Article

The role of flexible flat feet (FF) in the development of musculoskeletal
symptoms at joints proximal to the ankle is unclear.
We undertook an
observational study to investigate the relationship between foot posture and the
proximal joints in children. It was hypothesised that reduced arch height would
be associated with proximal joint symptoms and altered gait kinematics and
kinetics particularly in the transverse plane at the hip and knee. Ninety-five
children between the ages of 8-15 were recruited into this ethically approved
study. Foot posture was classified using the arch height index (AHI). The
frequency of knee and hip/back pain was documented, and each child underwent
three dimensional gait analysis. Reduced arch height was associated with
increased odds of knee symptoms (p<0.01) and hip/back symptoms (p=0.01). A flat
foot posture was also significantly associated with a reduction in the second
peak of the vertical ground reaction force (p=0.03), which concomitantly affected
late stance hip and knee moments. A reduced AHI was also associated with
increased pelvic retraction and increased knee valgus in midstance. No kinematic
and kinetic parameter associated with a flat foot posture related to increased
proximal joint symptoms in the FF group. Children with a flatter foot posture are
more likely to have pain or discomfort at the knee, hip and back; however, the
mechanisms by which this occurs remain unclear.
Treating FF without explicit
understanding of how it relates to symptoms is difficult, and further work in
this area is required.
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