Footprint-based estimates of arch structure are confounded by body composition in adults

Previous research employing indirect measures of arch structure, such as those derived from footprints, have indicated that obesity results in a "flatter" foot type. In the absence of radiographic measures, however, definitive conclusions regarding the osseous alignment of the foot cannot be made. We determined the effect of body mass index (BMI) on radiographic and footprint-based measures of arch structure. The research was a cross-sectional study in which radiographic and footprint-based measures of foot structure were made in 30 subjects (10 males, 20 female) in addition to standard anthropometric measures of height, weight, and BMI. Multiple (univariate) regression analysis demonstrated that both BMI (β = 0.39, t(26) = 2.12, p = 0.04) and radiographic arch alignment (β = 0.51, t(26) = 3.32, p < 0.01) were significant predictors of footprint-based measures of arch height after controlling for all variables in the model (R(2) = 0.59, F(3,26) = 12.3, p < 0.01). In contrast, radiographic arch alignment was not significantly associated with BMI (β = -0.03, t(26) = -0.13, p = 0.89) when Arch Index and age were held constant (R(2) = 0.52, F(3,26) = 9.3, p < 0.01). Adult obesity does not influence osseous alignment of the medial longitudinal arch, but selectively distorts footprint-based measures of arch structure. Footprint-based measures of arch structure should be interpreted with caution when comparing groups of varying body composition.