Assessment Of Plantar Arch Index And Prevalence Of Flat Feet Among Residents In Ovia Northeast L.G.A, Edo State.

Anatomy Project and Seminar Material

Assessment Of Plantar Arch Index And Prevalence Of Flat Feet Among Residents In Ovia Northeast L.G.A, Edo State.


Abstract


The aim of this study was to assess the plantar arch index among residents in ovia northeast L.G.A and to determine the prevalence of pes planus. A total of 380 subjects comprising of 194 males and 186 females aged 16-35 years were used for the study. The dynamic footprints of the subjects were obtained using endorsing ink and plain duplicating paper. The plantar arch index was determined as the ratio of the mid arch width to the mid heel width from the foot prints. Descriptive statistics for each variable included mean and standard deviation(SD). Mean 2SD was regarded as normal but greater than that that was considered as pes planus. After results were analyzed, a total of 60 males and 53 females had pes planus. The overall prevalence of pes planus was 29.72% with a prevalence of 15.78% among males and 13.94% among females. Bilateral pes planuswas commoner among males 4(1.05%) than females 2(0.52%). The results showed that the prevalence of pes planus was higher(P<0.05) among males than females in our study. 0(0%)cases of Pes Cavus was reported in this research,74(19.47%) males were normal, they didn’t have Pes planus or Pes Cavus, 100(26.317%) were normal, they didn’t have Pes planus or Pes Cavus.


Table of Content


  • Title Page
  • Dedication
  • Acknowledgment
  • Certification
  • Abstract
  • Table of Content
  • List of Tables
  • List of Abbreviations

Chapter One

1.0 Introduction

  • 1.1 Background to the Study
  • 1.2 Statement of Problem
  • 1.3 Aims and Objectives of the Study
  • 1.4 Significance of the Study
  • 1.5 Research Question
  • 1.6 Scope of the Study
  • 1.7 Limitation
  • 1.8 Operational Definition of Terms

Chapter Two

2.0 Literature Review

  • 2.1 Introduction
  • 2.2 Anatomy of the Foot
  • 2.3 the General Osteology and Foot Shape
  • 2.4 Arches of the Foot
  • 2.5 Pes Cavus
  • 2.6 Epidemiology of Plantar Arch Index and Prevalence of Flat Feet

Chapter Three

3.0 Methodology

  • 3.1 Introduction
  • 3.2 Study Setting
  • 3.3 Study Population
  • 3.4 Sample Size Determination
  • 3.5 Sampling Techniques
  • 3.6 Instruments of Data Collection
  • 3.7 Method of Data Collection
  • 3.8 Method of Data Analysis
  • 3.9 Inclusion and Exclusion Criteria

Chapter Four

4.0 Results

  • 4.1 Demographic Characteristics of Participants

Chapter Five

5.0 Discussion, Conclusion, Recommendation

  • 5.1 Discussion
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • Appendices

List of Abbreviations


  • A: width of the central region of the foot
  • B: width of the heel region
  • BILAT: bilateral
  • H: height
  • MLA: medial longitudinal arch
  • MTP: metatarsophalangeal
  • PAI and PI: plantar arch index
  • SD: standard deviation
  • UNILAT: unilateral
  • WT: weight

Chapter One


1.0 Introducton

1.1 Background of the Study

There is a functional relationship that exists between the structure of the arch of the foot and the biomechanics of the lower limb. The arch of the foot provides an elastic, springy connection between the forefoot and hindfoot. This relationship ensures that most of the forces incurred during weight bearing can be dissipated before reaching the long bones of the leg and thigh.

The arch of the foot demonstrates two extremes of anatomical structural position—the high arch characterizes of the pes cavus and the flat arch the pes planus. Although three distinct arches function to support the foot, the medial longitudinal arch (MLA) has been found to be the arch of clinical significance in both these disorders. Problems and mal-alignments originating specifically with the MLA ultimately affect the functioning of the muscles and joints of the ankle, knee, hip, and low back, all of which depend on the base of support provided by the MLA.

The prevalence of pes planus declines with age, being higher in children with ligament laxity and early shoe wearing which impairs longitudinal arch development (Hernandez et al., 2007). The lower limb, and particularly the foot, is amongst the most distinctive characteristics of human anatomy (Hernandez et al., 2007). Footprint of hominoids already demonstrated the existence of plantar arch 3.7 million years ago (Hernandez et al., 2007). The orthopaedic examination served to recognize disorders that are known to change feet consistency. The identification of congenital problems, particularly involving the feet; postural abnormalities of the spine, pelvis, hips.

