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Table 1 Study characteristics

From: The typically developing paediatric foot: how flat should it be? A systematic review

Authors Study Type Study aim Population N Participants (Boys:Girls) Age range in years
(mean ± SD)
Foot posture measures
Bertsch et al. [23] Longitudinal Cohort Evaluate plantar pressure data in infants to understand the maturation of the lower extremity and therefore differentiate pathological disorders German infants, new walkers (Data collected longitudinally over 12 months) 42 (20:22) 10–17 months (14.8 ± 1.8) months at first exam Foot shape index % (midfoot width/length)
Bosch et al. [24] Longitudinal Cohort Establish a plantar pressure database of infants for analysis of individual clinical cases German infants, new walkers (Data collected longitudinally over 4 years) 43–90 (NR) NR (15.3 ± 2.3)months at first exam Foot form index % (midfoot width/length)
Chang et al. [36] Cross-sectional To use a 3D scanner to evaluate the arch of pre-school children and describe the flexibility of the arch Taiwanese kindergarten children 44 (24:20) 2–6 (NR) Navicular height computed from ‘Peripher 3D Scanner’
Delgado-Abellán et al. [38] Cross-sectional To analyse age and gender differences in foot morphology in Spanish school aged children Spanish school children 1031 (497:534) 6–12 (NR) Arch height computed from 3D foot digitiser
Didia et al. [27] Cross-sectional To create a data base of foot arch characteristics of a Nigerian population Nigerian school children 990 (458:532) 5–14 (8.6 ± 1.9)a Contact index II
Dowling et al. [62] Cross-sectional To determine whether a pedograph could be used to predict plantar pressures of the feet of primary school children Australian, pre-pubertal children 51 (22:29) NR (8.4 ± 1.0) Clarke’s angle Chippaux-Smirak index
El et al. [45] Cross-sectional To analyse the longitudinal arch morphology and related factors including hypermobility, age, gender and rearfoot alignment in primary school children Turkish primary school children 579 (299:280) 6–12 (9.23 ± 1.66) Rearfoot angle
Staheli arch index
Evans [40] Cross-sectional To investigate the relationship between flat foot posture and body weight and related anthropometric measurements in school aged children Australian, primary school children 140 (68:72) 7–10 (8.71 ± 0.91) FPI-6
Evans and Karimi [42] Cross-sectional Examine the relationship between body mass index and foot posture in children Five data sets including Australian and United Kingdom children 728 (375:353) 3–15 (9.07 ± 2.38) FPI-6
Forriol and Pascual [28] Cross-sectional To investigate the development of the footprint according to age, gender, growth and foot type Spanish children 1676 (663:1013) 3–17 (NR) Clarke’s angle Chippaux-Smirak index
Gijon-Nogueron et al. [43] Cross-sectional To establish normative FPI-6 reference values for children aged 6–11 years Spanish children 1762 (863:899) 6–11 (8.28 ± 1.72) FPI-6
Gill et al. [48] Cross-sectional Examine the relationship between foot arch height and walking characteristics in children and adults American children 254 (121:133)
18 (10:8)
2–17 (9.13 ± 3.26)
4–8 (6.22 ± 1.26)
Chippaux-Smirak index
Keimig index
Gilmour and Burns [29] Cross-sectional Examine the influence of gender, limb preference and body weight in relation to the medial longitudinal arch in children Australian children 272 (128:144) 5.5–10.9 (8.4 ± 1.7) Arch index
Navicular height
Hallemans et al. [46] Cross-sectional To perform a longitudinal study investigating foot function changes within the first 5 months of walking Belgian toddlers 10 (3:7) 10–15 (12.6 ± 1.7) months Foot form index % (width/length)
Hawke et al. [41] Cross-sectional A post hoc analysis to explore the relationships between foot posture, flexibility and body mass in children New Zealander children; 90% Caucasian, 7% Asian, 3% Maori. 30 (10:20) 7–15 (10.7 ± 2.3) FPI-6
Igbigbi and Msamati [32] Cross-sectional To determine the arch index, classify the arch type and report the incidence of pes planus amongst the Malawian population Indigenous Malawian teenagers 305 (139:166) 13–17 (NR) Arch index
Igbigbi et al. [33] Cross-sectional To determine the AI, classify the arch type and report the incidence of pes planus amongst a Kenyan and Tanzanian population Kenyan teenagers
Tanzanian teenagers
314 (174:140)
249 (135:114)
