Prevalence of Flat Foot using Plantar Arch Index among Young Adults of Delta State, Nigeria

@#Introduction: Traditionally, feet are classified as high, normal or low arched. Studies on flat foot (pes planus) have been conducted in different ethnic groups in Nigeria but none has been conducted among young Ika adults. This study is therefore aimed at determining the prevalence of flat foot using plantar arch index among young adults of Ika. Methods: A total of 384 subjects comprising 199 females and 185 males aged 18-37 years participated in the study. Foot prints of subjects were obtained using the simple ink and duplicating paper method. The Plantar Arch Index was calculated by dividing the foot prints in three equidistant regions excluding the toes. The index value was the ratio between the area of the mid foot and the total area of the foot print. Descriptive statistics for each variable included mean and standard deviation while statistical tools included independent sample t-tests and paired samples test respectively. Results: After data analyses, the total prevalence of flat foot was 8.6% while a total of 24(6.3%) males had flat foot on their right foot while 16(4.2%) had on their left. However, 14(3.6%) and 12(3.1%) females had flat foot on their right and left foot sides respectively. The prevalence of Pes planus was significantly higher among males (P< 0.05) than their female counterparts on both foot sides. Furthermore, there was a statistically significant difference between flat and normal foot on both foot sides while the difference between flat foot of the right side and that of the left was not statistically significant. Conclusion: Being the first of its kind in Ika, this study is therefore important to the Orthopaedist and Podiatrist in Nigeria for diagnosis and treatment choices of foot deformities amongst young adults of Ika.

Impact of Pedal Arch Patency on Tissue Loss and Time to Healing in Diabetic Patients with Foot Wounds Undergoing Infrainguinal Endovascular Revascularization

OBJECTIVE: To retrospectively evaluate the impact of pedal arch quality on tissue loss and time to healing in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization. MATERIALS AND METHODS: Between January 2014 and June 2015, 137 consecutive diabetic patients with foot wounds underwent infrainguinal endovascular revascularization (femoro-popliteal or below-the-knee, arteries). Postprocedural angiography of the foot was used to divide the patients into the following three groups according to the pedal arch status: complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA). Time to healing and estimated 1-year outcomes in terms of freedom from minor amputation, limb salvage, and survival were evaluated and compared among the three groups. RESULTS: Postprocedural angiography showed the presence of a CPA in 42 patients (30.7%), IPA in 60 patients (43.8%), and APA in 35 patients (25.5%). Healing within 3 months from the procedure was achieved in 21 patients with CPA (50%), 17 patients with IPA (28.3%), and in 7 patients with APA (20%) (p = 0.01). There was a significant difference in terms of 1-year freedom from minor amputation among the three groups (CPA 84.1% vs. IPA 82.4% vs. APA 48.9%, p = 0.001). Estimated 1-year limb salvage was significantly better in patients with CPA (CPA 100% vs. IPA 93.8% vs. APA 70.1%, p < 0.001). Estimated 1-year survival was significantly better in patients with CPA (CPA 90% vs. IPA 80.8% vs. APA 62.7%, p = 0.004). CONCLUSION: Pedal arch status has a positive impact on time to healing, limb salvage, and survival in diabetic patients with foot wounds undergoing infrainguinal endovascular revascularization.

Características morfofuncionales del pie de deportistas universitarios chilenos en diez disciplinas deportivas / Morphofunctional foot characteristics of Chilean university athletes in ten sports disciplines