Knees Achilles Tendon shortening, and restraint to subtalar joint movements are essential for ruling out the possibility of secondary pes planus. (Hernandez et al., 2007). The medial longitudinal arch of the foot is of great importance because it helps protect the foot from injuries (Xiong et al., 2010). An important highly variable structure characteristics of the human foot is its medial and longitudinal arch, which provides necessary shock absorption for the foot during activities. Traditionally, feet are classified as being high, normal or low arched. A high arched foot is supposed to be at increased risk of injuries to the bony structures on the lateral aspect of the foot(oversupinated), where as a low arched foot can be at greater risk for soft tissue damage on the medial part of the foot(over pronated) (Xiong et al., 2010).


1.2 Statement of Problem

Having lived in Ovia North East L.G.A. the researcher have observed some unhealthy attitudes and suffering of indigenes of the community; such as having pins, nails or bottle fragments stuck in their foot which leads to infection in the blood. While others carry open injuries in the aches of their foot, exposing the injuries to dirt, infections and causing social embarrassment to the patient or guardian.

The foot should be covered and well protected, because it reduces it’s chances of being prone to injuries and infections.

Hence, the researcher wants to determine the different types of foot arches, age variance of people and also to learn the prevention of the problems associated with the arches of the foot.


1.3 Objective of the Study

  1. To find out what people know about the arches of the foot.
  2. To determine the prevalence of pes planus among residents in Ovia North East.
  3. To determine the prevalence of pes cavus among residents in Ovia North East.
  4. To know the lower limb disorders that affect pes planus.

1.4 Significance of the Study

This research work if communicated and published will help

  1. Parents, guardians and teachers learn more about the arches of the foot and enforce it among their children.
  2. It will serve as bases for further learning and research.
  3. Minimize the incidence of foot injuries due to utilization of appropriate techniques on the preventive measures of the foot.

This study for the very first time will report plantar arch index and prevalence of pes planus among residents in Ovia North East L.G.A, Okada.

The zeal behind this work was to thoroughly investigate plantar arch index among residents in Ovia North East L.G.A. physical therapists need to understand the applied anatomy of the arch of the foot as it relates to the disorders of the lower limb. Muscular imbalances, compensatory pronation of the foot, are sometimes caused by pes planus or pes cavus. If a standardized research work can be made available with equipment’s for physical therapists, the knowledge gotten will help them balance the foot and restore normal function of the lower limb.


1.5 Research Questions

  1. What do people know about the arches of the foot?
  2. To find out if the residents have disorder of the lower limb.

1.6 Scope of the Study

The study is delimited to the residents of Ovia North East L.G.A. This study is carried out in a bid to use the plantar arch index in studying the prevalence of pes planus among residents in Ovia North East L.G.A. The spatial scope is Okada in Edo State.

The subjects of this study are the male and female residents of ages 16 to 35years of Okada. The residents comprise of all ethnicity, class, tribes and race none would be left out.


1.7 Limitation to the Study

The objective of this research wouldn’t be smoothly or accurately realized because of some hindrances, some of the limitations include ;

  1. The difficulty in moving instruments of research from one point to another.
  2. People refusing to foot print materials because of ink stain on their foot.
  3. People being scared of filling the questionnaire because they think giving off information might be detrimental.
  4. Indifference in people’s participation to research work.

1.8 Operational Definition of Terms

Ovia North:

Area of the study

Residents:

In sub-Saharan Africa, the term “Residents” is associated with people of different races that live in a community.

Arches of the Foot:

They are formed by tarsals and metatarsal bones, it allows the foot to support the weight of the body in the erect posture with the least weight.


Chapter Five


5.0 Discussion, Conclusion and Recommendation

5.1 Discussion

Research shows that Subjects (people) with pes planus are frequently considered unsuitable for military service, because they wouldn’t be able to stand for long. And in the military training standing for long is required on a daily basis. However, athletes with pes planus (some long distance runners especially) are not impeded by the condition.

Increase in physical activity and the growth of the plantar fascia, muscles and ligaments give rise to the medial and lateral longitudinal arches. If the foot does not respond to the increased activity, the symptoms of flat foot generally become evident and with this, the extent of the contact width of the sole with the ground increases.

According to our calculations, thirteen (3.42%) cases of pes planus were identified on the right side and forty (10.52%) on the left side in females out of which two (0.52%) cases was bilateral. Twenty two cases (5.78%) of pes planus were identified on the right side and Thirty four (8.95%) on the left side in males out of which four (1.05%) cases were bilateral cases. In this research work, 0(0%)cases of Pes Cavus was reported, 74(19.47%) males were normal, they didn’t have Pes planus or Pes Cavus, 100(26.317%) females were normal, they didn’t have Pes planus or Pes Cavus, 20/186(5.26%) females had arthritis, 8/186(2.10%) females had anterior cruciate ligament injury, (17.63%) were normal. while in males 40/194(10.52%) had arthritis, while 12/194(3.16%) males had anterior cruciate ligament injury and (52.9%) were normal. Neither of this disorders provided a limitation to this study. In a previous study by Ukoha et al. (2012) rn Anambra State of Nigeria, a prevalence of 4.9% and 4.0% bilateral pes planus was observed in the male and female respectively. Another study by Eluwa et al. (2009) in the University of Calabar, stated observed that the prevalence of bilateral pes planus was 5.0% and 6.2% in male and female subjects respectively. Also, the present study shows a lower incidence of bilateral pes planus and unilateral pes planus than another study by (Didia et al., 1987) who reported an incidence of 7.5% and 3.5% of bilateral, and unilateral pes planus respectively. However, both studies show a higher incidence of bilateral pes planus than unilateral. This study shows that there was higher incidence of unilateral pes planus amongst males than females. An earlier work by (Eluwa et al, 2009) which reported ‘an incidence of 5.6% and 5.8% among females and males respectively. This higher prevalence in females may be due to the fact that adult females tend to have small bones and less bulky muscles (Hicks, 1955).

