Original Article
A STUDY ON PREVALENCE OF FLAT FEET AM ONG SCHOOL
CHILDREN IN KANCHIPURAM POPULATION
D.Krupa Daniel *
1, Chithambaram Chandrasekaran
2, Ajith M ano
3.
ABSTRACT
Address for Correspondence: Dr.D.Krupa Daniel, Associate Professor of Anatomy, Sout hern M edical Universit y, Guangzhou P.R, China. Phone no.: +86-15626441489.
E-M ail: danielkrupa1309@gmail.com.
* 1 Associate Professor of Anat omy, Sout hern M edical Universit y, Guangzhou P.R, CHINA.
2 M BBS-4t h Year, Sout hern M edical Universit y, Guangzhou P.R, CHINA.
3 M BBS-2nd Year, Sout hern M edical Universit y, Guangzhou P.R, CHINA.
Background: A flexible flat foot is considered to be a variat ion of a norm al foot . Any deviation from t he anat omical plant igrade foot is a deform ed foot . Som e of t he deform it ies of t he foot are: Flat Foot . The norm al concavit y due t o t he m edial longit udinal arch is absent . High Ar ch Foot - A norm al foot has a m edial longit udinal ar ch w hich is higher.
M at erials and M ethods: A t ot al populat ion of 625, in age ranging fr om 5 year t o 9 years in Kanchipuram dist rict w as chosen. Each individual w as m ade t o sit and t he foot w as brought in cont act w it h t he Foot Im pression gaining Kit on w hit e sheet s in standing post ure.
Results: The flat feet and high arch feet evaluat ion w as obt ained by m eans of f oot print s and t he plant ar arch index w as est ablished. The m ean values of plant ar arch index w it hin t he age group w ere st able and r anges from 0.72 t o 0.73. Wit h plant ar arch indices great er t han 1.15 w as regarded as flat f eet and less t han 0.10 w as regarded as High ar ch feet .
Discussion: In norm al feet w it h presence of an arch, t he st ress w ill be dist ribut ed in an even m anner so t hat t he per son w ill not experience any kind of pain. Under an abnorm al condit ion t hat occur s due t o lack of st ret ching of m uscles, bones and t endons, t here w ill be absence of arch am ong t hese people. In t his condit ion, all t he w eight w ill be concent rat ed in sm aller area on t he f eet and generat es a lot m ore pain t han norm al. This condit ion m ight occur in bot h children and adult s. In som e people bot h feet w ill be flat and in som e only one foot w ill be flat .
Conclusion: Flat foot is highly prevalent in t he ages bet w een 5-9. The average values for plant ar arch indices are st able and r anges from 0.72 t o 0.73 in our sam ple regarded as Norm al foot . Plant ar arch index > 1.15 is regarded as Flat f oot . Plant ar arch index < 0.10 is regar ded as High ar ch foot .
KEY W ORDS: Norm al foot , Flat foot , High arch foot , Plantar arch Index, Types of feet .
INTRODUCTION
Int J Anat Res 2015, Vol 3(3):1240-44. ISSN 2321- 4287 DOI: ht t p:/ / dx.doi.org/10.16965/ ijar.2015.201
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Received: 13 Jun 2015 Accept ed: 20 Jul 2015 Peer Review : 13 Jun 2015 Published (O):02 Aug 2015 Revised: 20 Jun 2015 Published (P):30 Sep 2015
Int ernat ional Journal of Anat omy and Research ISSN 2321-4287
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DOI: 10.16965/ ijar.2015.201
In bipeds, t he foot t akes on t he im por t ant responsibilit y of receiving t he w eight of t he w hole body and at t he same t ime st abilizing t he individual in changing postural and environment-al condit ions. A normenvironment-al foot must be plant igrade,
h ave n or m al an at o m ical d i spo si t i o n an d physio m echanics, be r esili ent w it h p r oper springiness t o provide a rhyt hmic normal gait [1].
flexible flat foot function normally. M ost children are born w it h very lit t le arch in t he feet . As t hey grow and walk, t he soft tissues along t he bot tom of t he feet t ight en, w hich gradually shapes t he arches of t he feet [1].
Children w it h flexible flat foot oft en do not begin t o develop an arch unt il t he age of 5 years or older. Some children never develop an arch.If flexible flat foot cont inues int o adolescence, a child m ay experience aching pain along t he bot tom of the foot . A doctor should be consulted if a child’s flat feet cause pain.Three main arches are recognized in t he foot . They are t he medial longit udinal, t he lat eral longit udinal and t he t ransverse [2].
Lateral longitudinal arch: The bones m aking u p t h e l at er al l o ngi t ud i n al ar ch ar e t h e calcaneus, t he cuboid and t he fourt h and fift h met at arsals. The pillars are t he calcaneus and t he lat eral t w o m et at arsal heads. The m ost significant ligament s are plant ar aponeurosis and t he long and short plant ar ligament s. The most import ant contribut ion t o the maint enance of t he lat eral arch is m ade by t he peroneus longus t endon. The lat eral t w o t endons of flexor digit orum longus and lat er al half of f lexor digit orum brevis and abduct or digit i minimi also assist by prevent ing separat ion of t he pillars of t he arch [2,3].
