Association between flatfoot and age is mediated by sex: A cross-sectional study
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Department of Medical Rehabilitation, University of Nigeria, Enugu, Nigeria
Ukachukwu Okoroafor Abaraogu   

Department of Medical Rehabilitation, Faculty of Health Science and Technology, University of Nigeria, Enugu 400006, Nigeria. Tel.: +234 08063582105.
Submission date: 2015-12-28
Acceptance date: 2016-02-02
Online publication date: 2016-05-04
Publication date: 2020-03-24
Pol. Ann. Med. 2016;23(2):141–146
Flatfoot (pes planus) is one of the most frequently encountered pediatric foot deformities. In spite of the numerous evidences for adverse implications of flatfoot to the locomotive system and musculoskeletal health of patients, in the continuum of developmental milestone, the age to which patients should be monitored for flatfoot remains debatable.

We investigated the prevalence and pattern of flatfoot in a Nigerian population ranging from 6 to 25 years of age in order to describe the triad of age-sex-flatfoot preponderance.

Material and methods:
This was a cross-sectional study among 620 participants using the footprint method and the planter arch index – Staheli arch index criteria for flatfoot diagnosis.

Results and discussion:
Flatfoot prevalence in the study population was 27.4%; children had the highest prevalence (28.3%) and adults had the lowest (20.0%). Most of the flatfoot was unilateral (60.0%) and was the flexible form (73.8%). The transition from childhood to adulthood was associated with a significant decrease in prevalence of flatfoot among the male participants, but there was no association between prevalence of flatfoot and age beyond 9 years among the female participants.

The incidence of flatfoot in the Nigerian population is high. Monitoring for flatfoot into adulthood is advisable particularly for the male patients.

