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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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Núñez-Trull A, Álvarez-Medina J, Jaén-Carrillo D, Rubio-Peirotén A, Abat F, Roche-Seruendo LE, Gómez-Trullén EM. Does Lower-Limb Tendon Structure Influence Walking Gait? Healthcare (Basel) 2023; 11:3142. [PMID: 38132032 PMCID: PMC10742778 DOI: 10.3390/healthcare11243142] [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: 11/06/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Within the exploration of human gait, key focal points include the examination of functional rockers and the influential role of tendon behavior in the intricate stretch-shortening cycle. To date, the possible relationship between these two fundamental factors in the analysis of human gait has not been studied. Therefore, this study aimed to analyze the relationship between the morphology of the patellar and Achilles tendons and plantar fascia with respect to the duration of the rockers. METHODS Thirty-nine healthy men (age: 28.42 ± 6.97 years; height: 173 ± 7.17 cm; weight: 67.75 ± 9.43 kg) were included. Data of the rockers were recorded using a baropodometric platform while participants walked over a 10 m walkway at a comfortable velocity. Before the trials, the thickness and cross-sectional area were recorded for the patellar tendon, Achilles tendon and plantar fascia using ultrasound examination. The relationship between the morphology of the soft tissue and the duration of the rockers was determined using a pairwise mean comparison (t-test). RESULTS A significant difference was found for rocker 1 duration, where a longer duration was found in the group of subjects with thicker patellar tendons. Regarding the Achilles tendon and plantar fascia, no significant differences were observed in terms of tendon morphology. However, subjects with thicker Achilles tendons showed a longer duration of rocker 1. CONCLUSIONS The findings underscore a compelling association, revealing that an increased thickness of the patellar tendon significantly contributes to the extension of rocker 1 duration during walking in healthy adults.
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Affiliation(s)
- Alejandro Núñez-Trull
- Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, 50009 Zaragoza, Spain; (A.N.-T.); (J.Á.-M.)
| | - Javier Álvarez-Medina
- Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, 50009 Zaragoza, Spain; (A.N.-T.); (J.Á.-M.)
| | - Diego Jaén-Carrillo
- Department of Sport Science, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria;
| | - Alberto Rubio-Peirotén
- Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830 Villanueva de Gállego, Zaragoza, Spain;
| | - Ferrán Abat
- Grup de Recerca GRACIS (GRC 01604), Sports Orthopaedic Department, ReSport Clinic, Universitat Pompeu Fabra, Escola Superior de Ciències de la Salut TecnoCampus, 08002 Mataró, Barcelona, Spain;
| | - Luis E. Roche-Seruendo
- Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830 Villanueva de Gállego, Zaragoza, Spain;
| | - Eva M. Gómez-Trullén
- iHealthy, Research Group, Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, 50009 Zaragoza, Spain;
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Zhao Y, Zhou J, Qiu F, Liao X, Jiang J, Chen H, Lin X, Hu Y, He J, Chen J. A deep learning method for foot-type classification using plantar pressure images. Front Bioeng Biotechnol 2023; 11:1239246. [PMID: 37767108 PMCID: PMC10519788 DOI: 10.3389/fbioe.2023.1239246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Flat foot deformity is a prevalent and challenging condition often leading to various clinical complications. Accurate identification of abnormal foot types is essential for appropriate interventions. Method: A dataset consisting of 1573 plantar pressure images from 125 individuals was collected. The performance of the You Only Look Once v5 (YOLO-v5) model, improved YOLO-v5 model, and multi-label classification model was evaluated for foot type identification using the collected images. A new dataset was also collected to verify and compare the models. Results: The multi-label classification algorithm based on ResNet-50 outperformed other algorithms. The improved YOLO-v5 model with Squeeze-and-Excitation (SE), the improved YOLO-v5 model with Convolutional Block Attention Module (CBAM), and the multilabel classification model based on ResNet-50 achieved an accuracy of 0.652, 0.717, and 0.826, respectively, which is significantly higher than those obtained using the ordinary plantar-pressure system and the standard YOLO-v5 model. Conclusion: These results indicate that the proposed DL-based multilabel classification model based on ResNet-50 is superior in flat foot type detection and can be used to evaluate the clinical rehabilitation status of patients with abnormal foot types and various foot pathologies when more data on patients with various diseases are available for training.
