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Yang L, Liu X, Liu Y, Zheng W, Wang W, Yan S. Altered gait patterns during arch important development period in children with persistent obesity: An experimental longitudinal study. Gait Posture 2024; 111:143-149. [PMID: 38703442 DOI: 10.1016/j.gaitpost.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/29/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Obesity can cause structural changes and functional adjustments in growing children's feet. However, there is a lack of continuous observation of changes in feet in children with persistent obesity during important developmental periods. This makes it challenging to provide precise preventive measures. OBJECTIVE This study aimed to investigate the effects of persistent obesity on gait patterns in children at an important stage in the formation of a robust foot arch. METHODS The Footscan® plantar pressure system was used for 3 checks over two years. A total of 372 children aged 7-8 years participated in the study, and gait data from 33 children who maintained normal weight and 26 children with persistent obesity were finally selected. Repeated measures ANOVA or Friedman's test were used for longitudinal comparisons. Independent-Sample t-tests or the Mann-Whitney-Wilcoxon tests were used for cross-sectional comparisons. RESULTS During the important period of development, children with persistent obesity did not exhibit a significant decrease in the arch index and had significantly higher values than the normal group in the third check. The persistently obese children showed increased load accumulation in the lateral rearfoot, first metatarsophalangeal joints, and the great toe regions. Children with persistent obesity had significantly greater medial-lateral displacements in the initial contact phase and forefoot contact phase than normal children in the first check. These differences diminished between the second and third checks. SIGNIFICANCE Persistent obesity during an important period of foot development leads to slow or abnormal development of arch structure and affects foot loading patterns with heel inverted and forefoot everted. Additionally, the development of gait stability is not limited by persistent obesity.
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Affiliation(s)
- Luming Yang
- National Engineering Laboratory for Clean Technology of Leather Manufacture, Sichuan University, Chengdu, China
| | - Xinye Liu
- National Engineering Laboratory for Clean Technology of Leather Manufacture, Sichuan University, Chengdu, China
| | - Yuan Liu
- National Engineering Laboratory for Clean Technology of Leather Manufacture, Sichuan University, Chengdu, China
| | - Wenxiao Zheng
- Jihua 3515 Leather and Leather Shoe Co., Ltd., Luohe, China
| | - Wei Wang
- National Engineering Laboratory for Clean Technology of Leather Manufacture, Sichuan University, Chengdu, China
| | - Shiyang Yan
- National Engineering Laboratory for Clean Technology of Leather Manufacture, Sichuan University, Chengdu, China; Zhejiang Red Dragonfly Footwear Co., Ltd, Wenzhou, China.
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Feng ZY, She JY, Hu XY, Liu HS, Wang HJ, Zhu LG, Zheng S, Li JY, Zhang KR, Li YK, Chen C. Exploring flatfeet morphology in children aged 6-12 years: relationships with body mass and body height through footprints and three-dimensional measurements. Eur J Pediatr 2024; 183:1901-1910. [PMID: 38337095 DOI: 10.1007/s00431-024-05471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
The aim of the study was to determine the relationship between flatfoot morphology and body mass and height in children aged 6-12 years. A total of 6471 Chinese children (mean age 9.0 ± 1.9 years, 41% female) were assessed for foot morphometry, body height, and body mass index. Foot morphology, including foot length, width, girth, arch height, hallux valgus angle, and rearfoot valgus angle, was measured using a 3D laser scanner. Flatfoot evaluations were conducted using the Sztriter-Godunov index (KY) from footprints. All measurements were analyzed by age and sex using the mean values of the left and right sides. Comparisons were performed between flatfoot groups, between body mass index (BMI) groups, and between body height groups. The study revealed a significant decrease in the incidence of bipedal flatfoot with age (p < 0.001), whereas the prevalence of obesity remained consistent (p > 0.05). Bipedal flatfoot was associated with distinct morphological changes, including lower arches, reduced instep height, diminished ankle heights and a greater rearfoot valgus angle (p < 0.05). When comparing the BMI groups, overweight children had larger and thicker feet (p < 0.05), but no differences were found in arch height and ankle height (p > 0.05). When comparing the body height groups, short-statured children had a shorter feet girth, shorter arches, and shorter ankle height (p < 0.05), but no differences were found in the rearfoot valgus angle (p > 0.05). CONCLUSION The main characteristics of flat feet include lower arches and instep heights and ankle heights but higher rearfoot valgus angles. In general, overweight children's feet do not have the common features of flat feet. In contrast, short children had similar features of flatfoot except for rearfoot valgus. Assessment of posture, such as rearfoot valgus, can be critical in identifying children with flat feet. WHAT IS KNOWN • The morphology of children's feet is associated with body growth, but the relationship between flatfeet and body mass and height remains controversial. WHAT IS NEW • Three-dimensional foot measurement shows that body mass is generally not associated with flatfeet, while short children have lower arches but no rearfoot valgus.
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Affiliation(s)
- Zi-Yu Feng
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China
| | - Jing-Yi She
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China
| | - Xin-Yao Hu
- Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, China
| | - Hong-Sheng Liu
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hua-Jun Wang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Li-Guo Zhu
- Wangjing Hospital of China Academy of Chinese Medical Sciences (Key Laboratory of Beijing of Traditional Chinese Medicine Bone Setting), Beijing, China
| | - Sheng Zheng
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China
| | - Jian-You Li
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, China
| | - Kai-Rui Zhang
- Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yi-Kai Li
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China.
| | - Chao Chen
- School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China.
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Vergillos Luna M, Khal AA, Milliken KA, Solla F, Rampal V. Pediatric Flatfoot: Is There a Need for Surgical Referral? J Clin Med 2023; 12:jcm12113809. [PMID: 37298004 DOI: 10.3390/jcm12113809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Pediatric foot deformities are a common finding, concerning up to 44% of preschool aged children. The absence of accepted international guidelines, as well as heterogeneity in definitions and measurements, makes management of pediatric flatfoot a challenge, and decisions surrounding specialized care referral confusing and biased. The objective of this narrative review is to provide guidance to primary care physicians treating these patients. A non-systematic review of the literature regarding the development, etiology, and clinical and radiographic assessment of flatfeet using the PubMed and Cochrane Library databases was performed. The exclusion criteria for the review were adult populations, papers detailing the outcome of a specific surgical procedure, and publications prior to 2001. The included articles showed great heterogeneity in definition and proposed management, which makes the study of pediatric flatfoot challenging. Flatfoot is a common finding in children under 10 years old, and should not be considered pathological unless stiffness or functional limitation are present. Surgical referral should be reserved to children with stiff or painful flatfoot, while simple observation is indicated for flexible, asymptomatic flatfeet.
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Affiliation(s)
- Manuel Vergillos Luna
- Department of Orthopedics, Regina Montis Regalis Hospital, 12084 Mondovì, Italy
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Adyb-Adrian Khal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Kara A Milliken
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Federico Solla
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
| | - Virginie Rampal
- Department of Orthopedics, Lenval University Children's Hospital, 06200 Nice, France
- Laboratoire Motricité Humaine Expertise Sport Santé, Unité de Formation et Recherche Sciences et Techniques des Activités Physiques et Sportives, 06205 Nice, France
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