Foot morphology in Spanish school children according to sex and age

High Rate of Change of the Foot in Ecuadorian Children: The Need for Proper Shoe Design

BACKGROUND

Physiological changes in the foot may be influenced by external factors such as shoe types or demographic parameters, leading to podiatric conditions in adulthood. The aim of this study was to assess the changes in morphological measurements of the feet of boys and girls during childhood and adolescence.

METHODS

A total of 1678 Ecuadorian children aged 8 to 17 years participated in the study. The length, width, and height of the foot were analyzed using a 3D scanner to obtain the arch height ratio for the diagnosis of pediatric flat foot.

RESULTS

Statistical differences were observed for lengths, widths, and perimeters of the foot in boys aged 5 to 15-16 years and girls aged 5 to 12-13 years. Differences in the height of the navicular bone were found in all age groups, with changes from 2.8 to 4.1% in boys and from 1.3 to 1.5% in girls. The greatest differences between boys and girls of the same age were found at 14 years old onwards. The highest prevalence of flat foot was found in 8-year-old girls (64.9%) and in 12-year-old boys (82.5%).

CONCLUSIONS

The feet of Ecuadorian children develop progressively during childhood and adolescence. Boys presented with longer and wider feet than girls of the same age. The highest prevalence of flat foot was found in 12-year-old boys and 8-year-old girls.

Sexual dimorphism and determination using foot outlines, foot print angles, and foot indices

Sex determination is one of the fundamental procedures in the forensic investigation during personal identification. Foot dimensions, prints, indices, and angles are assessment tools used by podiatrists and forensic anthropologists. The arch index remains a tool for clinical evaluation of the incidence of pes planus by clinicians. This cross-sectional study was performed to investigate sexual dimorphism and discriminate sex using foot and footprint dimensions, foot angles, and foot indices among the Ebira ethnic group of Nigeria. Bilateral foot outlines and prints were obtained from 317 females and 283 males using a digital Vernier caliper, improvised footpad, and A4 paper. The results revealed that in the right foot and print, the males' bare right foot length (BRFL), bare right foot breadth (BRFB), right arch index (RAI), right Chippaux-Smirak index (RCSI), right footprint angle (RFPA), right ball angle (RBA), and all the measurements of the corresponding toes in the prints are significantly greater (p < 0.05) than the females. The same trend was also observed in the left footprint except for the left ball angle (LBA). The stepwise, binary logistics regression model for sex determination showed that bare left foot breadth (BLFB) and bare right foot length (BRFL) were the single best predictors of sex with an accuracy of 72.5% and 71.7% accuracy. Other foot variables marginally increased the percentage accuracy at each step. The receiver operating characteristic (ROC) curve analysis confirmed the sexing potential of the bare left foot breadth and bare right foot length to be 79%. Sexual dimorphism exists in all the foot dimensions, arch indices, Chippaux-Smirak indices, footprint angles, and ball angles, except the left ball angle. The sexual dimorphism in the foot variables forms the basis of sex determination, with left foot breadth and right foot length as the best sex predictors. Therefore, 25 cm can be regarded as the cut-off point for foot length and 9 cm as the cut-off point for foot breadth among this tribe.

Athletic Injury Research: Frameworks, Models and the Need for Causal Knowledge

Within applied sports science and medicine research, many challenges hinder the establishment and detailed understanding of athletic injury causality as well as the development and implementation of appropriate athletic injury prevention strategies. Applied research efforts are faced with a lack of variable control, while the capacity to compensate for this lack of control through the application of randomised controlled trials is often confronted by a number of obstacles relating to ethical or practical constraints. Such difficulties have led to a large reliance upon observational research to guide applied practice in this area. However, the reliance upon observational research, in conjunction with the general absence of supporting causal inference tools and structures, has hindered both the acquisition of causal knowledge in relation to athletic injury and the development of appropriate injury prevention strategies. Indeed, much of athletic injury research functions on a (causal) model-blind observational approach primarily driven by the existence and availability of various technologies and data, with little regard for how these technologies and their associated metrics can conceptually relate to athletic injury causality and mechanisms. In this article, a potential solution to these issues is proposed and a new model for investigating athletic injury aetiology and mechanisms, and for developing and evaluating injury prevention strategies, is presented. This solution is centred on the construction and utilisation of various causal diagrams, such as frameworks, models and causal directed acyclic graphs (DAGs), to help guide athletic injury research and prevention efforts. This approach will alleviate many of the challenges facing athletic injury research by facilitating the investigation of specific causal links, mechanisms and assumptions with appropriate scientific methods, aiding the translation of lab-based research into the applied sporting world, and guiding causal inferences from applied research efforts by establishing appropriate supporting causal structures. Further, this approach will also help guide the development and adoption of both relevant metrics (and technologies) and injury prevention strategies, as well as encourage the construction of appropriate theoretical and conceptual foundations prior to the commencement of applied injury research studies. This will help minimise the risk of resource wastage, data fishing, p-hacking and hypothesising after the results are known (HARK-ing) in athletic injury research.

