Risk Factors of Flatfoot in Children: A Systematic Review and Meta-Analysis

Background: This study aimed to explore the risk factors for flatfoot in children and adolescents to provide a reference basis for studying foot growth and development in children and adolescents. Methods: We examined the cross-sectional research literature regarding flatfoot in children and adolescents published in the past 20 years, from 2001 to 2021, in four electronic databases: PubMed, Web of Science, EBSCO, and Cochrane Library. Two researchers independently searched the literature according to the inclusion and exclusion criteria and evaluated the literature quality of the selected research; from this, a total of 20 articles were included in our review. After the relevant data were extracted, the data were reviewed using Manager 5.4 software (The Cochrane Collaboration, Copenhagen, Denmark), and the detection rate and risk factors for flatfoot in children were analyzed. Results: In total, 3602 children with flatfoot from 15 studies were included in the analysis. The meta-analysis results showed that being male (OR = 1.33, 95% CI: 1.09, 1.62, p = 0.005), being aged <9 years (age <6, OR = 3.11, 95% CI: 2.47, 3.90, p < 0.001; age 6−9 years, OR = 0.54, 95% CI: 0.41, 0.70, p < 0.001), joint relaxation (OR = 4.82, 95% CI: 1.19, 19.41, p = 0.03), wearing sports shoes (OR = 2.97, 95% CI: 1.46, 6.03, p = 0.003), being a child living in an urban environment (OR = 2.10, 95% CI: 1.66, 2.64, p < 0.001) and doing less exercise (OR = 0.25, 95% CI: 0.08, 0.80, p = 0.02) were risk factors for the detection of flatfoot. Conclusion: In summary, the detection rate of flatfoot in children in the past 20 years was found to be 25% through a meta-analysis. Among the children included, boys were more prone to flatfoot than girls, and the proportion of flatfoot decreased with age.