RESUMEN: Se sabe que hay gran variabilidad en la morfología de las zonas del pie entre sujetos. Esto es más evidente en deportistas, ya que la práctica de deportes somete a los pies a presiones y deformaciones anatómicas mayores que las que se ejercen en actividades de la vida diaria. Por lo anterior, se desprende que el conocimiento de la morfología del pie de la población objetivo es de alto interés para la confección de calzado apropiado a su forma y dimensiones. El objetivo de esta investigación es caracterizar variables morfológicas referidas a las dimensiones del pie de deportistas seleccionados universitarios chilenos. La muestra se conformó de 169 sujetos de ambos sexos de una población de deportistas universitarios de 23,27 años, 71 kilogramos, 1,71 metros de estatura e índice de masa corporal de 24,29. En las mediciones se utilizó un antropómetro y la clasificación del Arco Plantar Longitudinal Medial (APLM) se realizó mediante el Arch Index. Se demostró que la longitud del pie en hombres y mujeres se corresponde con el 15 % de la estatura del sujeto. La variable Ancho Antepie Normalizado (AAN) equivale al 39 % de la Longitud del Pie (LP), no registrándose diferencias entre sexos. El Ancho del Retropié por su parte, fue correspondiente con el 25 % de LP. El Ancho de Retropie (AR) equivale al 63 % del Ancho Antepie (AA). En cuanto al APLM, las mujeres presentan valores de normalidad ubicados entre 0,13 y 0,24 para pie izquierdo y 0,17 y 0,24 para pie derecho. Se aprecia que la prevalencia de pies planos fue mayor en hombres (25 % a 28 %) que en mujeres (4 % a 6 %) y la prevalencia de pies cavos fue mayor en mujeres (47 % a 53 %) respecto a hombres (27 % a 31 %).

SUMMARY: It is known that there is great variability in the morphology of feet areas among different subjects. This is more evident in athletes, since the practice of sports subjects their feet to greater pressures and anatomical deformations, other than those exerted during daily life activities. It is clear therefore, that knowledge of the target population foot morphology is of high interest for the production of appropriate footwear to its shapes and dimensions. The objective of this research is to characterize morphological variables related to the feet of selected Chilean university athletes. The sample consisted of 169 subjects of both sexes of university population athletes of an average age of 23.27 years, 71 kilograms, 1.71 meters height and body mass index of 24.29. An anthropometer was used for measurements and the classification of the Medial Longitudinal Plantar Arch (MLPA) was performed by the Arch Index. It was shown that foot length corresponds to 15 % of the subject's height. The Normal Forefoot Width (NFW) variable is equal to 39% of Foot Length (FL), with no differences between sexes. Posterior foot width corresponded to 25 % of LP; posterior foot Width is 63 % of the Forefoot Width (AA). Regarding the APLM, women presented values of normality located between 0.13 and 0.24 for left foot and 0.17 and 0.24 for right foot. The prevalence of flat foot was higher in men (25 % to 28%) than in women (4 % to 6 %) and the prevalence of cavus foot was higher in women (47 % to 53 %) than in men (27 % to 31 %).

The effects of foot morphology and anthropometry on unipodal postural control

The maintenance of posture is a constant challenge for the body, as it requires rapid and accurate responses to unforeseen disturbances, which are needed to prevent falls and maintain balance. The purpose of the present study was to compare different types of plantar arch in relation to postural balance, and analyze the relationships between variations the plantar arch and anthropometric characteristics of the feet with unipedal static balance. We evaluated 100 men and women between the ages of 20 and 40 years old, to determine anthropometry and posturography with a force platform. There was a weak correlation between plantar arches and anthropometric measurements and postural balance, except for the length of the male foot, which showed a correlation between increased size and poorer static balance. We conclude that the type of plantar arch does not influence postural balance, and of the anthropometric factors, only foot length was related to postural balance.

Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R2=0.15 for acute phase PF; R2=0.17 for chronic PF) and maximum force (R2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R2=0.18) and chronic (R2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R2=0.19) and chronic (R2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot.

Anatomical basis of the flap based on the perforator of plantar arch / 中华显微外科杂志

Objective To provide the anatomical basis for the flap based on the perforator of Plantar arch,through investigation of the morphological features of the perforator of the arch of the foot.Methods From November,2015 to March,2016,the first metatarsal base and the fifth metatarsal tuberosity were chosen as the observation point on 25 specimens of adult human feet perfused with red latex.The following contents were observed under surgical magnifier:①The origin,courses,branches and distribution of the perforator of Plantar arch.②The anastomoses among the perforator of Plantar arch and the fete arteriosum dorsale pedis.Mimic operation was performed on another fresh specimen perfused with red latex.Results There were 3 perforators in Plantar arch,which passed through the 2nd-4th metatarsal dorsal muscles to the dorsi pedis and then divided into an ascending branch and a descending branch.The ascending branch anastomosed with the rete arteriosum dorsale pedis,and the descending branch stretched to the 2nd-4th plantar arteries.The initiative outer diameters of the 1st-3rd dorsal perforators of Plantar arch were (1.5 ± 0.3)mm,(1.1 ± 0.4) mm and (0.9-± 0.3) mm respectively,and the lengths of the stem were (1.1 ± 0.2) cm,(1.5 ± 0.1) cm and (1.5 ± 0.5) cm respectively.Conclusion The flap can be used for repair of soft-tissue defects of dorsal and front foot through dorsal transposition or a V-Y advancing flap with the perforator of Plantar arch as its vascular pedicle.

