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Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study

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Abstract

The purpose of this study was to evaluate foot arch types of obese children and adolescents aged 9–16.5 years using both indirect and direct measures. Fifty-eight obese children/adolescents attending the paediatric endocrinology unit of the University Hospital “Lozano Blesa” in Zaragoza were selected as experimental subjects. Fifty-eight gender and age matched, normal-weight children/adolescents were selected as control subjects. To assess the medial longitudinal arch (MLA) height, which is used as a main reference for the diagnosis of flatfoot, footprints from both feet were collected (in both groups) and lateral weight-bearing radiographs of both feet were taken (of 49 of the 58 obese children). Footprint angle (FA) and the Chippaux-Smirak index (CSI) were calculated from the footprints. Talus-first metatarsal (TFMA) and calcaneal inclination angles (CIA) were obtained from lateral feet radiographs. In the normal-weight group, mean values of FA and CSI indicated a normal MLA. In the obese group, morphological flatfoot was identified. Comparison between both groups, by side and gender, showed a decrease of FA (p < 0.001) and an increase of CSI (p <0.001) in obese subjects. Mean values of TFMA and CIA in the obese group indicated a lowering of the MLA. Obese children/adolescents between 9 and 16.5 years of age had significantly lower values of FA and higher CSI, related to a lower MLA. Radiographic parameters supported these findings and mean values were associated with a fall of this arch.

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Abbreviations

MLA:

Medial longitudinal arch

FA:

Footprint angle

CSI:

Chippaux-Smirak index

TFMA:

Talus-first metatarsal angle

CIA:

Calcaneal inclination angle

References

  1. Bird AR, Payne CB (1999) Foot function and low back pain. Foot 9:175–180. doi:10.1054/foot.1999.0563

    Article  Google Scholar 

  2. Cavanagh PR, Morag E, Boulton AJM, Young MJ, Deffner KT, Pammer SE (1997) The relationship of static foot structure to dynamic foot function. J Biomech 30:243–250. doi:10.1016/S0021–9290(96)00136–4

    Article  PubMed  CAS  Google Scholar 

  3. Cavanagh PR, Rodgers MM (1987) The arch index: a useful measure from footprints. J Biomech 20:547–551. doi:10.1016/0021–9290(87)90255–7

    Article  PubMed  CAS  Google Scholar 

  4. Chen CH, Huang MH, Chen TW, Weng MC, Lee CL, Wang GJ (2006) The correlation between selected measurement from footprint and radiograph of flatfoot. Arch Phys Med Rehabil 87:235–240. doi:10.1016/j.apmr.2005.10.014

    Article  PubMed  Google Scholar 

  5. Chi TD, Toolan BC, Sangeorzan BJ, Hansen ST (1999) The lateral column lengthening and medial column stabilization procedures. Clin Orthop Relat Res 365:81–90. doi:10.1097/00003086–199908000–00011

    Article  PubMed  Google Scholar 

  6. Clarke HH (1933) An objective method of measuring the height of the longitudinal arch in foot examinations. Res Q 4:99–107

    Google Scholar 

  7. Cole T, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1–6. doi:10.1136/bmj.320.7244.1240

    Article  Google Scholar 

  8. Di Giovanni J, Smith S (1976) Normal biomechanics of the adult rearfoot. J Am Pod Assoc 66:812–824

    Google Scholar 

  9. Do Prado I, De Souza CA (1994) Radiographic goniometric study in the lateral incidence of children’s normal feet. Rev Bras Ortop 29:479–482

    Google Scholar 

  10. Dowling AM, Steele JR, Baur LA (2004) What are the effects of obesity in children on plantar pressure distributions? Int J Obes 28:1514–1519. doi:10.1038/sj.ijo.0802729

    Article  CAS  Google Scholar 

  11. Echarri JJ, Forriol F (2003) 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 12:141–146. doi:10.1097/00009957–200303000–00012

    Article  PubMed  Google Scholar 

  12. Forriol F, Pascual J (1990) Footprint analysis between three and seventeen years of age. Foot Ankle 11:101–104

    PubMed  CAS  Google Scholar 

  13. Gilmour JC, Burns Y (2001) The measurement of the medial longitudinal arch in children. Foot Ankle Int 22:493–498

    PubMed  CAS  Google Scholar 

  14. Gould N (1982) Graphing the adult foot and ankle. Foot Ankle 2:213–219

    PubMed  CAS  Google Scholar 

  15. Hak D, Gautsch TL (1995) A review of radiographic lines and angles used in orthopedics. Am J Orthop 24:590–601

    PubMed  CAS  Google Scholar 

  16. Hawes MR, Nachbauer W, Sovak D, Nigg BM (1992) Footprints parameters as a measure of arch height. Foot Ankle Int 13:22–26

