BACKGROUND: Flatfoot is a condition characterized by a diminished or absent medial longitudinal arch, which can lead to pain, altered biomechanics, and reduced functional performance. Overweight adolescents with functional flat feet are particularly at risk due to increased weight-bearing stress, which exacerbates symptoms and impacts daily activities. Aquatic exercise, known for its low-impact nature and supportive environment, has shown promise in alleviating pain and improving functional performance in musculoskeletal conditions. However, its specific effects on functional flat feet in overweight adolescents remain underexplored. OBJECTIVE: To evaluate the impact of an aquatic exercise program on pain reduction and functional performance in overweight adolescent runners with functional flat feet. METHODS: This was a comparative study conducted at Krishna College of Physiotherapy, Karad. Ninety-two participants of the age group 13 to 19 were taken according to inclusion criteria and by using Foot Posture Index-6 and navicular drop test. Participants were divided using a simple random sampling technique and assessed using three outcome measures: the Visual Analog Scale, Clarke's angle, and the 50-meter sprint run test. RESULTS: The study interpreted those overweight adolescent runners with functional flat feet exhibited significant improvement in group B than group A. The aquatic exercise program showed extremely significant results (p < 0.0001) in the outcomes; Visual Analog Scale, Clarke's angle, and 50-meter sprint run test than the land-based exercise program. CONCLUSION: The study concluded that the aquatic exercise program had a significant impact on the outcomes of Visual Analog Scale, Clarke's angle, and 50-meter sprint run test. The unique properties of water, including buoyancy and resistance, facilitated enhanced strength, flexibility, and stability while minimizing joint stress. Aquatic exercises led to significantly greater improvements in pain reduction and functional performance compared to land-based exercises in overweight adolescent runners with functional flat feet.

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