The influence of gender and body mass index on the FPI-6 evaluated foot posture of 10- to 14-year-old school children in São Paulo, Brazil: a cross-sectional study

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Abstract

Background

Adolescence is marked by changes to the body, including the feet. The Foot Posture Index (FPI-6) stands out from other foot type classification methods as valid, reliable, and multidimensional. However, the current literature differs according to age group, with little consolidation of normative data in school children, largely due to the influence of such factors as sex, age and body mass index (BMI). Thus, this study assesses foot posture in adolescents according to age, sex and BMI.

Methods

The study evaluated 1.394 adolescents from Amparo and Pedreira regions in São Paulo, Brazil. Subjects were positioned barefoot on a wooden base and each foot was assessed by FPI-6 criteria. Each criterion was scored on a scale of −2 to +2, negative for supinated and positive for pronated posture. Initially the data were assessed for normality using the Shapiro-Wilk test and descriptive statistics were calculated. To investigate and compare the scores of FPI-6 with regards to age and body mass index, analysis of variance (ANOVA) was used, followed by post hoc Tukey. To compare the FPI-6 with regard to gender, an independent student t test was used. All data were analyzed using SPSS version 21.0 and the 5% significance level.

Results

Boys had higher scores than girls ( p = 0.037) for the right foot, and the group with normal BMI values scored higher than the obese group ( p = 0.001). For the left foot, 11- and 13-year-olds differed ( p = 0.024) with respect to age in general. The overweight and obese group scored lower than the normal BMI group ( p = 0.039; p = 0.001, respectively).

Conclusions

Overall, the feet in this study were classified as normal, with a tendency to pronation, particularly in boys. There were differences between the 11 and 13 year groups and, with regard to BMI, there were higher scores for the group with normal BMI. Therefore, a higher BMI in adolescence is not indicative of a pronated foot type.

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Most cited references 33

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Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index.

Anthony C. Redmond, Jack Crosbie, Robert Ouvrier (2006)

The limitations of clinical methods for appraising foot posture are well documented. A new measure, the Foot Posture Index is proposed, and its development and validation described. A four-phase development process was used: (i) to derive a series of candidate measures, (ii) to define an appropriate scoring system, (iii) to evaluate the validity of components and modify the instrument as appropriate, and (iv) to investigate the predictive validity of the finalised instrument relative to static and dynamic kinematic models. Methods included initial concurrent validation using Rose's Valgus Index, determination of inter-item reliability, factor analysis, and benchmarking against three dimensional kinematic models derived from electromagnetic motion tracking of the lower limb. Thirty-six candidate components were reduced to six in the final instrument. The draft version of the instrument predicted 59% of the variance in concurrent Valgus Index scores and demonstrated good inter item reliability (Cronbach's alpha = 0.83). The relevant variables from the motion tracking lower limb model predicted 58-80% of the variance in the six components retained in the final instrument. The finalised instrument predicted 64% of the variance in static standing posture, and 41% of the variance in midstance posture during normal walking. The Foot Posture Index has been subjected to thorough evaluation in the course of its development and a final version is proposed comprising six component measures that performed satisfactorily during the validation process. The Foot Posture Index assessment is quick and simple to perform and allows a multiple segment, multiple plane evaluation that offers some advantages over existing clinical measures of foot posture.

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Normative values for the Foot Posture Index

Anthony C. Redmond, Yvonne Z Crane, Hylton B. Menz (2008)

Background The Foot Posture Index (FPI) is a validated method for quantifying standing foot posture, and is being used in a variety of clinical settings. There have however, been no normative data available to date for comparison and reference. This study aimed to establish normative FPI reference values. Methods Studies reporting FPI data were identified by searching online databases. Nine authors contributed anonymised versions of their original datasets comprising 1648 individual observations. The datasets included information relating to centre, age, gender, pathology (if relevant), FPI scores and body mass index (BMI) where available. FPI total scores were transformed to interval logit scores as per the Rasch model and normal ranges were defined. Comparisons between groups employed t-tests or ANOVA models as appropriate and data were explored descriptively and graphically. Results The main analysis based on a normal healthy population (n = 619) confirmed that a slightly pronated foot posture is the normal position at rest (mean back transformed FPI raw score = +4). A 'U' shaped relationship existed for age, with minors and older adults exhibiting significantly higher FPI scores than the general adult population (F = 51.07, p < 0.001). There was no difference between the FPI scores of males and females (2.3 versus 2.5; t = -1.44, p = 0.149). No relationship was found between the FPI and BMI. Systematic differences from the adult normals were confirmed in patients with neurogenic and idiopathic cavus (F = 216.981, p < 0.001), indicating some sensitivity of the instrument to detect a posturally pathological population. Conclusion A set of population norms for children, adults and older people have been derived from a large sample. Foot posture is related to age and the presence of pathology, but not influenced by gender or BMI. The normative values identified may assist in classifying foot type for the purpose of research and clinical decision making.