    CAS  Google Scholar 

  17. Henderson RC (1992) Tibia vara: a complication of adolescent obesity. J Pediatr 121:482–486. doi:10.1016/S0022–3476(05)81811–6

    Article  PubMed  CAS  Google Scholar 

  18. Huang CK, Kitaoka HB, An KN, Chao EY (1993) Biomechanical evaluation of longitudinal arch stability. Foot Ankle 14:353–357

    PubMed  CAS  Google Scholar 

  19. Janssen I, Katzmarzyk PT, Boyce WF, King MA, Pickett W (2004) Overweight and obesity in Canadian adolescents and their associations with dietary habits and physical activity patterns. J Adolesc Health 35:360–367

    PubMed  Google Scholar 

  20. Jaworski JM, Puch EA (1987) Morphology of overweighted children foot. Versammlung der Anatomischen Gesellschaft, Leipzig

    Google Scholar 

  21. Kanatli U, Yetkin H, Cila E (2001) Footprint and radiographic analysis of the feet. J Pediatr Orthop 21:225–228

    Article  PubMed  CAS  Google Scholar 

  22. Kaschak TJ, Laine W (1988) Surgical radiology. Clin Podiatr Med Surg 5:797–829

    PubMed  CAS  Google Scholar 

  23. Katz MA, Davidson RS, Chan PSH, Sullivan RJ (1997) Plain radiographic evaluation of the pediatric foot and its deformities. Univ Pa Orthop J 10:30–39

    Google Scholar 

  24. Kim HW, Weinstein SL (2000) Flatfoot in children: differential diagnosis and management. Curr Orthop 14:441–447. doi:10.1054/cuor.2000.0156

    Article  Google Scholar 

  25. Lobstein T, Baur L, Uauy R (2004) Obesity in children and young people: a crisis in public health. Obes Rev 5(suppl 1):4–85. doi:10.1111/j.1467–789X.2004.00133.x

    Article  PubMed  Google Scholar 

  26. Loder RT, Aronson DD, Greenfield MI (1993) The epidemiology of bilateral slipped capital femoral epiphysis. A study of children in Michigan. J Bone Joint Surg Am 75:1141–1147

    PubMed  CAS  Google Scholar 

  27. McCrory JL, Young MJ, Boulton AJM, Cavanagh PR (1997) Arch index as a predictor of arch height. Foot 7:79–81. doi:10.1016/S0958–2592(97)90052–3

    Article  Google Scholar 

  28. Meary R (1967) On the measurement of the angle between the talus and the first metatarsal. Rev Chir Orthop Repar Appar Mot 53:389

    Google Scholar 

  29. Menz HB (1998) Alternative techniques for the clinical assessment of foot pronation. J Am Podiatr Med Assoc 88:119–129

    PubMed  CAS  Google Scholar 

  30. Mickle KJ, Steele J, Munro BJ (2006) The feet of overweight and obese young children: are there flat or fat? Obesity (Silver Spring) 14:1949–1953. doi:10.1038/oby.2006.227

    Article  Google Scholar 

  31. Moreno LA, Fleta J, Mur L, Feja C, Sarría A (1997) Indices of body fat distribution in Spanish children aged 4.0 to 14.9 years. J Pediatr Gastroenterol Nutr 25:175–181. doi:10.1097/00005176–199708000–00008

    Article  PubMed  CAS  Google Scholar 

  32. Norkin CC, Levangie PK (2000) Joint structure and function, 2nd edn. Davis FA, Philadelphia

    Google Scholar 

  33. Pedowitz W, Kovatis P (1995) Flatfoot in the adult. J Am Acad Orthop Surg 3:293–302

    PubMed  Google Scholar 

  34. Pfeiffer M, Kotz R, Ledl T, Hauser G, Sluga M (2006) Prevalence of flatfoot in preschool-aged children. Pediatrics 118:634–639. doi:10.1542/peds.2005–2126