Association of height, foot length, and pubertal development in children aged 3-18: a cross-sectional survey in China

Objective

This study aimed to analyze the growth patterns of height and foot length (FL) among Chinese children aged 3-18 and examine their associations with puberty development.

Methods

A cross-sectional survey was conducted in September 2022 in Beijing. Data were collected through questionnaires and on-site physical examinations. The growth patterns and velocity of height and FL in different age groups were described, and their associations with puberty development were analyzed.

Results

From an age perspective, the peak FL growth occurred between 9 and 11 years (boys were 11 years and girls were 9 years), while the peak height growth occurred at 11 ~ 13 years for boys and 9 ~ 11 years for girls. Additionally, boys and girls reached 99.0% of their final FL at the ages of 14 and 13, respectively, while they reached 99.0% of their final height at the ages of 16 and 15, respectively. From the perspective of Tanner stage, the age of peak FL growth in boys coincided with the age of the G2 stage, while in girls it occurred slightly earlier than the mean age of the B2 stage. The peak height growth for both boys and girls occurred between Tanner stages 2 and 3.

Conclusion

Boys and girls reach their peak FL growth at 11 and 9 years old, respectively, which were both 2 years earlier than their peak height growth. The peak FL growth occurred around the onset of puberty, while the peak height growth occurred between Tanner stages 2 and 3.

Correlation analysis between body mass index and foot length in Chinese adolescents: a regional study

This study aims to analyse the relationship between body mass index and foot length in Chinese adolescents and to provide theoretical guidance for preventing a flat foot in Chinese adolescents. This study recruited 1477 students aged 14-23 years. The participants' height, weight, and body mass index were measured, as well as baseline data, including age, gender and foot length. Differences in foot length (bilateral) and flat foot distribution were statistically significant except for the normal foot and high arch foot distribution based on different body mass index groups. Linear correlation analysis demonstrated that body height, weight and body mass index were positively correlated with bilateral foot length regardless of gender. Body mass index acted as a risk factor for flat foot (bilateral) through disordered multi-classification logistic regression analysis. Body mass index was positively correlated with left and right foot length regardless of gender and acted as a risk factor for a flat foot in Chinese adolescents. Practitioner summary: Significant differences exist in the anthropometric data of various races and ethnic groups. The study was investigated in the form of a cross-sectional study. BMI was positively correlated with bilateral foot length and acted as a risk factor for a flat foot in Chinese adolescents.

Understanding foot conditions, morphologies and functions in children: a current review

This study provided a comprehensive updated review of the biological aspects of children foot morphology across different ages, sex, and weight, aiming to reveal the patterns of normal and pathological changes in children feet during growth and development. This review article comprised 25 papers in total that satisfied the screening standards. The aim was to investigate how weight changes, age and sex affect foot type, and gain a deeper understanding of the prevalent foot deformities that occur during children growth. Three different foot morphological conditions were discussed, specifically including the effect of sex and age differences, the effect of weight changes, and abnormal foot morphologies commonly documented during growth. This review found that sex, age, and weight changes would affect foot size, bony structure, foot posture, and plantar pressures during child growth. As a result of this biological nature, the children's feet generally exhibit neutral and internally rotated foot postures, which frequently lead to abnormal foot morphologies (e.g., flat foot, pronated foot, etc.). In the future, attention shall be paid to the causal factors leading to specific foot morphologies during the growth and development of children. However, sufficient evidence could not be provided due to a relatively short period of investigation and non-uniformed research methodology in the current literature. A more comprehensive and in-depth exploration is recommended to provide scientific evidence for the discovery of children foot development and personalized growth pattern.

Characteristics of paediatric foot arches according to body mass among primary school students in Wrocław, Poland

Background

The purpose of this study, conducted within the framework of the project entitled ‘Let’s get the kids moving’, was to determine the associations between children’s longitudinal and transverse foot arch and their weight, gender and age.

Method

The pro-health initiative ‘Let’s get the kids moving’ was created by researchers of the Medical University and the Run for Health Foundation. A total of 655 children (51.5% boys) aged 7 to 10 years from primary schools in south-western Poland participated in the study. The mean age of the subjects was 8.7 ± 0.8 years. In all the children, we assessed anthropometric measurements (weight and height) and the longitudinal and transverse arch of the foot under the load of their weight. A two-dimensional foot scanner (Sensor Medica, Italy) was used to examine the plantar part of the children’s feet.

Results

The data collected from the 655 subjects revealed that excessive weight predisposed them to less longitudinal and transverse arching. The foot shape was not differentiated by gender or age.