13–17 (NR) Arch index
Jankowicz-Szymanska and Mikolajczyk [49] Longitudinal Cohort To investigate the changes in the height of the medial longitudinal and transverse arches of the foot over a 2-year follow-up Polish kindergarten children 207 (102:105) 3.5–4.49 (NR) at first exam Clarke’s angle
Gamma angle
Mauch et al. [61] Cross-sectional To investigate the shape of children’s feet and assess if a difference exists between the feet of German and Australian children Australian pre and primary school children
German pre and primary school children
86 (34:52)
419 (190:229)
86 (34:52)
419 (190:229)
3–5 (4.3 ± 0.6)
7–12 (9.6 ± 1.4)
3–5 (4.2 ± 0.7)
7–12 (9.6 ± 1.4)
Clarke’s angle
Chippaux-Smirak index
Jankowicz-Szymanska and Mikolajczyk [49] Cross-sectional To assess the somatic features and to determine the correlation between skin fold thickness and MLA height and knee position children Polish primary school children 90 (45:45) 7 (NR) Clarke’s angle
Morita et al. [63]   To investigate muscle strength and arch height and explore the relationships between these measures and lower limb physical performance Japanese primary school children 301 (146:155) Third grade n = 158
(8.6 ± 0.5)
Fifth grade
N = 143
(10.6 ± 0.5)
Foot arch height (FAH) – height of navicular tuberosity to ground
Foot arch index – (FAH/foot length × 100)
Morrison et al. [37] Cross-sectional To evaluate the impact of excessive body mass on the anthropometric structure of the prepubescent foot Scottish primary school children 200 (90:110) 9–12
(10.4 ± 0.9) ♂
(10.1 ± 0.8) ♀
Navicular height
Muller et al. [4] Cross-sectional To measure the static and dynamic foot characteristics in infants and children to establish foot structure and function in different age groups German children 7788 (3738:4050) 1–13 (7.2 ± 2.9) Arch index
Nikolaidou and Boudolos [44] Cross-sectional To establish a footprint-based classification technique for the rational classification of foot types in young schoolchildren Greek school children 132 (67:65) NR (10.4 ± 0.9) Arch index
Martirosov’s K index
Chippaux-Smirak index
Clarke’s angle
Pfeiffer et al. [3] Cross-sectional To establish the prevalence of flat foot in a population of 3–6 year olds, evaluating cofactors including age, gender and weight Austrian children 835 (424:411) 3–6 (4.4 ± 0.9) Rearfoot angle
Pinto et al. [47] Cross-sectional To evaluate whether a footprint taken during the Jack test could be quantified in children 2–5 years Brazilian children 60 (35:25) 2–5 (3.4 ± NR) Volpon footprint
Valenti footprint
Redmond et al. [39] Cross-sectional To establish normative FPI reference values for use in research and clinical decision making 3 accumulated data sets; data sets inclusive of 4, 5 and 9
Ethnicity un-known
397 3–17 (8.5 ± NR) FPI-6
Sacco et al. [25] Longitudinal Cohort To compare the anthropometric characteristics of children’s feet from 3–10 years between German and Brazilian populations
(Data reordered longitudinally for 9 years)
German children
Brazilian children
51–94 (NR)
391 (183:208)
3–10 (NR)
3–10 (NR)
Chippaux-Smirak index
Staheli arch index
Sadeghi-Demneh et al. [35] Cross-sectional Determine the prevalence of flatfoot among elementary and secondary school children. Evaluating also age, gender, joint laxity and obesity Iranian children 667 (340:327) 7–14 (10.6 ± 2.3) Arch index
Rearfoot angle
Arch angle
Tong and Kong [30] Longitudinal cohort To examine the medial longitudinal arch of children during development and explore the relationship between different footwear use Singaporean children 111 (52:59) (6.9 ± 0.3) Arch index
Sobel et al. [34] Cross-sectional Determine the rearfoot angle in children in different age groups African American children 150 (52:98) 6–12 (10.79 ± 2.75) Rearfoot angle
Tudor et al. [64] Cross-sectional To determine if there is an association between the severity of foot flatness and motor skills necessary for sport performance Croatian children 218 (106:112) 11–15 (13.07 ± 1.24) Arch index
Unger and Rosenbaum [26] Cross-sectional To evaluate the foot shape statically and dynamically during walking German Infant new walkers 42 (20:22) NR Arch index
Foot shape index % (width/length)
Waseda et al. [22] Cross-sectional To establish standardised values of foot length and arch height in children and adolescents Japanese school children 10,155 (5311:4844) 6–18 (NR) Navicular height
Arch height ratio