Overweight, obesity and foot posture in children: A cross‐sectional study

Gijón-Noguerón, Gabriel; Montes-Alguacil, Jesús; Nova, Alfonso Martínez; Alfageme-García, Pilar; Cervera-Marín, José Antonio; Morales-Asencio, José Miguel

doi:10.1111/jpc.13314

Cited by 35 publications

(32 citation statements)

References 29 publications

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“…This greatly challenges the validity of the measures using this construct. At a minimum, these measures are reportedly influenced by the weight of the participants [ 72 ].…”

Section: Discussionmentioning

confidence: 99%

Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review

Banwell

Paris

Mackintosh

et al. 2018

Journal of Foot and Ankle Research

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BackgroundFlexible flat foot is a normal observation in typically developing children, however, some children with flat feet present with pain and impaired lower limb function. The challenge for health professionals is to identify when foot posture is outside of expected findings and may warrant intervention. Diagnoses of flexible flat foot is often based on radiographic or clinical measures, yet the validity and reliability of these measures for a paediatric population is not clearly understood. The aim of this systematic review was to investigate how paediatric foot posture is defined and measured within the literature, and if the psychometric properties of these measures support any given diagnoses.MethodsElectronic databases (MEDLINE, CINAHL, EMBASE, Cochrane, AMED, SportDiscus, PsycINFO, and Web of Science) were systematically searched in January 2017 for empirical studies where participants had diagnosed flexible flat foot and were aged 18 years or younger. Outcomes of interest were the foot posture measures and definitions used. Further articles were sought where cited in relation to the psychometric properties of the measures used.ResultsOf the 1101 unique records identified by the searches, 27 studies met the inclusion criteria involving 20 foot posture measures and 40 definitions of paediatric flexible flat foot. A further 18 citations were sought in relation to the psychometric properties of these measures. Three measures were deemed valid and reliable, the FPI-6 > + 6 for children aged three to 15 years, a Staheli arch index of > 1.07 for children aged three to six and ≥ 1.28 for children six to nine, and a Chippaux-Smirak index of > 62.7% in three to seven year olds, > 59% in six to nine year olds and ≥ 40% for children aged nine to 16 years. No further measures were found to be valid for the paediatric population.ConclusionNo universally accepted criteria for diagnosing paediatric flat foot was found within existing literature, and psychometric data for foot posture measures and definitions used was limited. The outcomes of this review indicate that the FPI – 6, Staheli arch index or Chippaux-Smirak index should be the preferred method of paediatric foot posture measurement in future research.Electronic supplementary materialThe online version of this article (10.1186/s13047-018-0264-3) contains supplementary material, which is available to authorized users.

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“…This greatly challenges the validity of the measures using this construct. At a minimum, these measures are reportedly influenced by the weight of the participants [ 72 ].…”

Section: Discussionmentioning

confidence: 99%

Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review

Banwell

Paris

Mackintosh

et al. 2018

Journal of Foot and Ankle Research

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“…This is important as previous studies have identified a relationship between increased BMI and flat feet in children using footprints . However, this finding has been refuted using the FPI measures . This has been queried previously, with footprints postulated to assess the spread of foot adipose with weight‐bearing rather than skeletal foot position …”

Section: Discussionmentioning

confidence: 99%

“…39,40 However, this finding has been refuted using the FPI measures. 29,41 This has been queried previously, with footprints postulated to assess the spread of foot adipose with weight-bearing rather than skeletal foot position. 13,29 Therefore, according to the current knowledge, the exclusive use of footprints to associate foot type and injuries or to assess foot structure is not recommended.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the paediatric foot using footprints and foot posture index: A cross‐sectional study

Gijón-Noguerón

Marchena‐Rodriguez

Montes-Alguacil

et al. 2019

J Paediatrics Child Health

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Aim Footprints have long been used as proxy measures of foot morphology, yet there is little consensus regarding footprints versus measures of foot posture, which address foot anatomy directly. Foot posture in children can be a confusing clinical presentation, with previous studies both supporting and refuting the relationship between childhood obesity and flat feet. The aim of this study was to determine the relationship between footprints and foot posture in children. Methods A total of 316 school children (153 boys, 163 girls) from Spain, aged 6–9 years, were assessed for both footprint (Clarke's angle (CA)), by Tecniwork Pedrograph Plate, and foot posture (foot posture index (FPI)) measures, with participants barefoot, in a relaxed standing position, on a 50‐cm elevated platform. Results A negative correlation was found between FPI and footprints (CA) (rho = −0.505 left, P < 0.001) and by gender (rho = −0.457 for the left foot in girls, P < 0.001; rho = −0.548 for the left foot in boys, P < 0.001). The children with pes cavus according to the CA (73.3%) had normal feet according to FPI, and the children with severe pes planus according to the CA (78.98%) had pronated feet according to the FPI. A χ2 test showed these results to be statistically significant (P > 0.001). Conclusions An inverse relationship between CA and FPI was identified, that is, the greater the FPI, the smaller the CA, but not all pronated foot are planus feet and not all cavus feet are supinated feet. Footprints may overestimate and misguide paediatric foot posture concerns.

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“…The FPI was assessed with the children in a relaxed stance on a bench that was 50 cm tall. The same protocol that has been reported in other studies [ 6 , 49 , 50 , 51 ] was used. The FPI reflects the multisegmental nature of the posture of the foot in all three planes and does not require the use of specialized equipment.…”

Section: Methodsmentioning

confidence: 99%

Backpacks Effect on Foot Posture in Schoolchildren with a Neutral Foot Posture: A Three-Year Prospective Study

Alfageme-García

Calderón‐García

Nova

et al. 2020

IJERPH

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Background: There is a paucity of data on the relationship between backpack use and foot posture in children. The aim of this study was to assess the effects of a backpack on foot posture in children with neutral foot posture during three years of follow-up. Methods: A prospective longitudinal observational study was conducted in a sample of 627 children with neutral foot. For each participant included in the study, age, sex, weight, height, body mass index, type of schoolbag (backpack or non-backpack), foot shape, metatarsal formula and type of shoes were recorded. Foot posture was described by the mean of the foot posture index (FPI) and reassessed after three years in a follow-up study. Results: The average age of the children was 8.32 ± 1.32 years. A total of 458 used a backpack when going to school. Over the three-year follow-up period, 50 children who had neutral foot developed supinated foot (n = 18) or pronated foot (n = 32). Univariate and multivariate analysis showed that the children using a backpack were at a higher risk of developing pronated foot (adjusted Odds Ratio (aOR) = 2.05, 95% IC: 1.08–3.89, p = 0.028). Backpack use was not associated with the change from neutral foot to supinated foot. Conclusions: We found a positive association between using a backpack and the risk of developing pronated but not supinated foot. Clinical trials should be conducted to analyze the effect of backpack use on the foot among schoolchildren.

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Overweight, obesity and foot posture in children: A cross‐sectional study

Abstract: In children aged between 6 and 12 years, body mass does not appear to have an important bearing on static foot posture. Furthermore, the variables gender and age are of scant importance in determining foot posture in children.

Cited by 35 publications

References 29 publications

Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review

Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review

Evaluation of the paediatric foot using footprints and foot posture index: A cross‐sectional study

Backpacks Effect on Foot Posture in Schoolchildren with a Neutral Foot Posture: A Three-Year Prospective Study

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