Conclusions

Screening school-aged children’s footprints can detect abnormalities in the shape of children’s feet early on, which allows for early diagnosis of functional or structural flatfoot in children.

Measurement of the Developing Foot in Shod and Barefoot Paediatric Populations: A Narrative Review

The theory that footwear may change foot shape dates back 100 years. Since this period, research has revealed the anatomical and functional consequences that footwear can cause to the foot. Children’s feet remain malleable as they undergo developmental changes until adolescence, which is why childhood is arguably a crucial period to understand how footwear can affect natural foot development. This review explored the development of the foot in children and adolescents and the methods used to measure the different foot structures; it comments on the key issues with some of these methods and gives direction for future research. Various internal and external factors can affect foot development; the main factors are age, gender, ethnicity, body mass index (BMI) and footwear habits. Research on how footwear can affect foot development has increased over the years and the final section of this review aimed to unpick the findings. Studies investigating the influence of footwear habits on foot length and width have established inconsistent findings. Many of the studies in the review did not control for internal and external factors that can affect foot development. There was also a limited number of studies that investigated hallux valgus angle and muscle strength differences in those with different footwear habits. Moreover, multiple studies in the final section of this review did not successfully examine the footwear habits of the participants and instead used observations or self-assessments, which is a major limitation. Future research should examine footwear behaviors and other confounding factors when investigating the development of the foot in children and adolescents. Moreover, researchers should critically evaluate the methods used to quantify the different structures of the foot to ensure valid and reliable parameters are being used.

Impact of length and width of footwear on foot structure of preschool-aged children

Background

Due to the dynamics of developmental changes, the preschool age is of crucial importance for the later health and efficiency of the feet. The aim of this study was the analysis of the fitting of indoor footwear and its impact on the features of the foot structure in 6-year-old children.

Methods

The study group consisted of 100 children, including 50 girls and 50 boys at the age of 6 years. The applied device was the CQ-ST podoscope and the Clevermess. The data were analyzed based on Mann-Whitney U test, Chi-square test and regression analysis.

Results

About 60% of children wore correctly fitted shoes in terms of length and width. Multiple regression models with two variables explaining the variance of the Clarke's angle were statistically significant for girls (right foot: p < 0.001 and left foot: p = 0.009), and boys (right foot: p < 0.001 and left foot: p < 0.001). The influence of predictive variables on the values of the heel angle (γ) was statistically significant for girls (right foot: p < 0.001 and left foot: p < 0.001) and boys (right foot p < 0.001 and left foot: p < 0.001).

Conclusions

Both in the case of girls and boys, the frequency of using too long and too wide shoes was higher in relation to the frequency of using too short and too narrow shoes. The length and width of the shoes affected the length and width of the footwear both in girls and boys. The longer and wider the shoes, the lower the height of the arch. Longer shoes are accompanied by a greater transverse arch, and wider ones with a lower transverse arch of the foot.

The typically developing pediatric foot - The data of the 1744 children in China

BACKGROUND

The medial longitudinal arch (MLA) improves with age in childhood. However, it still causes parents to worry that children have flat feet. Due to the lack of a standard to quantitatively assess the arch development in kids at certain age, the pediatricians judge the flat feet by experience, causing many cases to be overtreated. The aim of this study was to plot the distribution of MLA parameters in children.

METHODS

Children without lower limb deformity and lower limb pain were recruited from 12 primary schools and kindergartens in Chongqing province-level city. Foot length (FL) and navicular height (NH) was measured manually, arch index (AI) and arch volume (AV) were measured with the Foot Plantar Scanner. Each parameter was measured in both weight-bearing and non-weight-bearing positions. Significant differences were also compared between the measurements of consecutive years.

RESULTS

This study was the first to use a three-dimensional laser surface scanner to measure the MLA parameters of children aged 3-12 years in China. 1744 children (871 girls, 873 boys) participated in this study. FL, NH, AI and AV varied significantly with age in both the weight-bearing and non-weight-bearing positions. These parameters have significant differences between the weighted and non-weighted positions (p < 0.05).

CONCLUSIONS

The age distribution characteristics of these parameters indicated that the MLA improves with age. The establishment of a developmental scale for the children's MLA is necessary.

Effect of Longitudinal and Transverse Foot Arch on the Position of the Hallux and Fifth Toe in Preschool Children in the Light of Regression Analysis

The aim of the study was to analyze the development of foot structure and the impact of longitudinal and transverse arching of the foot on the position of the hallux and fifth toe in preschool children. The study was carried out among 200 children aged 6 (100 G, 100 B). The research tool was the podoscope CQ-ST. The collected research results were analyzed with the use of the Mann–Whitney U test, Pearson Chi-square test and regression analysis. A statistically significant influence of the heel angle on the value of the varus angle of the fifth toe of the right (girls: p = 0.032; boys: p = 0.001) and left foot (girls: p = 0.004; boys: p = 0.005) was found. Boys’ feet are longer and wider than girls’ feet; moreover, they have a lower longitudinal arch. The frequency of longitudinal and transverse arch deformities of the feet, as well as valgus of the hallux and varus of the fifth toe do not depend on gender. In both sexes, decreasing the transverse arch of the foot has an influence on the severity of varus of the fifth toe. Changes in the height of the longitudinal foot arch does not affect the position of the hallux and fifth toe.

