Development of the Medial Longitudinal Arch of the Foot in Czech Pre- and Primary School Children-A Cross-Sectional...

Background/Objectives: The medial longitudinal arch (MLA) is initially masked by a fat pad that makes the foot appear flat. In preschool age, this fat pad resorbs, and the arch becomes more defined. The exact age at which the arch attains its final form remains uncertain due to high inter-individual variability and differing assessment methods, which complicates the distinction between physiological development and potential abnormalities. Moreover, commonly used classification terms such as "flat" or "normal" do not adequately reflect the developmental progression and may be misleading in young children. This study aimed to describe the MLA developmental patterns and propose an adjusted classification terminology to improve clinical differentiation between feet undergoing normal developmental changes and cases requiring intervention. Methods: The present study employs both cross-sectional (285 children aged 4.00-8.99 years) and longitudinal (50 children measured annually between ages 4-6) designs. Foot dimensions were assessed using standard anthropometry, and the MLA was assessed via podograms using the Chippaux-Smirak index (CSI). To better reflect the developmental nature of the MLA, the arch was categorized as "formed" and "unformed". Cross-sectional data were analyzed with ANOVA and visualized using LOESS regression, longitudinal data with linear mixed models, and relationships between CSI and foot dimensions with Spearman's correlation. Results: MLA development showed significant changes up to age 6, with the most pronounced changes occurring between ages 4 and 5 and slowing thereafter. Children with an unformed arch at age 4 exhibited a steeper developmental trajectory than those with an already advanced arch form. Correlations between arch shape and foot dimensions were statistically significant but weak. No significant between-sex differences were observed. Conclusions: The timing of the most pronounced phase of medial longitudinal arch (MLA) development varies between individuals and is typically completed by 6 years of age, with no sex-dependent differences. Age 6 therefore represents a practical milestone for reliable clinical assessment, since earlier classifications risk misinterpreting normal developmental variation as pathology.