M edial longitudinal arch: The m edial m argin of t he foot arches up bet w een t he heel and t he first met et arsophalangeal joint t o form a visible arch. It is made up of calcaneus, talus, navicular, t he three cuniforms and t heir t hree met at arsals. The pillar s ar e t he post er ior aspect of t he calcaneus and t he t hree met at arsal heads. The bo nes t hem selv es co nt r ib ut e l it t le t o t he st abilit y of t he arch, w hereas t he ligam ent s cont ribut e significant ly. The m ost im port ant ligament ous structure is the plantar aponeurosis, w hich act s as a t ie beam bet ween t he support ing pillars.
M uscles also have a role in t he maint enance of t he m edial longit udinal arch. Flexor halluis longus is import ant in t his regard and act s as a bow st ring. Flexor digit orum longus, abduct or hallucis and m edial half of f lexor digit or um
m aint enance of t he arch. The im port ance of t ibialis post erior is manifest by t he collapse of m edial longit udinal ar ch t hat accom panies failure of t he t ibialis t endon[2,3].
Transverse arch: The bones involved in t he t r an sver se ar ch ar e t he b ases o f f i v e met atarsals, the cuboid and t he cuneiforms. The int ermediat e and lat eral cuneiforms are w edge shaped t hus adapt ed t o maint enance of t he t ransverse arch. The st abilit y of t he arch is mainly provided by t he ligament s, w hich bind t he cuneiforms and met at arsal bases of t he foot . A shallow arch is maint ained at t he met at arsal h ead s b y t h e d eep t r an sver se l igam en t s, t ransverse fibres t hat bind t oget her t he digit al slips of t he plant ar aponeurosis, and t o a lesser ext ent , by t he t ransverse head of adduct or hallucis.
Any deviat ion from t he anat omical plant igrade foot is a deformed foot . Some of the deformities of t he foot can be grouped under t he follow ing headings [2,3].
Flat Foot (Pes Planus): Collapse of m edial longit udinal arch leads t o Flat Foot . The normal concavit y due t o t he medial longit udinal arch is absent and inst ead, t he medial side of t he foot bugles as a medial convexit y, part icularly on w eight bearing.
High Arch Foot (Pes Cavus): A normal foot has a medial longit udinal arch w hich is higher t han t he lat eral one. When t his normal port ion is accent uat ed, t he medial side of t he foot t ends t o assume t he shape of a high arch.
In broad-spect rum of classification of feet , t hree t ypes of feet have been recognized.
Types of feet:
1. Egypt ian Type of foot : The great t oe is longer t han t he 2nd t oe, t he second t oe is longer
t han t he 3rd t oe and so on.
2. Square / Intermediate Rectangular type of foot : The great and second t oes are equal. How ever the 2nd toe may be equal or longer t han
3rd t oe. The 3rd t oe may be equal or longer t han
t he 4t h t oe. The 4t h t oe may be equal or longer
t han t he 5t h t oe.
t oe. The 4t h t oe is bigger t han t he 5t h t oe.
1 3
M ATERIALS AND M ETHODS 2
Foot Im pression gaining kit w it h Ink Pad Ink, St an d ar d M easur i n g t o ol s li ke In ch Scal e et c.,W hit e sheet s and st at ionary needs and M easuring t hrough Plant ar arch Index (PI).
Support w idt h of cent ral region Support w idt h of heel region* PI =
Dat a Collect ion done w it h a t ot al populat ion of 625, in age ranging from 5 year t o 9 years in Kanchipuram dist rict was chosen.Each individual w as made t o sit and t he foot w as brought in cont act w it h t he Foot Im pression gaining Kit (Pict ure 1), w it hout any loss of im age each individual foot impression w as pressed on w hit e sheet s in st anding post ure (Pict ure 2 & Pict ure 3). Lat er, on ever y sheet a line w as draw n t angent t o t he medial forefoot edge and t he heel region. The M ean point of t his line w as calculat ed. From t his point a perpendicular line w as draw n crossing t he foot print and sam e procedure repeated for heel t angency point (Pic-t ure 4 & Pic(Pic-t ure5).
3 2
1
4 5
RESULTS
Inclusion Crit eria for t he st udy were Children age bet w een 5 t o 9 years, Bot h sexes.
Exclusion Crit eria for t he st udy w ere Children w it h burns, fract ures over foot region, Boils, Congenit al Deformit ies, Obese Children.
Table 1: Show ing t he stat ist ical data on various param -et ers of t he bot h sides.
Table 2: Show ing t he stat ist ical data on various param -et ers Gender Wise St udy: Right Side.
Table 3: Show ing t he stat ist ical data on various param -et ers Gender Wise St udy: Left Side.
Table 4: Show ing t he stat ist ical data on various param -et ers Age Wise St udy: Right Side.
Table 5: Show ing t he stat ist ical data on various param -et ers Age Wise St udy: Left Side.
Average plant ar indexes being 0.73 for right side and 0.72 for left side in our group of st udy.