A Study on Prevalence of Flat Feet Among School Children in Kanchipuram Population.

Background: A flexible flatfoot is considered to be a variation of a normal foot. Any deviation from the anatomical plantigrade foot is a deformed foot. Some of the deformities of the foot are: Flat Foot. The normal concavity due to the medial longitudinal arch is absent. High Arch Foot - A normal foot has a medial longitudinal arch which is higher. Materials and Methods: A total population of 625, in age ranging from 5 year to 9 years in Kanchipuram district was chosen. Each individual was made to sit and the foot was brought in contact with the Foot Impression gaining Kit on white sheets in standing posture. Results: The flat feet and high arch feet evaluation was obtained by means of foot prints and the plantar arch index was established. The mean values of plantar arch index within the age group were stable and ranges from 0.72 to 0.73. With plantar arch indices greater than 1.15 was regarded as flatfeet and less than 0.10 was regarded as High arch feet. Discussion: In normal feet with presence of an arch, the stress will be distributed in an even manner so that the person will not experience any kind of pain. Under an abnormal condition that occurs due to lack of stretching of muscles, bones and tendons, there will be absence of arch among these people. In this condition, all the weight will be concentrated in smaller area on the feet and generates a lot more pain than normal. This condition might occur in both children and adults. In some people both feet will be flat and in some only one foot will be flat. Conclusion: Flat foot is highly prevalent in the ages between 5-9. The average values for plantar arch indices are stable and ranges from 0.72 to 0.73 in our sample regarded as Normal foot. Plantar arch index > 1.15 is regarded as Flat foot. Plantar arch index < 0.10 is regarded as High arch foot.

The anatomy of the plantar arterial arch / Anatomía del arco plantar arterial

The plantar arterial arch provides the dominant vascular supply to the digits of the foot, with variability in length, shape, and dominant blood supply from the contributing arteries. According to the standard definition, the plantar arterial arch is formed from the continuation of the lateral plantar artery and the anastomoses between the deep branch of dorsalis pedis artery. In this study, 40 adult feet were dissected and the plantar arch with variations in shape and arterial supply was observed. The standard description of the plantar arch was observed in 55% of the specimens with variations present in 45%. Variations in terms of shape were classified into three types: Type A (10%): plantar arterial arch formed a sharp irregular curve; type B (60%): obtuse curve; type C (3%): spiral curve. Variation in the dominant contributing artery was classified into six types: type A (25%), predominance in the deep branch of dorsalis pedis artery supplying all digits; type B (5%), predominance in the lateral plantar artery supplying digits 3 and 4; and type C (20%), predominance in the deep branch of dorsalis pedis artery supplying digits 2 to 4; type D (24%), equal dominance showed; type E (10%), predominance in the lateral plantar artery supplying digits 3 to 5; and type F (21%), predominance of all digits supplied by lateral plantar artery. The foot was divided into three parts to determine the location of the plantar arterial arch. The second part was further divided into three parts: middle anterior (90%), intermediate middle (10%), and middle posterior (0%). Knowledge of the vascular anatomy of the plantar arterial arch is crucial for understanding sites of partial amputations.

