Flatfoot and associated factors among Ethiopian school children aged 11 to 15 years: A school-based study

BACKGROUND: The Foot health of a child plays a pivotal role in their participation in play, locomotive activities, healthy lifestyle, somatic development, and weight management. The burden of flatfoot among children in Ethiopia is not known. The objective of this study was to analyze the structure of the medial foot arch using Staheli plantar arch index and investigate its associated factors among larger sample school children, aged 11–15 years in Ethiopia. METHODS: A school-based cross-sectional study was conducted among children aged 11–15 years from eleven randomly selected primary schools. The sample size was determined proportionally across school strength and governmental and private schools to ensure variety within the sample. Data collection consisted of physical measurements, footprint-based measures whilst full weight-bearing, and a structured questionnaire on foot pain, footwear type, and physical activity. Data were analyzed descriptively and through uni- and multivariate logistic regression model. RESULTS: A total of 823 children participated. The overall prevalence of flatfoot was 17.6% with a significant difference between age, gender, type of school, BMI, and type of footwear. Being younger (OR 3.3, 95% CI 1.6–6.7), male (OR 1.6, 95% CI 1.0–2.4), experiencing foot pain (OR 1.9, 95% CI 1.0–3.5), wearing closed shoe (OR 4.4, 95% CI 1.6–11.9), overweight (OR 3.8, 95% CI 1.2–8.7), obese (OR 4.2, 95% CI 2.5–10.9), and low level of physical activity (OR 2.1, 95% CI 1.0–4.6) were significantly associated with flatfoot. Children who were overweight, obese, and also experiencing foot pain have a 2.8 (95% CI 1.62–5.94) and 4.1 (95% CI 2.85–8.31) times greater chance of having flatfoot respectively. The prevalence of flatfoot among 560 normal weight children was 17.5%. CONCLUSIONS: The findings of this study demonstrated that the overall prevalence and the prevalence of flatfoot among normal-weight children are almost the same. There is a definite need to develop a screening algorithm for diagnosis and treatment indication for this children's lower extremity disorder.