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Background <p>Flexible flatfoot is a prevalent musculoskeletal condition in pediatric populations, often regarded as a benign and self-limiting developmental variation. However, persistent cases may contribute to discomfort, functional limitations, and reduced physical activity levels. Despite its frequency, few studies have comprehensively evaluated its functional impact using standardized clinical and functional assessment tools in school-aged children.</p> Objectives <p>This study aimed to (1) determine the prevalence of flexible flatfoot among children aged 6–12 years using standardized clinical criteria and the Foot Posture Index-6 (FPI-6); and (2) evaluate its functional implications by analyzing associations with pain intensity, physical activity levels, and body mass index (BMI).</p> Methods <p>A cross-sectional clinical study was conducted among 326 school-aged children. Flexible flatfoot was diagnosed based on clinical examination and an FPI-6 score &gt; + 6. Pain was measured using the Visual Analogue Scale (VAS), physical activity using the Physical Activity Questionnaire for Children (PAQ-C), and BMI using standard anthropometric techniques.</p> Results <p>Flexible flatfoot was identified in 98 children (30.06%; 95% CI: 25.08–35.04), with a predominance of bilateral cases and higher prevalence among males. Affected children showed significantly higher VAS pain scores (4.12 ± 1.03 vs. 2.91 ± 0.89; <i>p</i> &lt; 0.001), lower PAQ-C physical activity scores (2.53 ± 0.54 vs. 3.05 ± 0.61; <i>p</i> &lt; 0.001), and elevated FPI-6 and BMI values compared to their non-flatfooted peers. Multiple regression analyses identified FPI-6 scores and BMI as independent predictors of both pain and reduced physical activity, accounting for 31% and 26% of the variance, respectively.</p> Conclusion <p>Flexible flatfoot in school-aged children is significantly associated with increased pain perception, decreased physical activity, and elevated BMI. These findings underscore the importance of early detection and functional assessment, particularly in children with modifiable risk factors such as obesity and sedentary behavior, to support timely and targeted musculoskeletal interventions.</p>

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Prevalence and functional impact of flexible flatfoot in school-aged children: a cross-sectional clinical and postural assessment

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月21日

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  • Saleh M. Kardm,
  • Ziad Ahmed Alanazi,
  • Tariq Abdullah S. Aldugman,
  • Ravi Shankar Reddy,
  • Ajay Prashad Gautam

摘要

Background

Flexible flatfoot is a prevalent musculoskeletal condition in pediatric populations, often regarded as a benign and self-limiting developmental variation. However, persistent cases may contribute to discomfort, functional limitations, and reduced physical activity levels. Despite its frequency, few studies have comprehensively evaluated its functional impact using standardized clinical and functional assessment tools in school-aged children.

Objectives

This study aimed to (1) determine the prevalence of flexible flatfoot among children aged 6–12 years using standardized clinical criteria and the Foot Posture Index-6 (FPI-6); and (2) evaluate its functional implications by analyzing associations with pain intensity, physical activity levels, and body mass index (BMI).

Methods

A cross-sectional clinical study was conducted among 326 school-aged children. Flexible flatfoot was diagnosed based on clinical examination and an FPI-6 score > + 6. Pain was measured using the Visual Analogue Scale (VAS), physical activity using the Physical Activity Questionnaire for Children (PAQ-C), and BMI using standard anthropometric techniques.

Results

Flexible flatfoot was identified in 98 children (30.06%; 95% CI: 25.08–35.04), with a predominance of bilateral cases and higher prevalence among males. Affected children showed significantly higher VAS pain scores (4.12 ± 1.03 vs. 2.91 ± 0.89; p < 0.001), lower PAQ-C physical activity scores (2.53 ± 0.54 vs. 3.05 ± 0.61; p < 0.001), and elevated FPI-6 and BMI values compared to their non-flatfooted peers. Multiple regression analyses identified FPI-6 scores and BMI as independent predictors of both pain and reduced physical activity, accounting for 31% and 26% of the variance, respectively.

Conclusion

Flexible flatfoot in school-aged children is significantly associated with increased pain perception, decreased physical activity, and elevated BMI. These findings underscore the importance of early detection and functional assessment, particularly in children with modifiable risk factors such as obesity and sedentary behavior, to support timely and targeted musculoskeletal interventions.