Relationship of the Use of Short Footwear with the Development of Hallux Valgus in a Sample of Andalusian Schoolchildren

Background: Several studies have shown the relationship between poor footwear fit and the risk of feet deformities. The available evidence seems to show that the development of hallux valgus deformity in the feet of schoolchildren may be related to the use of shoes that are poorly fitting in length. The objective of this cross-sectional study was to analyze the relationship between poor footwear fit in length and risk of developing hallux valgus. Methods: Using an instrument that was designed and calibrated for this purpose, maximum foot length was obtained and compared to the inner length of the shoe in 187 schoolchildren. Hallux valgus angle (HVA) was measured on weight-bearing podogram image obtained from the longest foot in 188 schoolchildren. Results: By default, the footwear was poorly fitting in length (too short or close-fitting) in 38.5% of the schoolchildren, with boys having the worst footwear fit; though no significant differences stood out. (p = 0.276). Regarding the HVA, no significant differences were recorded according to age or gender (p = 0.573). A strong correlation was observed between too-short footwear and the increase in HVA in 10-year-old boys (r = 0.817; p = 0.025) and in 9-year-old girls (r = 0.705; p = 0.005). Conclusions: Inadequate footwear fit in length may be a predisposing extrinsic risk factor for the development of hallux valgus in schoolchildren of both sexes. Results of the present study demonstrate the need to adapt the sizes of footwear to the rapid increase in foot-length that occur at puberty to avoid the risk of developing hallux valgus, especially at the ages of onset pubertal foot growth.

Environmental Factors as a Cause of Differences in the Feet of Ecuadorian Children and Its Relation to Their Footwear

The objective of this study was to analyze the differences in foot measurements of Ecuadorian children according to their geographical location of residence, taking into account climatic differences (1). A total of 1662 children (2) participated in the study. Three groups were established: coast, mountains and amazonia. The type of footwear (3) used was recorded and the lengths, widths, perimeters, heights and angles of both (4) feet were analyzed with a 3D foot digitizer (5). The variable ‘fitting of the foot to footwear’ was also obtained. Children living in coastal areas presented greater lengths, widths, perimeters and heights compared to those living in the mountain (p > 0.001) and amazonia (p < 0.001) between ages 5 to 13. Mountain residents showed a greater first toe angle than coast residents (p > 0.001) aged 8 to 17. Children used shoes smaller than required by their foot length (p < 0.01). Ecuadorian children from the coast presented longer and wider feet with higher foot arches, whilst those from mountains presented greater first toe angle. The studied sample used footwear up to one size smaller than the size corresponding to their foot length. The fitting and type of footwear used according to climatic differences could be interfering with normal foot development.

Paediatric flat foot and foot dimension in Central Anatolia

Background

Information on the foot structures of Central Anatolian children is limited. Foot structures of children aged 6–10 years were shown to be different according to sex and increasing age.

Objective

This study aimed to compare the foot anthropometric values by age and sex and collect the foot anthropometric data to reveal the relationship between pes planus and pes cavus in the arches of children according to age.

Methods

Footprints of 335 children (180 boys and 155 girls) aged 6–10 years were taken by the pedigraph method and evaluated using 18 different parameters. The TFL (Truncated foot length), FL (foot length), Arch Index, Chippaux Smirak Index, Staheli Arc Index, and foot rotation values of the children were examined. To examine the relationship between the parameters, normality values were examined. Independent samples t-test was used to analyze sex differences in terms of foot size and shape.

Results

Correlations between other parameters were determined using the correlations analysis method. TFL, metatarsal circumference, and FL were strongly correlated with age in the children. Foot rotation increased with body mass index in the girls compared to that in the boys. According to the evaluation results with the classification made with the Staheli arch index, 63.3% pes planus, 9.8% pes cavus and 27.7% of the normal arch structure were identified.

Conclusions

Planning shoe production accordingly will contribute to the development of healthy feet in children. This article focused on foot structures of in Central Anatolia and to identify early foot deformities in children. This study found that the length of the TFL was smaller in boys than in girls.

The impact of functional excess of footwear on the foot shape of 7-year-old girls and boys

Background

Properly fitted shoes can support the development of growing feet and prevent problems and pathologies, not only in childhood, but also in adulthood. This points to the need to conduct research on the impact of shoe fitting on the structure of the foot in order to raise awareness and importance of this problem, to enable proper decisions regarding the purchase and use of shoes. The aim of this study was to analyze indoor footwear fit and its impact on foot structure in 7-year-old schoolchildren.

