Abstract
BackgroundResearch is needed to determine the prevalence and variables associated with the diagnosis of flatfoot, and to evaluate the validity of three footprint analysis methods for diagnosing flatfoot, using clinical diagnosis as a benchmark.MethodsWe conducted a cross-sectional study of a population-based random sample ≥40 years old (n = 1002) in A Coruña, Spain. Anthropometric variables, Charlson’s comorbidity score, and podiatric examination (including measurement of Clarke’s angle, the Chippaux-Smirak index, and the Staheli index) were used for comparison with a clinical diagnosis method using a podoscope. Multivariate regression was performed. Informed patient consent and ethical review approval were obtained.ResultsPrevalence of flatfoot in the left and right footprint, measured using the podoscope, was 19.0% and 18.9%, respectively. Variables independently associated with flatfoot diagnosis were age (OR 1.07), female gender (OR 3.55) and BMI (OR 1.39). The area under the receiver operating characteristic curve (AUC) showed that Clarke’s angle is highly accurate in predicting flatfoot (AUC 0.94), followed by the Chippaux-Smirak (AUC 0.83) and Staheli (AUC 0.80) indices. Sensitivity values were 89.8% for Clarke’s angle, 94.2% for the Chippaux-Smirak index, and 81.8% for the Staheli index, with respective positive likelihood ratios or 9.7, 2.1, and 2.0.ConclusionsAge, gender, and BMI were associated with a flatfoot diagnosis. The indices studied are suitable for diagnosing flatfoot in adults, especially Clarke’s angle, which is highly accurate for flatfoot diagnosis in this population.
Highlights
Flatfoot is a complex foot deformity that is commonly seen in clinical practice
The aim of the present study was to determine the prevalence and variables associated with the clinical diagnosis of flatfoot and to evaluate the diagnostic accuracy of these indices (Clarke’s angle, Chippaux-Smirak index, and the Staheli index) for diagnosing flatfoot in a clinical setting, using the clinical diagnosis with a podoscope as a gold standard, in a random sample of patients aged 40 and older
The prevalence of flatfoot in the left footprint using the podoscope was 19.0%, and that in the right foot was 18.9%, with prevalence in both feet increasing with age
Summary
Flatfoot is a complex foot deformity that is commonly seen in clinical practice. The flatfoot deformity is characterized by a combination of a collapse of the medial longitudinal arch, foot abduction at the talonavicular joint, and hindfoot valgus (subtalar joint eversion).[1,2]. Research is needed to determine the prevalence and variables associated with the diagnosis of flatfoot, and to evaluate the validity of three footprint analysis methods for diagnosing flatfoot, using clinical diagnosis as a benchmark. Anthropometric variables, Charlson’s comorbidity score, and podiatric examination (including measurement of Clarke’s angle, the Chippaux-Smirak index, and the Staheli index) were used for comparison with a clinical diagnosis method using a podoscope. Variables independently associated with flatfoot diagnosis were age (OR 1.07), female gender (OR 3.55) and BMI (OR 1.39). The area under the receiver operating characteristic curve (AUC) showed that Clarke’s angle is highly accurate in predicting flatfoot (AUC 0.94), followed by the Chippaux-Smirak (AUC 0.83) and Staheli (AUC 0.80) indices. The indices studied are suitable for diagnosing flatfoot in adults, especially Clarke’s angle, which is highly accurate for flatfoot diagnosis in this population
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