DISCUSSION
The normal human foot has medial and lat eral longit udinal arches and t he t ransverse half arch at t he level of t he m id t arsal joint s . There is also ant erior t ransverse arch at t he level of t he heads of t he met at arsal bones.
Foot has t w o funct ions t o perform st at ic and dynamic functions. In standing, it performs static funct ion by form ing a st able w eight bearing support t o t he body. During walking, it functions as an efficient lever t o propel t he body w eight forw ard [3].
Arches of foot are held t oget her by t he st rong ligament s especially t he spring ligament , long p lan t ar l i gam en t , sho r t p l an t ar li gam ent , i n t er o sseo us l igam en t s an d p l ant ar aponeurosis. Of t he muscles, t ibialis anterior, post erior and peroneus longus help in int egrit y and m aint enance of t he ar ches and help in efficient post ure [2].
Tendon of t he t ibialis posterior, on it s way t o it s final insert ion in t he int ernal cuneiform and m et at arsals, at t aches t o it , inst ead of t o t he under surface of t he scaphoid t ubercle. This relat ionship is t he cause of it s influence on flat -foot.
The longit udinal arch consist s of m edial and lat eral component s rest ing on a common pillar post eriorly t he t uberosit y of t he calcaneum . Talus is t he key st one of t he arches.It receives t he body w eight and t ransmit s it t o t he arches b el o w . Th ro u gh t h e ar ch es w ei gh t i s t ransmit t ed t o calcaneus and t he heads of first and fift h met at arsals [2].
Any deviat ion from t he anat omical plant igrade foot is a deformed foot . Some of the deformities of t he foot can be grouped under t he follow ing as Flat foot / (pes planus), High arch foot / (pes cavus).
FLAT FOOT: Collapse of medial longit udinal arch leads t o flat foot .
The follow ing are types of flat foot:
Acquired flat foot: The causes of flat foot in adult s are muscle w eakness , rapid increase of
Congenital flat foot: Appears in all new born babies as t he post ural muscles have not yet developed. In some, foot is not only flat but t he undersurface is convex and w hole foot is in valgus posit ion or ever t ed posit ion due t o congenit al abnormalit y of t alus in w hich it lies in vert ical t alus posit ion [2,3].
Com pensat ory flat foo t : In child r en genu valgum at knee can cause a compensat ory flat foot . In some cases of paralyt ic equines due t o polio or cerebral palsy, it is compensated at t he t arsal joint by flat t ening of t he arch [3].
Spasmodic flat foot: Spasmodic flat foot is seen due t o spasm of per o neal m uscles due t o unaccust omed st rain in adolescent s, subt aloid ar t h r i t i s o r co ngen i t al cal can eo n av icu lar anom alies [ 3,4]. M edial arch is oblit er at ed, navicular bone is prom inent , area of w eight bearing increases and m ay cause increased callosit y.
I nf a n t ile f la t f o ot : Inf an t i l e f l at f o o t i s physiological flat foot of children .Arches become obviously flat and flat foot disappears as t he post ural m uscles st art developing. There is a possibilit y of flat foot with t he poor development of post ural muscles[2,3].
Flat foot can be furt her classified as [4,5,6].
Flexible flat foot: Non-w eight bearing, Normal development of arch.
St at ic flat foot : Fault y post ur al act ivit y of muscles.
Rigid flat foot: During non-w eight bearing also, M edial arch does not develop.
In many cases it probably has a congenit al basis, but it m ay be caused b y sel ect iv e m uscle w eakness or paralysis. All infant s have flat feet for an year or t w o[7] t ill t hey begin t o st and, or even up t o age four [8]. Ot hers aut hors describe major variat ions on plant ar arch can occur unt il age six and seven [1].
l ack of st r et ch i n g o f m u scl es, b o nes an d t endons, t here w ill be absence of arch among t hese people. In t his condit ion, all t he w eight w ill be concent rat ed in a smaller area on t he feet and generat es a lot more pain t han normal. This condit ion might occur in bot h children and adult s [5,9,10]. In some people bot h feet w ill be flat and in some only one foot w ill be flat . To find w het her t he foot is flat or not , a simple t est u si n g p l ant ar ar ch i n dex [ 1,8,10] can b e performed and cat egorized int o unilat eral flat foot and bilateral flat foot.The children w it h flat feet w i ll not be able t o under t ake var ious act ivit ies li ke in an easy m anner. They w ill experience more pain w hen t hey are subject ed t o high impact act ivit ies such as running and jumping. There w ill be more amount of st ress in t he calf and ankle regions [11,12].
Foot pain is fairly common even in children. Heel pain is com mon in very act ive children, w hen high-impact exercise can irrit at e grow t h cent ers of t he heel.
CONCLUSION
Flat foot is highly prevalent in t he ages bet w een 5-9. The average values for plant ar arch indices are st able and ranges from 0.72 t o 0.73 in our sample regarded as Normal foot . Plant ar arch index > 1.15 is regarded as Flat foot . Plantar arch index < 0.10 is regarded as High arch foot .
Conflicts of Interests: None
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