Association Between Foot Type and Lower Extremity Injuries: Systematic Literature Review With Meta-analysis

Abstract

T he human foot is often classified into 3 structural categories: high, normal, and low arch, based on its anatomical alignment 89 and the height of the medial longitudinal arch. 27 Classification in these 3 categories is typically based on cutoff values determined from the distribution of data (standard deviations 65,93,102 or percentiles 15,16 ) from measurements taken on a large population. The interest in such classification is the belief that nonneutral foot morphology, such as a high or low arch (flatfoot), may lead to less than optimal foot function and be associated with the development of lower extremity and low back injuries. 23,28,29,59 A review of the literature provides conflicting evidence on the potential relationship between foot type and lower extremity injuries. Although a number of published reports have found no relationships between nonneutral foot types and lower extremity injuries, 40,94,96,99 the authors of a recent systematic review concluded that both high-and low-arch foot types were associated with runningrelated injuries. 14 The results of this systematic review, 14 which did not include a meta-analysis and effect-size estimates, contrast those of a few qualitative reviews that failed to demonstrate a relationship between foot type and future lower extremity injuries. 4,8,20,70 This lack of consensus in the literature could be attributed, in part, to the variation in the operational definition of foot type among investigators. 4,70 A large variety of methods have been developed to classify the foot based on structure and alignment. These T T OBJECTIVES:To investigate the association between nonneutral foot types (high arch and flatfoot) and lower extremity and low back injuries, and to identify the most appropriate methods to use for foot classification. T T METHODS:A search of 5 electronic databases (PubMed, Embase, CINAHL, SPORTDiscus, and ProQuest Dissertations and Theses), Google Scholar, and the reference lists of included studies was conducted to identify relevant articles. The review included comparative cross-sectional, casecontrol, and prospective studies that reported qualitative/quantitative associations between foot types and lower extremity and back injuries. Quality of the selected studies was evaluated, and data synthesis for the level of association between foot types and injuries was conducted. A randomeffects model was used to pool odds ratio (OR) and standardized mean difference (SMD) results for meta-analysis. T T RESULTS:Twenty-nine studies were included for meta-analysis. A significant association between nonneutral foot types and lower extremity injuries was determined (OR = 1.23; 95% confidence interval [CI]: 1.11, 1.37; P<.001). Foot posture index (OR = 2.58; 95% CI: 1.33, 5.02; P<.01) and visual/ physical examination (OR = 1.17; 95% CI: 1.06, 1.28; P<.01) were 2 assessment methods using distinct foot-type categories that showed a significant association with lower extremity injuries.

Evaluation of Foot Arch in Adult Women: Comparison between Five Different Footprint Parameters

“…A few participants have different foot arches between their left and right feet (Table 2). Our findings contradicted previous research, which reported that human possess only a pair of same foot arches (Tong & Kong 2013;Xiong et al 2010). Among the five footprint parameters tested, the Harris-imprint index showed the most significant (p=0.004) differences between the left and right feet compared to the other footprint parameters tested (Table 3).…”

Evaluation of the relationship between the static measurement of transverse arch flexibility of the forefoot and gait parameters in healthy subjects

“…Clinically, there is much limitation to the evaluation of lateral longitudinal and transverse arches, except the medial longitudinal arch15 ) . Clinical measurements of the forefoot are important, because forefoot deformity is highly correlated with lower leg pain and a risk of falling16, 17 ) .…”

Correlation of physical activity and fitness with arches of the foot in children

“…In the most common foot disorder, i.e. flat feet, there are significant changes to the talocalcanean joint and to the talonavicular joint, which result in an increased risk of injury [25]. It has been proven, too, that flat feet in children are related to an incorrect distribution of static forces that leads to the forefoot being in a lesser pronation in gait than in normal feet [26].…”