Methods

The CQ-ST podoscope and the Clevermess device were used for measurements. The analysis was carried out using the Mann Whitney U test, Wilcoxon signed-rank test, Chi-square test, regression analysis.

Results

About 40% of girls and boys had shoes that were incorrectly fitted in length, while as many as 74% of girls and 66% of boys wore shoes that were incorrectly fitted in width. Regression analysis demonstrated a statistically significant influence of the footwear length on longitudinal arch of the right and left foot and the transverse arch of the right foot. In boys, the length of the shoes shows associations with the right and left hallux valgus angle.

Conclusion

A significant percentage of the studied 7-year-olds, regardless of gender, wears inappropriately fitted shoes. In both sexes, the length of the footwear influenced the longitudinal arch of the right and left foot and the transverse arch of the right foot. Due to the deformity of the first metatarsophalangeal joint, the boys with hallux valgus require footwear which is wider and therefore their shoes need to be bigger in size.

A Cross-Sectional Study of Foot Growth and Its Correlation with Anthropometric Parameters in a Representative Cohort of Schoolchildren from Southern Spain

Background: The relationship between growth of the foot and other anthropometric parameters during body development until puberty has been scarcely studied. Some studies propose that growth of the foot in length may be an early index of puberty. The objective of this cross-sectional study was to analyze the relationship between the growth of the foot in length and width with other anthropometric parameters, in prepubertal and early pubertal schoolchildren (Tanner stage II). Methods: Using an instrument that was designed and calibrated for this purpose, maximum foot length, width and height were obtained in 1005 schoolchildren. Results: The findings indicate that the age of onset of pubertal foot growth spur was 7–8 years in girls, and 8–9 years in boys. Growth in foot length stabilized in both sexes after 12 years of age. In boys, a strong correlation was found between height and foot length (r = 0.884; p < 0.047), and between body mass index (BMI) and forefoot width at 12 years of age (r = 0.935; p < 0.020). A strong correlation was found between height and forefoot width at 6 years in girls (r = 0.719; p < 0.001), as well as between BMI and metatarsal width in 10 years-old girls (r = 0.812; p <0.001). Conclusions: The average increase in foot length and width that precedes the onset of Tanner’s stage II in both girls and boys can be considered as a useful biological indicator of the onset of puberty.

Influence of footwear fitting on feet morphology in 9 year old girls

Background

The human foot is shaped throughout all life in a way that is individual for every human being. Footwear fitting in the process of foot development is the issue covered by a limited range of empirical studies. This prompted the authors to undertake this subject of the study aimed at the influence of fitting of regularly worn inside the school footwear on feet morphology in primary schoolgirls.

Methods

The study group comprised 100 girls aged 9. Feet characteristics were recorded by CQ-ST podoscope. The footwear fitting to the feet of the examined girls was tested using the Clevermess device. The data were analyzed based on the Student’s t test, Wilcoxon test and regression analysis.

Results

Appropriately fitted right indoor footwear was worn by 48% of the subjects while the left one by 43% of the group. Appropriate fitting in relation to the left and right foot width was noted in 23% of the group. The statistically significant combined effect of predictors characterizing footwear on the value of Wejsflog index of the right (p < 0.001) and left (p < 0.001) foot and influence of the length excess on the heel angle of the left foot (p = 0.006) were found.

Conclusions

Most examined girls wear poorly fitted indoor footwear. The length excess of the indoor footwear has connections with the Wejsflog index of the right and left foot and the heel angle of the left foot. The larger the length excess, the lower the transverse arch. In the production of indoor footwear the differences in the feet width should be taken into account.

A data-driven classification of 3D foot types by archetypal shapes based on landmarks

The taxonomy of foot shapes or other parts of the body is important, especially for design purposes. We propose a methodology based on archetypoid analysis (ADA) that overcomes the weaknesses of previous methodologies used to establish typologies. ADA is an objective, data-driven methodology that seeks extreme patterns, the archetypal profiles in the data. ADA also explains the data as percentages of the archetypal patterns, which makes this technique understandable and accessible even for non-experts. Clustering techniques are usually considered for establishing taxonomies, but we will show that finding the purest or most extreme patterns is more appropriate than using the central points returned by clustering techniques. We apply the methodology to an anthropometric database of 775 3D right foot scans representing the Spanish adult female and male population for footwear design. Each foot is described by a 5626 × 3 configuration matrix of landmarks. No multivariate features are used for establishing the taxonomy, but all the information gathered from the 3D scanning is employed. We use ADA for shapes described by landmarks. Women’s and men’s feet are analyzed separately. We have analyzed 3 archetypal feet for both men and women. These archetypal feet could not have been recovered using multivariate techniques.