    Article  PubMed  Google Scholar 

  35. Rao UB, Joseph B (1992) The influence of footwear on the prevalence of flatfoot. J Bone Joint Surg Br 74B:525–527

    Google Scholar 

  36. Riddiford-Harland DL, Steele JR, Storlien LH (2000) Does obesity influence foot structure in prepubescent children? Int J Obes 24:541–544. doi:10.1038/sj.ijo.0801192

    Article  CAS  Google Scholar 

  37. Saltzman CL, Nawoczenski DA, Talbot KD (1995) Measurement of the medial longitudinal arch. Arch Phys Med Rehabil 76:45–49. doi:10.1016/S0003–9993(95)80041–7

    Article  PubMed  CAS  Google Scholar 

  38. Shiang T, Lee S, Lee S, Chu W (1998) Evaluating different footprint parameters as a predictor of arch height. IEEE Eng Med Biol 62–66

  39. Simkin A, Leichter I, Giladi M, Stein M, Milgrom C (1989) Combined effect of foot arch structure and orthotic device on stress fractures. Foot Ankle 10:25–29

    PubMed  CAS  Google Scholar 

  40. Stavlas P, Grivas T, Michas C, Vasiliadis E, Polyzois V (2005) The evolution of foot morphology in children between 6 and 17 years of age: a cross-sectional study based on footprints in a Mediterranean population. Foot Ankle Surg 44:424–428. doi:10.1053/j.jfas.2005.07.023

    Article  Google Scholar 

  41. Sthaeli LT, Chew DE, Corbett M (1987) The longitudinal arch. A survey of eight hundred and eighty-two feet in normal children and adults. J Bone Joint Surg 69A:427–428

    Google Scholar 

  42. Sullivan JA (1999) Pediatric flatfoot: evaluation and management. J Am Acad Orthop Surg 7:44–53

    PubMed  CAS  Google Scholar 

  43. Taylor ED, Theim KR, Mirch M, Ghorbani S, Tanofsky-Kraff M, Adler-Wailes D et al (2006) Orthopedic complications of overweight in children and adolescents. Pediatrics 117:2167–2174. doi:10.1542/peds.2005–1832

    Article  PubMed  Google Scholar 

  44. Vanderwilde R, Sthaeli LT, Chew DE, Malagon V (1988) Measurements on radiographs of the foot in normal infants and children. J Bone Joint Surg Am 70:407–415

    PubMed  CAS  Google Scholar 

  45. Volpon JB (1994) Footprint analysis during the growth period. J Pediatr Orthop 14:83–85

    PubMed  CAS  Google Scholar 

  46. Wearing SC, Hills AP, Byrne NM, Henning EM, McDonald M (2004) The arch index: a measure of flat or fat feet? Foot Ankle Int 25:575–581

    PubMed  Google Scholar 

  47. Welton EA (1992) The Harris & Beath footprint: interpretation and clinical value. Foot Ankle 13:462–468

    PubMed  CAS  Google Scholar 

  48. Younger AS, Sawatzky B, Dryden P (2005) Radiographic assessment of adult flatfoot. Foot Ankle Int 26:820–825

    PubMed  Google Scholar 

  49. Zifchock RA, Davis I, Hillstrom H, Song J (2006) The effect of gender, age and lateral dominance on arch height and arch stiffness. Foot Ankle Int 27:367–372

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain

    M. Adoración Villarroya & Concepción Tomás

  2. Hospital Clínico Universitario Lozano Blesa, Avd. Gómez Laguna, 50009, Zaragoza, Spain

    J. Manuel Esquivel, Ana Buenafé & Gloria Bueno

  3. Grupo “Nutrición, Alimentación, Crecimiento y Desarrollo”, E.U. Ciencias de la Salud, Universidad de Zaragoza, C/Domingo Miral s/n, 50009, Zaragoza, Spain

    Luis A. Moreno

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  1. M. Adoración Villarroya
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  2. J. Manuel Esquivel
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  3. Concepción Tomás
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  4. Luis A. Moreno
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  5. Ana Buenafé
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  6. Gloria Bueno
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Correspondence to M. Adoración Villarroya.

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Villarroya, M.A., Esquivel, J.M., Tomás, C. et al. Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study. Eur J Pediatr 168, 559–567 (2009). https://doi.org/10.1007/s00431-008-0789-8

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  • DOI: https://doi.org/10.1007/s00431-008-0789-8

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