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Review
. 2022 Jul 6;19(14):8247.
doi: 10.3390/ijerph19148247.

Risk Factors of Flatfoot in Children: A Systematic Review and Meta-Analysis

Liya Xu  1 , Hongyi Gu  1 , Yimin Zhang  2 , Tingting Sun  2 , Jingjing Yu  2
Affiliations
Review

Risk Factors of Flatfoot in Children: A Systematic Review and Meta-Analysis

Liya Xu et al. Int J Environ Res Public Health. .

Abstract

Background: This study aimed to explore the risk factors for flatfoot in children and adolescents to provide a reference basis for studying foot growth and development in children and adolescents. Methods: We examined the cross-sectional research literature regarding flatfoot in children and adolescents published in the past 20 years, from 2001 to 2021, in four electronic databases: PubMed, Web of Science, EBSCO, and Cochrane Library. Two researchers independently searched the literature according to the inclusion and exclusion criteria and evaluated the literature quality of the selected research; from this, a total of 20 articles were included in our review. After the relevant data were extracted, the data were reviewed using Manager 5.4 software (The Cochrane Collaboration, Copenhagen, Denmark), and the detection rate and risk factors for flatfoot in children were analyzed. Results: In total, 3602 children with flatfoot from 15 studies were included in the analysis. The meta-analysis results showed that being male (OR = 1.33, 95% CI: 1.09, 1.62, p = 0.005), being aged <9 years (age <6, OR = 3.11, 95% CI: 2.47, 3.90, p < 0.001; age 6−9 years, OR = 0.54, 95% CI: 0.41, 0.70, p < 0.001), joint relaxation (OR = 4.82, 95% CI: 1.19, 19.41, p = 0.03), wearing sports shoes (OR = 2.97, 95% CI: 1.46, 6.03, p = 0.003), being a child living in an urban environment (OR = 2.10, 95% CI: 1.66, 2.64, p < 0.001) and doing less exercise (OR = 0.25, 95% CI: 0.08, 0.80, p = 0.02) were risk factors for the detection of flatfoot. Conclusion: In summary, the detection rate of flatfoot in children in the past 20 years was found to be 25% through a meta-analysis. Among the children included, boys were more prone to flatfoot than girls, and the proportion of flatfoot decreased with age.

Keywords: children; flatfoot; meta-analysis; risk factors.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
The forest plot of age <6 years for flatfoot in children [8,12,14,17].
Figure 3
Figure 3
The forest plot of age 6–9 years for flatfoot in children [7,11,13,17].
Figure 4
Figure 4
The forest plot of sex for flatfoot in children [7,8,9,11,13,14,16,18,19,20].
Figure 5
Figure 5
The forest plot of joint relaxation for flatfoot in children [7,14].
Figure 6
Figure 6
The forest plot of shoe shape for flatfoot in children [11,20].
Figure 7
Figure 7
The forest plot of the region for flatfoot in children [11,17].
Figure 8
Figure 8
The forest plot of exercise time for flatfoot in children [9,16,20].
Figure 9
Figure 9
The forest plot of age 9–12 years for flatfoot in children [7,11,17,20].
Figure 10
Figure 10
The forest plot of BMI for flatfoot in children [8,9,13,14,17,20].
Figure 11
Figure 11
The funnel plot of publication bias for age <6 years for flatfoot in children.
Figure 12
Figure 12
The funnel plot of publication bias for age 6–9 years for flatfoot in children.
Figure 13
Figure 13
The funnel plot of publication bias for the region for flatfoot in children.
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Grants and funding

This study was funded by the China National key R & D plan (2020YFC2006701) of the Ministry of Science and Technology.

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