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Exploring flatfeet morphology in children aged 6–12 years: relationships with body mass and body height through footprints and three-dimensional measurements

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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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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

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Acknowledgements

We are grateful for the help of those who participated in the study.

Funding

This study was supported by the National Natural Science Foundation of China (No. 82374605), Administration of Traditional Chinese Medicine of Guangdong Province, China (No. 20241199), and Innovation Team and Talents Cultivation Program of National Administration of Traditional Chinese Medicine (No. ZYYCXTD-C-202003).

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Author notes

  1. Zi-Yu Feng and Jing-Yi She contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. School of Traditional Chinese Medicine, Southern Medical University, No. 1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, 510515, China

    Zi-Yu Feng, Jing-Yi She, Sheng Zheng, Yi-Kai Li & Chao Chen

  2. Institute of Human Factors and Ergonomics, College of Mechatronics and Control Engineering, Shenzhen University, Shenzhen, China

    Xin-Yao Hu

  3. Department of Radiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Hong-Sheng Liu

  4. Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, China

    Hua-Jun Wang

  5. Wangjing Hospital of China Academy of Chinese Medical Sciences (Key Laboratory of Beijing of Traditional Chinese Medicine Bone Setting), Beijing, China

    Li-Guo Zhu

  6. Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, China

    Jian-You Li

  7. Division of Orthopedics and Traumatology, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Kai-Rui Zhang

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Contributions

ZYF participated in the design of the study, contributed to data collection and data reduction/analysis and drafted the first draft; JYS, XYH participated in the design of the study and contributed to data collection; HSL, HJW contributed to data collection and analysis; LGZ, SZ participated in the design of the study and contributed to data collection; JYL, KRZ contributed to data collection; HJW contributed to data collection, revision of the manuscript; YKL participated in the design of the study, contributed to data collection, curation and supervision; CC participated in the design of the study, revision of the manuscript and project management. All authors have read and approved the final version of the manuscript, and agree with the order of presentation of the authors.

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Correspondence to Yi-Kai Li or Chao Chen.

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Feng, ZY., She, JY., Hu, XY. et al. 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 183, 1901–1910 (2024). https://doi.org/10.1007/s00431-024-05471-0

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