None declared.
Evans AM, Nicholson H, Zakarias N. The paediatric flatfoot proforma (p-FFP): improved and abridged following a reproducibility study. J Foot Ankle Res. 2009;2:25.
Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clin Biomech (Bristol Avon). 2006;21(1):89–98.
Hunt AE, Smith RM. Mechanics and control of the flat versus normal foot during the stance phase of walking. Clin Biomech (Bristol Avon). 2004;19(4):391–397.
McPoil TG, Cornwall MW, Vicenzino B, et al. Effect of using truncated versus total foot length to calculate the arch height ratio. Foot (Edinb). 2008;18(4):220–227.
Thomas JL, Kunkel MW, Lopez R, Sparks D. Radiographic values of the adult foot in a standardized population. J Foot Ankle Surg. 2006;45(1):3–12.
Menz HB, Munteanu SE. Validity of 3 clinical techniques for the measurement of static foot posture in older people. J Orthop Sports Phys Ther. 2006;36(3):179.
Burns J, Rosbie CJ, Hunt A, Ouvrier R. The effect of pescavus on foot pain and plantar pressure. Clin Biomech (Bristol Avon). 2005;20(9):877–882.
Simkin A, Leicher I, Gilad M, Syein M, Milgrom C. Combined effect of foot arch structure and an orthotic device on stress fractures. Foot Ankle. 1989;10(1):25–29.
Echarri JJ, Forriol F. The development in footprint morphology in 1851 Congolese children from urban and rural areas, and the relationship between this and wearing shoes. J Pediatr Orthop B. 2003;12(2):141–146.
Pfeiffer M, Kotz R, Ledl T, Hauser G, Sluga M. Prevalence of flat foot in preschool-aged children. Pediatrics. 2006;118(2):634–639.
Ezema CI, Abaraogu UO, Okafor GO. Flat foot and associated factors among primary school children: a cross-sectional study. Hong Kong Physiother J. 2014;32(1):13–20.
Volpon JB. Footprint analysis during the growth period. J Pediatr Orthop. 1994;14(1):83–85.
Lin CJ, Lai Kwan TS, Chou YL. Correlating factors and clinical significance of flexible flatfoot in preschool children. J Pediatr Orthop. 2001;21(3):378–382.
Eluwa MA, Omini RB, Kpela T, Ekanem TB, Akpantah AO. The incidence of Pes amongst Akwa Ibom State students in the University of Calabar. Int J Forensic Sci. 2009;3(2). Accessed: 28.12.2015.
Chang JH, Wang SH, Kuo CL, Shen HC, Hong YW, Lin LC. Prevalence of flexible flatfoot in Taiwanese school-aged children in relation to obesity, gender and age. Eur J Pediatr. 2010;169(4):447–452.
Staheli LT, Chew DE, Corbett M. The longitudinal arch. A survey of 882 feet in normal children and adults. J Bone Joint Surg Am. 1987;69(3):426–428.
Rose GK. Flatfoot in children. Br Med J. 1990;301:1330–1331.
Hernendez AJ, Kimura LK, Laraya MHF, Favaro E. Calculation of Staheli's plantar index and prevalence of flat feet: a study with 100 children aged 5–9 years. Acta Orthop Bras. 2007;15:68–71.
Canale ST. Pesplanus. In: Campbell's Operative Orthopaedics. 10th ed. St Louis: Mosby; 2003:4017–4042.
Daniel WW. Biostatistics: A Foundation for Analysis in the Health Sciences. 7th ed. New York: John Wiley & Sons; 1999:92.
Naing L, Winn T, Rusli BN. Practical issues in calculating the sample size for prevalence studies. Archiv Orofacial Sci. 2006;1:9–14.
World Health Organization. Young people's health – a challenge for society. Report of a Study Group on Young People and ‘‘Health for All by the Year 2000’’. Technical Report Series. Geneva: World Health Organization; 1986. No 731.
Ali M, Ullah MA, Amjad I. Prevalence of the flat foot in 6–10 years old school going children. RMJ. 2013;38(4):385–387.
Abdel-Fattah MM, Hassanin MM, Felembane FA, Nassaane MT. Flat foot among Saudi Arabian army recruits: prevalence and risk factors. East Mediterr Health J. 2006;12(1–2):211–217.
Hawes MR, Sovak D, Miyashita M, Kang SJ, YoshihukuY. Tanaka S. Ethnic differences in forefoot shape and the determination of shoe comfort. Ergonomics. 1994;37(1):187–196.
Mauch M, Grau S, Krauss I, Maiwald C, Horstmann T. Foot morphology of normal, underweight and overweight children. Int J Obesity (Lond). 2008;32(7):1068–1075.
Community Paediatrics Committee. Canadian Paediatric Society. Footwear for children. Paediatr Child Health. 1998;3(5):373–375.
Mei-Dan O, Kahn G, Zeev A, Rubin A, Constantini N, Even A. The medial longitudinal arch as a possible risk factor for ankle sprains: a prospective study in 83 female infantry recruits. Foot Ankle Int. 2005;26(2):180–183.
Wearing SC, Hills AP, Byrne NM, Hennig EM, McDonald M. The arch index: a measure of flat or fat feet? Foot Ankle Int. 2004;25(8):575–581.
Vicenzino B, Collins N, Cleland J, McPoil T. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. Br J Sports Med. 2010;44(12):862–866.
Cappello T, Song KM. Determining treatment of flat feet in children. Curr Opin Pediatr. 1998;10(1):77–81.
Cavanagh PR, Rodgers MM. The arch index: a useful measure from footprints. J Biomech. 1987;20(5):547–551.
Gould N, Moreland M, Alvarez R, Alvarez R, Trevino S, Fenwick J. Development of the child's arch. Foot Ankle. 1989;9(5):241–245.
Umar MBT, Paul A. Incidence of flat foot and anthropometric comparison between flat and normal foot of the Yoruba ethnic group of Nigeria. Res J Appl Sci. 2010;5(6):412–416.
Van Boerum DH, Sangeorzan BJ. Biomechanics and pathophysiology of flat foot. Foot Ankle Clin. 2003;8(3):419–430.
Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flatfoot. A survey of 1846 skeletally mature persons. J Bone Joint Surg Br. 1995;77(2):254–257.
Miller EE, Whitcome KK, Lieberman DE, Norton HL, Dyer RE. The effect of minimal shoes on arch structure and intrinsic foot muscle strength. J Sport Health Sci. 2014;3(2):74–85.