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Increased risk for falling associated with obesity: mathematical modeling of postural control.

P Corbeil, M. Simoneau, D. Rancourt … (2001)

Recent epidemiological studies report that obesity is positively related to fracture incidence. In the present experiment, a model of postural control was used to examine the impact of an abnormal distribution of body fat in the abdominal area upon postural stability. Obese and lightweight humanoids were destabilized by imposing a small initial angular speed from a neutral standing position. To avoid a loss of stability yielding a stepping reaction or a fall, an ankle torque is necessary to counteract the perturbation. Three torque parameters--ankle torque onset, time to peak torque, and muscular ankle torque--were entered in a program to simulate the intrinsic variability of the human postural control system. A loss of stability was detected when the center of pressure exceeded stability margins. The most striking observation is the nonlinear increase of torque needed to stabilize the humanoid when the motor response was characterized by delayed temporal parameters. The effect was more pronounced when an anterior position of the center of mass was included in the simulations. This suggests that, when submitted to daily postural stresses and perturbations, obese persons (particularly those with an abnormal distribution of body fat in the abdominal area) may be at higher risk of falling than lightweight individuals.

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Author and article information

Contributors

Barbarah Kelly Gonçalves de Carvalho: bkgcarvalho@usp.br

Patrícia Jundi Penha: ft.patriciapenha@gmail.com

Nárima Lívia Jundi Penha: narimapenha@hotmail.com

Rodrigo Mantelatto Andrade: rodrigomantelatt@hotmail.com

Ana Paula Ribeiro: apribeiro@usp.br

Sílvia Maria Amado João: smaj@usp.br

Journal

Journal ID (nlm-ta): J Foot Ankle Res

Journal ID (iso-abbrev): J Foot Ankle Res

Title: Journal of Foot and Ankle Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1757-1146

Publication date (Electronic): 27 June 2017

Publication date PMC-release: 27 June 2017

Publication date Collection: 2017

Volume: 10

Electronic Location Identifier: 1

Affiliations

[1 ]ISNI 0000 0004 1937 0722, GRID grid.11899.38, Faculty of Medicine, University of São Paulo, Department of Physical Therapy, Speech and Occupational Therapy, Musculoskeletal Evaluation Laboratory, , University of São Paulo, ; Rua Cipotânea, 51, Cidade Universitária, CEP: 05360-160 São Paulo, SP Brazil

[2 ]ISNI 0000 0001 2149 6891, GRID grid.412529.9, Department of Physical Therapy, Faculty of Human Sciences and Health, , Pontifícia Universidade Católica de São Paulo, ; São Paulo, Brazil

[3 ]ISNI 0000 0004 1937 0722, GRID grid.11899.38, Investigator in the Musculoskeletal Evaluation Laboratory, Department of Physical Therapy, Speech and Occupational Therapy, , University of São Paulo, ; São Paulo, Brazil

[4 ]ISNI 0000 0001 0106 6835, GRID grid.412283.e, Department of Physical Therapy, Faculty of Medicine, , University of Santo Amaro, ; São Paulo, Brazil

Article

Publisher ID: 183

DOI: 10.1186/s13047-016-0183-0

PMC ID: 5488407

PubMed ID: 28670344

SO-VID: a96e2372-797d-4eac-b295-f6d999c84a51

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 27 July 2016

Date accepted : 6 December 2016

Funding

Funded by: Fapesp

Award ID: 2013/25774-9

Funded by: CAPES

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: posture,evaluation,feet,adolescent

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: posture, evaluation, feet, adolescent

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The influence of gender and body mass index on the FPI-6 evaluated foot posture of 10- to 14-year-old school children in São Paulo, Brazil: a cross-sectional study

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Abstract

Background

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Orthopedics

Most cited references 33

Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index.

Normative values for the Foot Posture Index

Increased risk for falling associated with obesity: mathematical modeling of postural control.

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Cited by 8

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