Footwear fit in schoolchildren of southern Spain: a population study

Background

Recent studies support the theory that ill-fitting shoes are an important source of pain and may lead to foot malformations in the medium term. Taking as reference the ideal allowance considered in the literature, the purpose of this study was to verify the outdoor footwear fit in a population of schoolchildren of southern Spain.

Methods

Five hundred and five children within the range of 3–12 years of age participated in this study. Using a measuring instrument designed and validated for this purpose, maximum foot length, width and height were obtained from the longest foot. These measurements were compared with the inner length, width and height of the footwear. An adequate toe allowance of 5–15 mm in length and 10 mm in width were estimated.

Results

Inner footwear length was shorter than foot length in 33.3% of the schoolchildren. Based on the allowance established, it was observed that the footwear of the schoolchildren was too short and too narrow in 72.5 and 66.7% of the cases, respectively.

Conclusions

Only one third of the participants analysed had well-fitted footwear. The results show that it is necessary to raise awareness among parents and teachers about the importance of replacing, periodically, the footwear of children in primary education. Manufacturers should adapt the lasts considering the use of 90th percentiles instead of mean values obtained from the growth curves of schoolchildren’s feet.

Key concepts in children's footwear research: a scoping review focusing on therapeutic footwear

BACKGROUND

Reports suggest that children with mobility impairment represent a significant proportion of the population living with a disability. Footwear is considered to be the key extrinsic factor affecting children's gait and footwear modifications have been historically postulated to assist with locomotory difficulty. Although therapeutic footwear has been considered within the literature, there is a lack of consistency on terminology and paucity on the overall understanding. A scoping review was performed to chart the key concepts in children's footwear and to establish the range of studies that considered therapeutic footwear.

METHODS

A systematic search of MEDLINE, CINAHL, PubMed, SPORTdiscus, and Scopus electronic databases was performed using MeSH headings and free text terms in relation to children's footwear. All studies that used footwear as an intervention in children aged 9 months to 18 years with the outcome measures including design, fit, and the effects on development and health were included. Studies were charted by textual narrative synthesis into research groupings dependent on the topics discussed and the methods used in the studies.

RESULTS

The search yielded a total of 5006 articles with 287 of these articles meeting the inclusion criteria. Two overarching areas of research were identified; articles that discussed footwear design and those that discussed the effects of footwear. Eight further general groupings were charted and apportioned between the overarching areas and therapeutic footwear was charted into three subgroupings (corrective, accommodative and functional).

CONCLUSION

Children's footwear has become an increasing area of research in the past decade with a shift towards more empirical research, with most of the included articles examining biomechanical and anthropometric aspects. However, children's therapeutic footwear has not shared the same recent impetus with no focused review and limited research exploring its effects. Empirical research in this area is limited and there is ambiguity in the terminology used to describe therapeutic footwear. Based on the findings of this review the authors suggest the term children's therapeutic footwear be used as the standard definition for footwear that is designed specifically with the purpose to support or alleviate mobility impairment in childhood; with subgroupings of corrective, accommodative and functional dependent on the intended therapeutic role.

Relationship between lower-extremity defects and body mass among polish children: a cross-sectional study

BACKGROUND

Lower extremity defects in healthy children raises interest of researchers as confirmed by numerous published original and review articles. The relationship between lower extremity postural defects and body mass are unclear as published data are inconclusive. The aim of the present cross-sectional study was to analyse the prevalence of lower extremity defects in a large group of 8- to 12-year-old children; and further to assess the probability of defects associated with values of body mass variables.

METHODS

The study included prospective anthropometric measurements data of 6992 children (3476 boys and 3516 girls) from Gdansk (Northern Poland). Standard screening test used in Poland for assessment of lower limb defects were used (intermalleolar or intercondylar distance for knee alignment, linear vertical compass for valgus heel, computer podoscope or classical footprint and measuring the Sztriter-Godunow index for flatfeet). Body mass was assessed with local centile charts and IOTF cutoffs. Prevalence of postural defects was compared with an aid of Pearson's chi-squared test and Fisher's exact test. Probability of lower extremities postural defect was estimated on the basis of logistic regression analysis, and expressed as an odds ratio (OR) and its 95.0% CI.

RESULTS

The study demonstrated that cumulative prevalence of lower extremity defects (31.5%) was lower than reported in most published studies, most common defects were valgus heel (21.8%) and valgus knee (14.5%). Boys were significantly more frequently diagnosed with lower limb defects overall (p < 0.001), as well as with varus knee, valgus heel, flatfoot of any degree. Limb defects were found in 90,2% of obese children, 25,7% of normal weight and 15,1% of underweight children.

CONCLUSIONS

Prevalence of some lower extremities defects seems to be sex specific. Prevalence varied across body weight categories and was rising with the increase of BMI. Increased body mass is correlated with a higher risk of developing lower extremity postural defects in children.

