Preliminary normative values for foot loading parameters of the developing child
Introduction
It is well known that the foot progresses through different changes of shape and function during childhood [1], [2]. The first manifestation of this development can be observed in the fourth week of gestation. After birth, during the first years of life the foot develops rapidly. Half of the final foot length will be reached already at 1–1.5 years of age [3]. An important event is reached when the child stands upright and begins to walk. The further development of the child's foot is strongly influenced by this milestone. In the initial stages of independent walking the plantar fat pad protects the foot against overloading by distributing the pressure across the whole plantar surface [4]. During the first weeks of independent walking children usually show an unstable roll-over process [5]. After 1 year of independent walking some children show quite a mature plantar pressure pattern with increasing pressure values and a smaller midfoot region while others retain an immature, child-like pattern [6]. Furthermore, it has been shown that 2-year-old girls show a significantly smaller midfoot region and a lower foot form index than boys [7]. Therefore, there appears to be a wide range of normal foot shapes and functions which emerge at specific developmental stages.
Several cross-sectional studies investigated the growing foot by means of plantar pressure distribution measurements at a specific point in time [8], [9], [10], [11], [12], [13]. However, there are few longitudinal investigations in this area [5], [6]. Therefore, it is difficult to draw general conclusions with regard to developmental changes from the results of cross-sectional studies. A longitudinal evaluation with a large cohort provides the opportunity to identify and document intra-individual changes of foot shape and function. The wide range of foot shapes and the development of footprints have already been documented in detail [14]. The individual changes of shape and function of the child's foot during growth have not yet been followed by means of plantar pressure measurements over an extended period. Such measurements would allow evaluation of the changes of dynamic foot loading as the foot grows.
This information should be helpful to evaluate the normal roll-over process and to identify potential pathologies with regard to foot shape and function. Nowadays, plantar pressure measurements are a generally accepted tool in clinical analyses of foot function. However, no database exists to determine normality or pathology of an individual pressure pattern. Up to now, there have been no normative pressure values available for children of various ages. Only little information exists about the child's foot loading characteristics from the first steps until adolescence. Therefore, the aim of this study was to establish a database of plantar pressure patterns and Harris mat prints using a longitudinal study design that could be used for comparisons in individual analyses of clinical paediatric cases.
Section snippets
Material and methods
At the end of 1999, we began recruiting healthy German children who had just started to walk independently for a long-term longitudinal investigation of foot development. By the spring of 2005, a sample of 100 healthy children was entered into the study. The children were recruited from day nursery, playing groups, personal contacts and later through word of mouth from parents already participating. For the current analysis, 43–90 children could be evaluated over an investigation period of 4
Results
No systematic differences between left and right feet were observed for the parameters evaluated, therefore average values from both sides were used for further analyses. During the investigation period of 4 years the parameters peak pressure and normalized impulse showed a continuous increase in almost every selected foot region. A decreasing tendency could be observed only in the midfoot region. The values of the contact area of the midfoot region also showed a decrease.
The median of the peak
Discussion and conclusion
The evaluated normative values are still preliminary values of an ongoing longitudinal study, which is being carried out over a 9-year period.
The decreased loading of the midfoot region as indicated by the contact area, impulse and peak pressure confirm the development of the longitudinal arch. The increased loading of the other foot regions also demonstrates a more dynamic roll-over process and the maturation towards an adult-like foot loading pattern.
Peak pressures under children's feet are
Summary
By means of the percentile curves the typical course of foot loading and foot shape parameters were established indicating the normal development from the onset of independent walking until the age of 5. These values can be used for reference to normal development in clinical routine. The subdivision of the percentiles in 3%, 50% and 97% is conventionally used in paediatrics. Foot loading patterns and foot shape data, which are located outside the range between the 3rd and 97th percentile, can
Conflict of interest statement
Herewith the author and co-authors declare, that this study is not in conflict with any other scientific or business interests.
Acknowledgements
Thanks are due to the children and their parents for their continuing support. Special thanks go to Helga Raape, Christel Meyer and Christel Wallmann for supporting the measurements and the data management. This project is supported by the Deutsche Forschungsgemeinschaft (DFG; RO 2146/3-2).
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