Static postural differences between neutral and flat feet in children with and without symptoms

Flatfoot is a common variant of foot posture. Whilst usually benign, in some children flatfoot is accompanied by pain and functional complaints. Comparisons between the posture of asymptomatic and symptomatic flat feet are few. If a difference does exist, it may help understand symptoms and guide management.

This paper investigated differences in lower limb posture between neutral and flat feet with and without symptoms during standing using the multi-segment Oxford Foot Model. 97 children between five and 18years old were assessed by a physiotherapist; each foot was classified into one of four categories: asymptomatic neutral (n=88), asymptomatic mild flatfoot (n=47), asymptomatic flatfoot (n=29), or symptomatic flatfoot (n=30). For each child, Oxford Foot Model markers were applied, and mean values of 11-Euler angles at the foot, ankle, and knee joints during standing were calculated. Analysis of variance and post-hoc tests were used to identify differences between groups.

Hindfoot eversion was significantly increased (P<0.001) in children with asymptomatic and, to a greater extent, symptomatic flatfoot. The forefoot was significantly more abducted (P<0.001) in the symptomatic than asymptomatic groups, and in the flat than neutral group. The forefoot was more supinated relative to the hindfoot in the flatfoot groups (P=0.023), although post-hoc analysis did not identify specific group differences.

Hindfoot eversion and forefoot abduction were much greater in the symptomatic population. The differences in foot alignment may relate to the presence of symptoms.