Barefoot influence on arch height

Barefoot influence on arch height

 

“Our aims were to establish the prevalence of flat foot in a population of schoolchildren in rural India and to determine whether this prevalence varied between shod and unshod children”

 

First, it is hard to translate this research over to an American population. Just because it is the prevalence in India, doesn’t mean that it will be the prevalence in other countries. Until I have other research though…this is all I have to work with.

 

Unshod means not wearing shoes. Therefore, shod means wearing shoes.

 

“…2300 children between the ages of four and 13…static footprints of both feet were obtained from all 2300 children”

 

This encompasses a large age span from the time prior to arch formation to post arch formation. I remember learning in school that the arch starts to take shape around the age of 8, but this may just be a tradition that has carried through the ages of PT students. Anyway, this is a large sample size to look at.

 

“The footprints were classified as normal, high-arched or flat. Some form of footwear was worn by 1555 children and 745 never used shoes.”

 

It’s still hard to believe that there were this many children that hadn’t used shoes. The children in the study were between the ages of 4 and 13. We sometimes take for granted all of the “needs” that we have here in the states. Anyway, here is a link to give an idea of what the arches would look like on a static footprint. One way to think of it is to get your foot wet and go walk on a wood floor or deck. You would have an imprint of your foot as follows: picture of arch height.

 

“…1551 were considered to have normal arches in both feet, 595 had a high arch in one or both feet and 154 had unilateral or bilateral flat foot. The prevalence of flat foot progressively decreased with increasing age.”

 

This last statement is what is taught in PT school. There are so many facts that are taught in PT school, but we don’t learn the research behind the facts. A majority of children go on to develop normal arch height. There needs to be a further breakdown of the children that go on to develop an “abnormal arch height”.

 

“There was a significantly higher prevalence in children who wore shoes (8.6%) than among the unshod (2.8%)”

 

There is a large difference between the two populations of children, but we also have to consider the small sample size of 154 children. I would love to see this study take it one step further and search for all children in a larger radius with flat feet and see if the same types of prevalence rates are present. If this is the case, then we can start to make some assumptions regarding footwear affecting arch height. There are so many other variables that are not accounted for that could also play a role in arch formation, so this study has to be taken with a grain of salt. It does though make a statement that kids wearing shoes may not develop a normal arch compared to those not wearing shoes. It literally states: “…shoe-wearing predisposes to flat foot”.

 

“It seems that closed-toe shoes inhibit the development of the arch of the foot more than do slippers or sandals. This may because intrinsic muscle activity is necessary to keep slippers from falling off.”

 

This is a good theory, but would have to be proven. As a PT, we tend to recommend against sandal or flip flops because of the same reason: we have to work differently to keep the shoes from falling off. There is something called the windlass mechanism that can be altered when wearing shoes that can easily fall off. Again, more research is needed in order to figure out which party is right.

 

Excerpts taken from:

 

Rao UD, Joseph B. The Influence of Footwear On the Prevalence Of Flat Foot. J Bone Joint Surg [Br]. 1992;74-B:525-527.

 

Link to article

 

 

 

 

Author: Dr. Vince Gutierrez, PT, cert. MDT

After having dedicated 8 years to growing my knowledge regarding the profession of physical therapy, it seems only fitting that I join the social media world in order to spread a little of the knowledge that I have gained over the years. This by no means is meant to act in place of a one-one medical consultation, but only to supplement your baseline knowledge in which to choose a practitioner for your problem. Having completed a Master of Physical Therapy degree, the MDT (Mechanical Diagnosis and Therapy) certification and currently finishing a post-graduate doctorate degree, I have spent the previous 12 years in some sort of post-baccalalaureate study. Hopefully the reader finds the information insightful and uses the information in order to make more informed healthcare decisions. MISSION STATEMENT: My personal mission statement is as follows: As a professional, I will provide a thorough assessment of your clinical presentation and symptoms in order to determine both the provocative and relieving positions and movements. The assessment process and ensuing treatment will be based on current and relevant evidence. Furthermore, I will educate the patients regarding their symptoms and their likelihood of improving with either skilled therapy, an independent exercise program, spontaneous recovery or if the patient should be referred to a separate specialist to possibly provide a more rapid resolution of symptoms. Respecting the patient’s limited resources is important and I will provide an accurate overview of the prognosis within 7 visits, again based on current research. My goal is to empower the patient in order to take charge of both the symptomatic resolution and return to full function with as little dependence on the therapist as possible. Personally, I strive to be an example for family and friends. My goal is to demonstrate that success is not a byproduct of situations, but a series of choices and actions. I will mentor those, in any way possible, that are having difficulty with the choices and actions for success. I will continue to honor my family’s “blue-collar” roots by working to excel at my chosen career and life situations. I choose to be a leader of example, and not words, all the while reducing negativity in my life. I began working towards the professional aspect of the mission statement while still in physical therapy school. By choosing an internship that emphasized patient care and empowering the patient, instead of the internship that was either closest to home or where I knew that I would have the easiest road to graduation, I took the first step towards learning how to utilize the evidence to teach patients how to reduce their symptoms. I continued this process by completing Mechanical Diagnosis and Therapy courses A-D and passing the credentialing exam. I will continue to pursue my clinical education through CEU’s on MDT and my goal is to obtain the status of Diplomat of MDT. Returning back to school for the t-DPT was a major decision for me, as resources (i.e. time and money) are limited. My choice was between saving money for the Dip MDT course (about 15,000 dollars) and continuing on with the Fellowship of American Academy of Orthopedic Manual Physical Therapists (FAAOMPT) (about 5,000 dollars), as these courses are paired through the MDT curriculum or returning to school to work towards a Doctorate of Physical Therapy degree. I initially planned on saving for the Dip MDT and FAAOMPT, but life changes forced me to re-evaluate my situation. The decision then changed to return for the tDPT, as my employer paid for a portion of the DPT program. My goal for applying to and finishing the Dip MDT and FAAOMPT is 10 years. This is how long I anticipate that it will take to finish paying student loans and save for both programs, based on the current rate of payment. I don’t know if I will ever accomplish what I set forth in the mission statement, but I do know that it will be a forever struggle to maintain this standard that I set for myself.

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