Foot Morphology in Chinese Adolescents Aged Between 13 to 18 Years Varies by Gender and Age

Background

We recently reported age and gender differences in foot shape and size in Chinese school children aged between 7–12 years. This study aimed to analyze age and gender differences in foot shape and size in Chinese adolescents aged between 13–18 years.

Material/Methods

The study included 1,252 adolescent boys and 1274 adolescent girls from seven regions in China. Twelve measurements of foot shape were recorded using a video filming system. One-way analysis of variance (ANOVA) compared the changes in the measurements with age. An independent t-test was used to analyze gender-associated differences in foot size and shape.

Results

In adolescent boys, foot length and width increased significantly at 13–14 years and heel width, arch height, and fifth metatarsal head height increased until 18 years (P<0.05). In adolescent girls, most foot measurements ceased to increase after 15 years, except for arch height. Adolescent boys showed significantly larger foot length, width, height, and girth compared with adolescent girls (P<0.05) (Cohen’s d effect size >0.8). Adolescent boys showed a significant increase in ball width and girth, and instep length and height compared with adolescent girls, who had a longer medial foot length and higher fifth metatarsal head height compared with adolescent boys (P<0.05) (Cohen’s d effect size >0.5).

Conclusions

Age and gender associated differences were found in foot measurements in Chinese adolescents, aged between 13–18 years. These differences should be considered by shoe manufacturers and when making clinical decisions about normal foot development.

Foot Arch Height and Quality of Life in Adults: A Strobe Observational Study

Background: Variations in the foot structure related with the high or low arch are identified common lower limb conditions, and it is supposed to be the effect on the quality of life (QoL) associated to foot health in adults. Here we aimed to determine the relationships between relatively high and low feet arches and QoL. Methods: A cross-sectional study was carried out. Among 138 adults enrolled in the study, 66 had a high arch, 21 had a low arch, and 51 were within the normal range. Changes related to the foot structure were analyzed using Area Calc version 2.6 software, and data obtained using the Foot-Health-Status-Questionnaire (FHSQ), whose domains were compared between foot arch groups by means of the one-way analysis of variance (ANOVA). Results: The results of the FHSQ comparison between the three groups within the sample population did not show any statistically significant difference (p > 0.05) for any domains of specific foot (pain, function, general health and footwear) and general (general health, physical activity, social function and vigor) health-related QoL. Conclusions: Specific foot and general health-related QoL did not seem to be influenced by the foot arch height between high, normal and low feet arches heights. Nevertheless, further studies with higher sample sizes and matched-paired groups should be carried out.

Foot Morphology in Chinese School Children Varies by Sex and Age

Background

Knowledge of children’s foot shape is essential for podiatric healthcare and footwear design. Differences in foot shapes relative to sex and age were demonstrated among white children; however, no study has examined the foot characteristics of Asian children according to sex and age. This study aimed to analyze the age- and sex-associated differences in foot measurements in Chinese children.

Material/Methods

We recruited 1240 boys and 1303 girls from China as participants for the present study. Foot dimensions were recorded by a video filming system, and 12 foot-shape measurements were acquired. One-way ANOVA was used to calculated the changes in measurements with age for boys and girls. Scores were analyzed as raw and normalized to foot length using the independent-samples t test.

Results

Most measurements increased significantly at 7–8 and 8–9 years for girls and 8–9 and 10–11 years for boys. Arch height, instep length, and heel width showed greatest increases for both sexes ages 7–12 years (P<0.05). Sex differences in measurements mainly occurred at 8, 9, and 11 years. When we analyzed the normalized measurements of the same age children, instep length, heel width, ball girth, and instep girth were significantly different between boys and girls (P<0.05).

Conclusions

Sex- and age-associated differences were identified in the foot morphology of the Chinese school-aged children in this study. These differences should be considered when making clinical decisions about normal foot development and manufacturing shoes for Chinese school children.

Footprint analysis and prevalence of flatfoot: a study among the children of South 24 Parganas, West Bengal, India