El arco plantar arterial proporciona el suministro vascular dominante de los dedos del pie, con variaciones en la longitud, forma y dominancia del suministro de sangre de parte de las arterias intervinientes. De acuerdo con la definición clásica, el arco plantar arterial se forma a partir de la arteria plantar lateral y su anastomosis con la rama profunda de la arteria dorsal del pie. En este estudio se disecaron 40 pies, de cadáveres adultos, y se observó el arco plantar con variaciones en la forma y en la distribución arterial. Se observó la descripción clásica del arco plantar en el 55% de las muestras, con variaciones en el 45% restante. Las variaciones en cuanto a su forma se clasifican en tres tipos: Tipo A (10%): arco plantar arterial con una forma curva, de tipo irregular agudo; Tipo B (60%): arco de curva obtuso; tipo C (3%): arco de curva espiral. La variación en la arteria dominante fue clasificada en seis tipos: Tipo A (25%), la dominancia correspondiente a la rama profunda de la arteria dorsal del pie que suministra las arterias para los dedos; Tipo B (5%), el predominio correspondiente a la arteria plantar lateral, que otorga el suministro arterial para los dedos 3 y 4; y el tipo C (20%), la dominancia correspondiente a la rama profunda de la arteria dorsal del pie, que suministra las ramas para los dedos 2 a 4; Tipo D (24%), igual dominio al tipo C; Tipo E (10%), existe predominio de la arteria plantar lateral, que suministra arterias para los dedos 3 a 5; y tipo F (21%), con predominio de la arteria plantar lateral, que otorga las arterias para los dedos. El pie se dividió en tres partes para determinar la ubicación del arco plantar arterial. La segunda parte se divide en tres porciones: media anterior (90%), media intermedia (20%), y media posterior (0%). El conocimiento de la anatomía vascular del arco plantar arterial es crucial para la comprensión de los sitios de realización de amputaciones parciales.

Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and histories of plantar fasciitis

OBJECTIVE: To evaluate and compare rearfoot alignment and medial longitudinal arch index during static postures in runners, with and without symptoms and histories of plantar fasciitis (PF). INTRODUCTION: PF is the third most common injury in runners but, so far, its etiology remains unclear. In the literature, rearfoot misalignment and conformations of the longitudinal plantar arch have been described as risk factors for the development of PF. However, in most of the investigated literature, the results are still controversial, mainly regarding athletic individuals and the effects of pain associated with these injuries. METHODS: Forty-five runners with plantar fasciitis (30 symptomatic and 15 with previous histories of injuries) and 60 controls were evaluated. Pain was assessed by a visual analogue scale. The assessment of rearfoot alignment and the calculations of the arch index were performed by digital photographic images. RESULTS: There were observed similarities between the three groups regarding the misalignments of the rearfoot valgus. The medial longitudinal arches were more elevated in the group with symptoms and histories of PF, compared to the control runners. CONCLUSIONS: Runners with symptoms or histories of PF did not differ in rearfoot valgus misalignments, but showed increases in the longitudinal plantar arch during bipedal static stance, regardless of the presence of pain symptoms.

Ageing feet and plantar arch characteristics of the Thai elderly

Background: Ageing feet may lead to painful deformity and disability. There are different patterns of degenerative changes among each population. Objectives: To determine the prevalence, characteristics, and related factors of ageing foot disorders in healthy Thai older persons. Methods: A cross-section analytic study was done at the Faculty of Medicine, Chulalongkorn University, during September 2006 – August 2007. Healthy volunteers aged between 60-80 years old were recruited from urban areas of Bangkok. Medical status, musculoskeletal foot problems, plantar arch, and footwear used were assessed. Footprints were taken from standing, weight bearing position, and calculated for Staheli arch index. Factors for the foot disorders were analyzed. Results: There were 108 men and 105 women with a mean age = 68.7±5.4 years, mean body mass index (BMI) = 24.6±3.4 kg/m². Foot deformities were 87% (hallux valgus 45.5%, mallet toe 45%, hammer toe 25%, and claw toe 21.5%). Hallux valgus was more severe in women, having arch index value increasing with the severity. No other demographic or biomechanical variables including footwear types were found associated with foot deformities. More than 85% of the subjects had foot callus related to deformities and tight shoes. Thirty subjects (14%) had foot pain (1/5 of women, 1/20 of men). The pain resulted from plantar fasciitis, hallux valgus, callus, metatarsalgia, and improper footwear. Subjects with plantar fasciitis had higher BMI and higher arch index. Pes planus were more common in women (42% vs. 32%). Only 9% had pes cavus, all of when were men. The Staheli arch index showed good reliability in discriminating the plantar arch types. Conclusions: Ageing feet caused problems, mostly in women. Hallux valgus related to pes planus. Plantar fasciitis associated with overweight and pes planus.