Body weight-dependent foot loads, assessed in terms of BMI and adiposity, in school-aged children: a cross sectional study

Comparison of plantar pressure distribution in underweight, normal, overweight, and obese adolescents: A cross-sectional study evaluation of plantar pressure in adolescents

BACKGROUND

Repeated overload by body weight in the adolescents affects the foot structure.

OBJECTIVE

This study aimed to evaluate plantar pressure distribution in adolescents with different body mass indices during gait and standing.

STUDY DESIGN

This is a randomized, cross-sectional study.

METHODS

One hundred eighty-six adolescents between the ages of 8 and 15 years were included. The individuals were divided into groups according to body mass index (BMI). Plantar pressure distributions were examined during gait and standing. Surface areas, plantar pressures, forefoot-hindfoot load, surface amounts, and foot angles of the individuals were determined during gait and standing.

RESULTS

Significant differences were detected in left-right surfaces, maximum load quantities, average pressures, forefoot-hindfoot surface areas between static and dynamic plantar pressure distributions of underweight, normal, overweight, and obese adolescents (P < 001). Maximum, average pressure, right forefoot foot load, and foot angles increased in the obese group during standing as BMI increased; total surface areas, and loads in forefoot, hindfoot surface areas in right and left feet also increased in maximum and average pressures during gait (P < .05). No differences were detected between groups in foot angles during standing and gait (P > .05).

CONCLUSIONS

This study show that increased BMI causes increased plantar pressures during gait and standing, and weight gain would cause problems in adolescents.

Foot posture index and body composition measures in children with and without developmental coordination disorder

Background

Foot posture which forms the distal supporting structure influences on postural stability. Children with developmental coordination disorder (DCD) who are more likely to be overweight or obese may present with flat foot with symptoms that affect daily activities. The aim of this study was to compare the foot posture and body composition measures between children with and without DCD. In addition, this study aimed to investigate the relationship between foot posture and fat percentage.

Methods

Fifty-nine children with DCD (mean age = 8.07±1.10) and sixty-two typically developing children (mean age = 7.97±1.05) were recruited to the DCD and control group respectively. All children received a foot posture assessment and a whole-body dual-energy X-ray absorptiometry (DXA) scan. Foot Posture Index 6 (FPI-6) total scores, sub-scores and lower limb body composition measures including fat mass, lean mass, total mass, fat percentage and fat mass index were measured.

Results

Children with DCD revealed a significantly higher FPI-6 left (1.12; 95% CI: 0.172, 2.061) and right (1.15; 95% CI: 0.218, 2.079) total score. FPI-6 sub-scores (talar head palpation and abduction/adduction forefoot on rearfoot) illustrated significant differences between children with and without DCD. Children with DCD had a significantly higher total fat mass (1247.48g; 95% CI: 121.654, 2373.304), total fat percentage (1.82%; 95% CI: 0.115, 3.525) and fat mass index (0.56kg/m²; 95% CI: 0.036, 1.069). There was a significant relationship between FPI-6 right total score and total fat percentage.

Conclusion

The findings of this study showed that children with DCD exhibited significantly more pronated foot posture and higher body composition measures compared to typically developing children. Moreover, with FPI-6 right total score significantly related to the total fat percentage, it may require more than just detecting abnormal foot structures in children with DCD but also promoting a healthy lifestyle to prevent obesity.

Association between flat foot prevalence and nutritional status in schoolchildren

Introduction/Objective. The aim of this study was to examine the association between flat feet and socio-demographic factors and nutritional status in children aged 7?14 years of the Province of Vojvodina, Serbia. Methods. The research was conducted as a cross-sectional study. The survey instrument was a questionnaire, and anthropometric measurements were done using standardized procedures. To determine the impact of socio-demographic factors and nutritional status as independent variables on the flat feet in schoolchildren as a dependent variable, a multivariate logistic regression model was implemented. A multivariate model was adjusted for age, sex, type of settlement, and material status. Results. This study included 1376 children (685 boys and 691 girls). Significant differences were observed in the frequency of flat feet between normal weight, overweight, and obesity (p = 0.006), where obese children were rated highest in the flat foot category. Overweight children had a 1.76 times higher chance to have flat feet than those with normal weight (OR = 1.76; 95% CI 1.08?2.88), while obese children were 1.88 times more likely to have flat feet than those with normal weight (OR = 1.88; 95% CI 1.14?3.11). Conclusion. The research showed that nutritional status was significantly associated with the presence of flat feet in schoolchildren. The high prevalence of flat feet and obesity in schoolchildren should be accepted as a warning sign, and many public health policies should be undertaken to solve these issues.

Comparing Validity and Diagnostic Accuracy of Clarke's Angle and Foot Posture Index-6 to Determine Flexible Flatfoot in Adolescents: A Cross-Sectional Investigation

OBJECTIVE

Clinically, the foot posture index-6 (FPI-6) and Clarke's angle (CA) are widely utilized to assess static foot posture; however, due to scarcity of scientific evidence, clinicians continue to debate the validity and diagnostic accuracy of these measures in children and adolescents. This study aimed to evaluate and compare the validity and diagnostic accuracy of the FPI-6 and CA in determining adolescents' flexible flatfoot between ages of 12 and 18 years, considering radiographic investigation as a reference standard measure.