The present study envisages the morphological differences in anthropometric measurements on footprints among the preschool children and analyzes its manifestation in the different weight category. This study also focuses on the diagnosis of flatfoot among the studied population. Data has been collected from 160 participants (80 boys and 80 girls) from Bengali Hindu caste population aged 3 to 6 years. Anthropometric measurements included height, weight and body mass index. Other measurements on foot morphology included foot length, foot breadth diagonal, foot breadth horizontal, ball of the foot length, outside ball of the boot length, heel breadth, and toe lengths T1, T2, T3.T4, T5. Staheli’s Plantar Arch Index, Chippaux-Smirak Index and foot angle were calculated. Various statistical tests like t-test, Pearson’s correlation and ANOVA were performed. Among all the variables, foot breadth horizontal showed statistically significant difference between boys and girls (p<0.05). All the footprint dimensions showed a significant (p<0.05) positive correlation with height and weight in both the boys and the girls. However, the Staheli’s Plantar Arch Index showed a significant (p<0.05) negative correlation with height and weight and Chippaux-Smirak Index showed a significant (p<0.05) negative correlation with height only among both the boys and the girls. Significant differences (ANOVA) were found between the foot morphology of children in three different weight categories (underweight, healthy and overweight) except the foot angle, and both indices. The present study evinces that weight affects the foot structure of the children. The prevalence of flatfoot was found to be 57.5% among the children with no significant difference (p<0.05) between the boys and the girls. The results thus provide a podium for intricate studies in the future. Timely prognosis of flatfoot in children can instigate early rectification of flat-footedness.

The typically developing paediatric foot: how flat should it be? A systematic review

BACKGROUND

All typically developing children are born with flexible flat feet, progressively developing a medial longitudinal arch during the first decade of their lives. Whilst the child's foot is expected to be flat, there is currently no consensus as to how flat this foot should be. Furthermore, whilst feet are observed to decrease in flatness with increasing age, it is not known how flat they should be at each age increment. The objective of this systematic review is to define the postural characteristics of the 'typically' developing paediatric foot.

METHODS

The PRISMA protocol was applied to compare all data currently published describing the typical development of the paediatric foot. The Epidemiological Appraisal Instrument (EAI) was used to assess the risk of bias of the included studies.

RESULTS

Thirty four epidemiological papers pertaining to the development of the paediatric foot were graphically compared. Sixteen different foot posture assessments were identified of which footprint based measures were the most reported outcome.

CONCLUSION

Firstly, the use of the term normal in relation to foot posture is misleading in the categorisation of the paediatric foot, as indeed a flat foot posture is a normal finding at specific ages. Secondly, the foot posture of the developing child is indeed age dependent and has been shown to change over time. Thirdly, no firm conclusion could be reached as to which age the foot posture of children ceases to develop further, as no two foot measures are comparable, therefore future research needs to consider the development of consensus recommendations as to the measurement of the paediatric foot, using valid and reliable assessment tools.

Shod wear and foot alignment in clinical gait analysis

Sagittal plane alignment of the foot presents challenges when the subject wears shoes during gait analysis. Typically, visual alignment is performed by positioning two markers, the heel and toe markers, aligned with the foot within the shoe. Alternatively, software alignment is possible when the sole of the shoe lies parallel to the ground, and the change in the shoe's sole thickness is measured and entered as a parameter. The aim of this technical note was to evaluate the accuracy of visual and software foot alignment during shod gait analysis. We calculated the static standing ankle angles of 8 participants (mean age: 8.7 years, SD: 2.9 years) wearing bilateral solid ankle foot orthoses (BSAFOs) with and without shoes using the visual and software alignment methods. All participants were able to stand with flat feet in both static trials and the ankle angles obtained in BSAFOs without shoes was considered the reference. We showed that the current implementation of software alignment introduces a bias towards more ankle dorsiflexion, mean=3°, SD=3.4°, p=0.006, and proposed an adjusted software alignment method. We found no statistical differences using visual alignment and adjusted software alignment between the shoe and shoeless conditions, p=0.19 for both. Visual alignment or adjusted software alignment are advised to represent foot alignment accurately.

Comparisons of foot anthropometry and plantar arch indices between German and Brazilian children

Background

Nowadays, trades and research have become closely related between different countries and anthropometric data are important for the development in global markets. The appropriate use of anthropometry may improve wellbeing, health, comfort and safety especially for footwear design. For children a proper fit of footwear is very important, not constraining foot growth and allowing a normal development. The aim of this study was to compare the anthropometric characteristics of German and Brazilian children’s feet from 3 to 10 years of age.

Methods

We compared five indirect measures of two databases of children's feet. Forefoot, midfoot and rearfoot widths were measured in static footprints and the Chippaux-Smirak and Staheli indices of the longitudinal arch were calculated.

Results

Brazilian children showed a significantly narrower forefoot from 5 to 10 years, wider rearfoot from 3 to 4 years, wider midfoot for 4 year-olds and narrower midfoot for 10 year-old children. Nevertheless, the Chippaux-Smirak and Staheli indices showed no group differences. The only exception was for 4 year-old Brazilian children who showed a higher Chippaux-Smirak index compared to German children (48.4 ± 17.7%; 42.1 ± 13.8%).

Conclusions

Our study revealed anthropometric differences in absolute forefoot and rearfoot widths of German and Brazilian children, but a similar longitudinal arch development. At 4 years of age, Brazilian children present a foot anthropometry similar to the 3 year-olds and develop the plantar longitudinal arch from 4 to 5 years more rapidly when compared to German children.