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Footprint analysis of flatfoot in preschool-aged children

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Abstract

Our aim in this study was to analyze the footprint measurements of flatfoot in a population of preschool-aged children. Three footprint measurements, the Clarke's angle (CA), Chippaux-Smirak index (CSI), and Staheli arch index (AI), were used for comparison with clinical diagnosis. A total of 2,638 static footprints of children aged from 3 to 6 years were recorded. The clinical diagnosis as a gold standard compared with the results of the CA, CSI, and AI and displayed in a receiver operating characteristic (ROC) curve. In order to illustrate the diagnostic accuracy in clinical settings, their likelihood ratios were calculated given their cutoff points, and their pretest/posttest probabilities were plotted as the Fagan nomogram. The optimal cutoff points for CA, CSI, and AI were 14.04°, 62.70%, and 107.42%, respectively, and all of them showed high sensitivity. The areas under curves were 0.91, 0.95, and 0.92, respectively. The positive predictive values were 0.84, 0.91, and 0.85, and the negative predictive values were 0.82, 0.85, and 0.85, respectively. The positive likelihood ratio values for CA, CSI, and AI were 4.09, 7.52, and 4.61, and the negative likelihood ratio values were 0.18, 0.14, and 0.13, respectively. In conclusion, this study demonstrated that footprint analysis methods are suitable for diagnosing flatfoot in preschool-aged children, and that the most appropriate cutoffs are as follows: CA ≤ 14.04°, CSI > 62.70%, and AI > 107.42%. The CSI had a predictive probability of more than 90% and is recommended in screening for flatfoot in preschool-aged children.

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Abbreviations

CA:

Clarke's angle

CSI:

Chippaux-Smirak index

AI:

Staheli arch index

MLA:

medial longitudinal arch

BMI:

body mass index

ROC:

receiver operating characteristic

AUC:

area under the curve

FPR:

false-positive rate

TPR:

true-positive rate

PV+:

positive predictive value

PV−:

negative predictive value

LRs:

likelihood ratios

LR+:

positive likelihood ratio

LR−:

negative likelihood ratio

CI:

confidence interval

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Acknowledgments

The authors thank all participants in this study and the physical therapists, Shiao-Wen Liu, Shiou-Han Yang, and Pei-Shan Tsai, who kindly provided assistance with data collection. This study was supported by research grants from the National Science Council, Taiwan (NSC99-2314-B-040-004-MY3).

Financial disclosure statement

No party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated.

Conflict of interest statement

All authors state that they do not keep any commercial, financial, or personal relationships that may lead to a conflict of interest that could inappropriately influence (bias) their work.

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Authors and Affiliations

  1. Institute of Medicine, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Rd., Taichung City, 402, Taiwan

    Kun-Chung Chen & Shun-Fa Yang

  2. Physical Therapy Room, Chung Shan Medical University Hospital, No.110, Sec. 1, Jianguo N. Rd., Taichung City, 402, Taiwan

    Kun-Chung Chen, Jing-Fu Kuo & Chun-Hou Wang

  3. School of Public Health, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Rd., Taichung City, 402, Taiwan

    Chih-Jung Yeh

  4. School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No 17, Xuzhou Rd, Taipei, 100, Taiwan

    Ching-Lin Hsieh

  5. School of Physical Therapy, College of Medical Technology, Chung Shan Medical University, No.110, Sec. 1, Jianguo N. Rd., Taichung City, 402, Taiwan

    Chun-Hou Wang

Authors
  1. Kun-Chung Chen
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  2. Chih-Jung Yeh
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  3. Jing-Fu Kuo
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  4. Ching-Lin Hsieh
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Corresponding author

Correspondence to Chun-Hou Wang.

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Ethical Board Review statement

Each author certifies that his institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. (CSMUH No: CS09114).

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Chen, KC., Yeh, CJ., Kuo, JF. et al. Footprint analysis of flatfoot in preschool-aged children. Eur J Pediatr 170, 611–617 (2011). https://doi.org/10.1007/s00431-010-1330-4

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  • DOI: https://doi.org/10.1007/s00431-010-1330-4

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