DESIGN

Cross-sectional study.

SETTING

Governmental hospitals.

PARTICIPANTS AND METHODS

A sample of 460 people (920 feet) with flexible flatfoot between the ages of 12 and 18 (15.23 ± 0.84 years) was enrolled in the study. The findings of the investigated measures were compared to the reference standard radiographic measure and plotted on the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was determined as a measure of FPI-6 and CA diagnostic accuracy. Intra-rater reliability, sensitivity, specificity, predictive values, and likelihood ratios of FPI-6 and CA were calculated and compared. The post-test probability of flatfoot was determined using the Fagan nomogram.

RESULTS

CA had a substantially higher intra-rater reliability (ICC=0.99) than the FPI-6 (ICC=0.96), with p-value of 0.001. CA has greater sensitivity (98%) than FPI-6, as well as a superior specificity (99%), positive predictive value (98%), negative predictive value (98.9%), positive likelihood ratio (97), and a lower negative likelihood ratio (0.02). CA had such an area under ROC curve of 0.98 with a 95% confidence interval of 0.95-1.00, while FPI-6 had an area under ROC curve of 0.80 with a 95% confidence interval of (0.77-0.85).

CONCLUSION

FPI-6 and Clarke's angle are both valid and diagnostically accurate clinical tests for flatfoot detection, with Clarke's angle outperforming FPI-6 in adolescents aged 12 to 18 years with a normal BMI.

Assessment of the Foot's Longitudinal Arch by Different Indicators and Their Correlation with the Foot Loading Paradigm in School-Aged Children: A Cross Sectional Study

Background: There are numerous studies assessing the morphological structure of the foot, but there is a notable scarcity of those focused on juxtaposing various longitudinal arch indices with foot loading paradigm. The present study aimed to determine the overall reliability, diagnostic accuracy of respective variables, and their correlation with the foot loading paradigm. Methods: The study group consisted of 336 children, aged 10–15 years (girls 49.1% and boys 50.9%). The morphological structure of the plantar part of the foot in static conditions was assessed with the aid of a 2D podoscan. Individual foot loading paradigm in static conditions was assessed making use of the FreeMed platform. Results: Staheli (SI), Chippaux–Smirak (CSI), and Sztriter–Godunow (KY) indices were strongly correlated with each other (ρ > 0.84, p < 0.001). Own research corroborated an increased pressure of hollow feet, as assessed by the SI, CSI, and KY indices, on the forefoot and the hindfoot, foot zones B, E, F; these correlations being statistically significant. The results yielded by the present study also indicate an increased pressure on the metatarsal, and foot zones C, D of the flat feet. Conclusions: Flatfootedness is not believed to be a common deformity among children and adolescents. The SI, CSI, and KY indices were found to be strongly correlated, as well as proved reliable in assessing the foot’s longitudinal arch.

Vulnerability of the foot's morphological structure to deformities caused by foot loading paradigm in school-aged children: a cross-sectional study

The study aimed to assess the association between the key predictive foot structure variables and its loading paradigm in 625 school-aged children. Clinical appraisal relied primarily on having the plantar parts of their feet comprehensively assessed with Podoscan 2D Foot CAD, and a dynamometer platform, the research tools of choice widely acknowledged for their overall accuracy and reliability, with a view to determining the distribution of respective foot loads, as well as addressing both balance and gait issues. The Clarke's angle, Wejsflog index, length and width of the feet, regardless of gender, proved the key predictive variables for the foot-loading paradigm. Notably the Clarke's angle, construed the most sensitive variable in assessing flat-footedness, offered an extra added value in overall investigative effort. The actual design of the study protocol effectively complements a standard clinical assessment procedure, whereas by comprehensively addressing those variables, it is also believed to aid clinicians in gaining an extra, hands-on, diagnostic potential, so that any teenagers exposed to the highest risk of developing foot deformities could effectively be identified through pertinent screening tests, and consequently offered a task-oriented, therapeutic management, specifically aimed at preventing potential postural complaints in later life.

Children with Obesity Experience Different Age-Related Changes in Plantar Pressure Distributions: A Follow-Up Study in China

Age is a key factor in plantar pressure distributions during the development of obese children. However, the existing evidence for age-related plantar pressures of obese children is not sufficient to make clear how the plantar pressures would change with the increasing age. This study aimed to evaluate the plantar pressure redistributions of obese children after a three-year follow-up and to further compare these changes with normal-weighted children. Ten obese children and eleven normal-weighted counterparts were involved in this study. Plantar pressure measurements were undertaken using a Footscan^® plantar pressure plate on two test sessions three years apart. Peak pressure, pressure-time integral, standard maximum force, and z-scores of these variables were analyzed. Loading transference analyses were applied to detect the different loading transferring mechanisms between obese and normal-weighted children. Significantly increased plantar pressures were observed at the lateral forefoot and midfoot for obese children, which gradually deviated from those of normal-weighted children over the 3 years. With the increasing age, obese children displayed a lateral loading shift at the forefoot in contrast to the normal-weighted. Early interventions are cautiously recommended for obese children before the plantar loading deviation gets worse as they grow older.