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Longitudinal study on the foot development of school children
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Type
Thesis
Author
Tong, Jasper Weng Kong
Supervisor
Kong, Pui Wah
Abstract
Foot structure is often classified into flat foot, neutral and high arch type based on the variability of the Medial Longitudinal Arch (MLA). To date, the literature provided contrasting evidence on the age when MLA development stabilises in children. Moreover, factors associated with flat foot (e.g. gender and footwear habits) were not adequately investigated through longitudinal studies. Conflicting results on the relationship between foot type and function have also been reported.
Two studies were conducted to (i) ascertain a reliable method of MLA assessment from children footprints, (ii) examine the development of MLA with the associated factors influencing its development, and (iii) explore the relationship between foot type and function. Study 1 investigated on the between-day reliability of footprint geometric (e.g. foot length and Arch Index) and loading (e.g. pressure and force) measurements on 21 healthy primary school children aged 6.7 – 12.3 years. Results showed that dynamic footprint geometric and loading parameters of children using a 2-step approach displayed good to excellent reliability (0.61 ≤ ICC ≤ 0.98).
The reliable protocol was subsequently applied in Study 2 on another cohort of healthy Primary 1 school children (n = 111) at baseline (age: 6.9 years), 10-month (age: 7.7 years) and 22-month (age: 8.7 years) follow-up. Baseline demographics, footwear habits and Physical Activity participation data were surveyed. Foot structure (MLA, foot growth and type) and midfoot loading data were acquired from dynamic footprints longitudinally. One-leg static balance, heel-to-toe tandem walk (dynamic balance) and textile crunching were also assessed as foot function outcomes at every time point. Linear Mixed Modelling analysis was used to evaluate changes in foot growth (e.g. foot length and width), MLA (e.g. Arch Index) and midfoot loading across time, as well as between factor groups. Changes in foot function were also analysed across time between foot types.
The MLA of children displayed no changes from approximately 7 to 9 years old (e.g. left/right Arch Index: 0.25/0.25; p = 0.303/0.281), although proportions of flat foot type were decreasing from 55% to 45% from 7 to 8 years old. After adjusting for gait velocity, there were also no significant main effects of time for midfoot Peak Pressure (left/right: p = 0.557/0.612) and Maximum Force normalised to body mass (left/right: p = 0.555/0.809). Foot arches of boys (main effect of time on right Arch Index: p = 0.022) and those from household income more than $10,000/month (main effect of time on left Arch Index: p < 0.001) were still changing (becoming less flat) from 7 to 8 years old. Children who wore slippers at the onset of footwear use had the flattest MLA (overall group effect on left/right subarch angle: p = 0.007/0.020). Among all children who participated in moderate number of sports activities (1 to 2), those who wore footwear least frequently (< 3 days/week) at the commencement of using footwear had the highest arch (overall group effect on left Arch Index: p = 0.007). In the same subgroup of children, girls exhibited a higher arch than boys at age 7 years (overall group effect on left Arch Index: p = 0.036). No differences in one-leg static balance, heel-to-toe walk and textile crunching performance were observed between children with flat and neutral foot over time.
In conclusion, foot arch structure remained stable for school children from approximately 7 to 9 years old. However, the MLA of boys and those from higher household income may stabilise slightly later at about 8 years old. Less frequent use of footwear when the children began walking may support healthy arch development. Finally, flat foot had no impact on foot function in children.
Two studies were conducted to (i) ascertain a reliable method of MLA assessment from children footprints, (ii) examine the development of MLA with the associated factors influencing its development, and (iii) explore the relationship between foot type and function. Study 1 investigated on the between-day reliability of footprint geometric (e.g. foot length and Arch Index) and loading (e.g. pressure and force) measurements on 21 healthy primary school children aged 6.7 – 12.3 years. Results showed that dynamic footprint geometric and loading parameters of children using a 2-step approach displayed good to excellent reliability (0.61 ≤ ICC ≤ 0.98).
The reliable protocol was subsequently applied in Study 2 on another cohort of healthy Primary 1 school children (n = 111) at baseline (age: 6.9 years), 10-month (age: 7.7 years) and 22-month (age: 8.7 years) follow-up. Baseline demographics, footwear habits and Physical Activity participation data were surveyed. Foot structure (MLA, foot growth and type) and midfoot loading data were acquired from dynamic footprints longitudinally. One-leg static balance, heel-to-toe tandem walk (dynamic balance) and textile crunching were also assessed as foot function outcomes at every time point. Linear Mixed Modelling analysis was used to evaluate changes in foot growth (e.g. foot length and width), MLA (e.g. Arch Index) and midfoot loading across time, as well as between factor groups. Changes in foot function were also analysed across time between foot types.
The MLA of children displayed no changes from approximately 7 to 9 years old (e.g. left/right Arch Index: 0.25/0.25; p = 0.303/0.281), although proportions of flat foot type were decreasing from 55% to 45% from 7 to 8 years old. After adjusting for gait velocity, there were also no significant main effects of time for midfoot Peak Pressure (left/right: p = 0.557/0.612) and Maximum Force normalised to body mass (left/right: p = 0.555/0.809). Foot arches of boys (main effect of time on right Arch Index: p = 0.022) and those from household income more than $10,000/month (main effect of time on left Arch Index: p < 0.001) were still changing (becoming less flat) from 7 to 8 years old. Children who wore slippers at the onset of footwear use had the flattest MLA (overall group effect on left/right subarch angle: p = 0.007/0.020). Among all children who participated in moderate number of sports activities (1 to 2), those who wore footwear least frequently (< 3 days/week) at the commencement of using footwear had the highest arch (overall group effect on left Arch Index: p = 0.007). In the same subgroup of children, girls exhibited a higher arch than boys at age 7 years (overall group effect on left Arch Index: p = 0.036). No differences in one-leg static balance, heel-to-toe walk and textile crunching performance were observed between children with flat and neutral foot over time.
In conclusion, foot arch structure remained stable for school children from approximately 7 to 9 years old. However, the MLA of boys and those from higher household income may stabilise slightly later at about 8 years old. Less frequent use of footwear when the children began walking may support healthy arch development. Finally, flat foot had no impact on foot function in children.
Date Issued
2015
Call Number
QM549 Ton
Date Submitted
2015