lower limb muscle activation in young adults with FF. Methods: Ten FF individuals and ten matched controls performed level walking under four randomized conditions: shoe-only, SI, Toe, and SI+Toe. Gait was analyzed using OptoGait, COF trajectory via F-Scan, ankle angles using Kinovea, and muscle activity (semitendinosus, biceps femoris, tibialis anterior, peroneus longus, gastrocnemius, and soleus) via surface EMG. Results: Compared to controls, FF individuals exhibited medial COF deviation, increased ankle eversion, and altered muscle activity. In the FF group, SI+Toe reduced medial COF deviation, decreased eversion, and prolonged foot flat while shortening the propulsive phase. Semitendinosus and tibialis anterior activity increased under SI+Toe, while gastrocnemius and soleus remained reduced during propulsion. Conclusions: The combined utilization of 3D-printed insoles and toe spreaders produced immediate measurable improvements in foot alignment and muscle activity patterns in FF individuals. These findings support that integrating customized orthotic designs with toe spreader elements may provide a practical, non-invasive approach for improving lower limb biomechanics. Such strategies may help improve foot mechanics and reduce compensatory muscle activation in a clinical setting.