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Affiliation(s)
- Yangyang Zhao
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jiali Zhou
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Fei Qiu
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xuying Liao
- The School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
| | - Jianhua Jiang
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Heqing Chen
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Xiaomei Lin
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Yiqun Hu
- Department of Gastroenterology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jianquan He
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Jian Chen
- Department of Rehabilitation, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
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Núñez-Trull A, Alvarez-Medina J, Jaén-Carrillo D, Roche-Seruendo LE, Gómez-Trullén E. Absolute agreement and consistency of the OptoGait system and Freemed platform for measuring walking gait. Med Eng Phys 2022; 110:103912. [PMID: 36564137 DOI: 10.1016/j.medengphy.2022.103912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/03/2022] [Accepted: 10/19/2022] [Indexed: 11/28/2022]
Abstract
The gait cycle can be divided into four functional rocker units. Although the widespread use of the OptoGait (OG) system and the Freemed (FM) platform, their accuracy has not been tested. An observational study was completed with eighteen healthy volunteers to determine the accuracy of OG and FM for overground walking gait analysis. The pairwise comparison between data obtained from OG, FM and high-speed video analysis revealed significant differences for most of the measurements (p < 0.05). ICCs revealed an excellent absolute agreement between measurements (ICCs > 0.94) for all measures for OG systems compared to video-analysis. When considering FM vs. video-analysis, ICCs showed good absolute agreement for rocker 1 (ICC = 0.86) and 3 (ICC = 0.82), excellent for rocker 2 (ICC = 0.93) and poor (ICC < 0.5) for rocker 4. Bland-Altman plots (95% limits of agreement) revealed heteroscedasticity of error for OG in all variables for foot rockers (r2 > 0.1) while no heteroscedasticity of error was found when using FM (r2 < 0.1). This study indicates that the OG system and the FM platform can provide consistent foot rockers values when walking at a constant velocity. The differences between the systems assessed and their agreement and consistency values advise against their interchangeable use.
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Affiliation(s)
| | | | - Diego Jaén-Carrillo
- Campus Universitario, Universidad San Jorge, Villanueva de Gállego, Zaragoza, Spain.
| | | | - Eva Gómez-Trullén
- Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, Spain
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Xu L, Gu H, Zhang Y, Sun T, Yu J. Risk Factors of Flatfoot in Children: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148247. [PMID: 35886097 PMCID: PMC9319536 DOI: 10.3390/ijerph19148247] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 02/05/2023]
Abstract
Background: This study aimed to explore the risk factors for flatfoot in children and adolescents to provide a reference basis for studying foot growth and development in children and adolescents. Methods: We examined the cross-sectional research literature regarding flatfoot in children and adolescents published in the past 20 years, from 2001 to 2021, in four electronic databases: PubMed, Web of Science, EBSCO, and Cochrane Library. Two researchers independently searched the literature according to the inclusion and exclusion criteria and evaluated the literature quality of the selected research; from this, a total of 20 articles were included in our review. After the relevant data were extracted, the data were reviewed using Manager 5.4 software (The Cochrane Collaboration, Copenhagen, Denmark), and the detection rate and risk factors for flatfoot in children were analyzed. Results: In total, 3602 children with flatfoot from 15 studies were included in the analysis. The meta-analysis results showed that being male (OR = 1.33, 95% CI: 1.09, 1.62, p = 0.005), being aged <9 years (age <6, OR = 3.11, 95% CI: 2.47, 3.90, p < 0.001; age 6−9 years, OR = 0.54, 95% CI: 0.41, 0.70, p < 0.001), joint relaxation (OR = 4.82, 95% CI: 1.19, 19.41, p = 0.03), wearing sports shoes (OR = 2.97, 95% CI: 1.46, 6.03, p = 0.003), being a child living in an urban environment (OR = 2.10, 95% CI: 1.66, 2.64, p < 0.001) and doing less exercise (OR = 0.25, 95% CI: 0.08, 0.80, p = 0.02) were risk factors for the detection of flatfoot. Conclusion: In summary, the detection rate of flatfoot in children in the past 20 years was found to be 25% through a meta-analysis. Among the children included, boys were more prone to flatfoot than girls, and the proportion of flatfoot decreased with age.
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Affiliation(s)
- Liya Xu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing 100084, China; (L.X.); (H.G.)
| | - Hongyi Gu
- Faculty of Sports and Human Sciences, Beijing Sports University, Beijing 100084, China; (L.X.); (H.G.)
| | - Yimin Zhang
- Key Laboratory of Sports and Physical Health Ministry of Education, China Institute of Sports and Health, Beijing Sports University, Beijing 100084, China; (T.S.); (J.Y.)
- Correspondence: ; Tel.: +86-13641108252
| | - Tingting Sun
- Key Laboratory of Sports and Physical Health Ministry of Education, China Institute of Sports and Health, Beijing Sports University, Beijing 100084, China; (T.S.); (J.Y.)
| | - Jingjing Yu
- Key Laboratory of Sports and Physical Health Ministry of Education, China Institute of Sports and Health, Beijing Sports University, Beijing 100084, China; (T.S.); (J.Y.)
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