It was observed that there are significantly (P<0.05) lower contact index values in females than males. It suggests that arches may be better developed at the centre of the foot in males than in females. It may also be due to other factors such as type of foot wear used, physical activities, weight-bearing habits or body stances.

The foot has two functions: to be a strong and stable support for the body, and the lever to ambulation (Morton, 1937). This double functions makes feet to present a unique behavior during ambulation, when it is submitted to a successive load and unload cycle. The deformation experienced by the medial longitudinal arch during support makes feet to be the region suffering the highest variations in a human body (cavanagh et al 1987).These functional features make clinical examination of this region complex.

The wide variability found in all concepts concerning feet may be exemplified by the various names for pes planus. This condition has received many different names, not necessarily reflecting characterization of different problems (Rose et al., 1985).

Although there are people considering footprint a poor evaluation approach (Cobey et al,, 1981), there is almost an uncountable number of authors who advocate its use: (Gervis ,1970).

(Engel et al., 1974), (Viladot, 1992), (Cavanagh et al.,1987) and (Engel et al.,1994) (viladot, 1986), (cavanagh et al., 1987) (Staheli et al., 1987), (Volpon, 1994), (Chen, 2006) among others. The correlation between X ray studies and footprint shows that the footprint is effective for individual studies and population-based investigations (Kanatli et al., 2001). Some cannot find a correlation between footprint and clinical measurement of the plantar arch, regarding it as invalid to determine plantar arch height (Hawes et al., 1992), others also consider that footprints present several approach failures (Mosca, 1995). The plantar arch index and the navicular vertical height are correlated, but the second is better, because it directly measures navicular, which is the key to medial arch, in addition to be easy to achieve (Burns et al., 2001).

Using a sophisticated methodology, such as strength platforms, graded scales (cavanagh et al 1987), or “moire” photopodometry (Hanra et al., 1995), increases measurements accuracy, but these are more difficult to apply in clinical routine. The classification proposed by these authors may be used by obtaining a carton-based template of the area of plantar region of the feet (Rodriguez et al., 1997), which allows for calculating the plantar index from the areas of different regions of the feet. However, for large-scale studies (population- based), its practical application is more cumbersome. Any method showing a clear and homogenous footprint is, at first, worthy for assessing it. (Roehm, 1933) and (cavanagh et al 1987) mentioned several cases. The technique employed for obtaining footprints in this study is simple, not expensive, easy to apply and satisfactory for routine clinical analyses. Footprint is simple, available, low-cost, and non-invasive, and does not use radiation as well (Kanatli et al., 2001). The plantar arch index (PI) correlates foot central region, also called arch region, to the heel region, and has also been used by some other authors (Mathieson et al., 2002) (Hogan et al., 2002). The relationship between the areas of these regions was used by (Cavanagh et al.,1987), nevertheless making calculation difficult. Similarly to footprint, the PI calculation was performed in a simple and practical way, and both can be done in an outpatient basis – in clinical cases – as well as in large groups, for population-based studies.

The present study showed no significant difference between right-side and left-side plantar arch indexes which agrees with previous literatures (Staheli et al., 1987) (Didia et al., 1987). However, there are literatures (Sá et al., 2001) that presented differences between sides in the various feet measurements although they emphasize that these are almost unnoticeable on plantar index dimensions.

It is well established that a rigorous clinical application of an index not always leads to a correct diagnosis. The plantar arch index, as any other, must be applied in the light of clinical history and physical examination of the patient, and never in an isolate and absolute manner.


5.2 Conclusion

This study has provided the prevalence of pes planus among the adult Nigerian population, as baseline data and for comparison to other regions of the world and should initiate a guide in the understanding of plantar heel pain associated with flat foot and associated clinical biomechanics of the affected subjects in the environment, be it the youths, children or the old aged.


5.3 Recommendation

Based on the finding of this study, the following recommendation are made: programs I.e. health programs should be introduced to enlighten residents on having the knowledge of plantar arch index and prevalence of pes planus to help reduce heel pain and pes cavus.


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