Relationship between plantar pressures, physical activity and sedentariness among preschool children

Prevalence of flatfoot and gender differences in plantar pressure among third-year high school students in Tongzhou district Beijing

OBJECTIVE

To estimate the prevalence of flatfoot and to analyze the gender difference of plantar pressure in third-year high school students in Tongzhou District Beijing.

METHODS

From March 2019 to March 2021, 1217 third-year high school students in Tongzhou District, Beijing were tested for plantar pressure. The prevalence of flatfoot was calculated and related plantar pressure parameters were analyzed, including contact area and plantar pressure. The differences of plantar pressure parameters between different genders were analyzed.

RESULTS

The prevalence of flatfoot among third-year high school students in Tongzhou District, Beijing was 5.5% (95% CI: 4.3-6.7%), among which, the prevalence of flatfoot among boys was 5.3% (95% CI: 3.8-6.8%) and that among girls was 5.9% (95% CI: 3.9-7.9%). There was no significant difference in the prevalence of flatfoot among different genders (P = 0.326), and the left and right foot types were basically the same. The mean BMI of the study population was 22.6 ± 3.4 kg/m², with males having a slightly higher mean BMI (23.1 ± 3.6 kg/m²) compared to females (21.9 ± 3.0 kg/m²). In static phase, there were statistically significant differences in contact area, plantar pressure at great toe, plantar pressure at 2nd - 5th toe, plantar pressure at 2nd - 4th metatarsal, and plantar pressure at middle foot(P < 0.05) between male students and female students. In dynamic phase, there were significant differences in contact area, plantar pressure at great toe, plantar pressure at 2nd - 5th toe and plantar pressure at 5th metatarsal (P < 0.05).

CONCLUSION

The findings of this study suggest that while flatfoot prevalence is similar between genders in third-year high school students, significant gender-specific differences exist in plantar pressure distribution patterns. These differences persist in both static and dynamic phases, with potential implications for gender-specific foot health assessment and preventive interventions. Understanding these patterns may help in early detection of foot abnormalities and implementation of appropriate interventions to prevent long-term biomechanical issues in this age group.

Prevalence of flatfoot and analysis of plantar pressure distribution in adolescents based on body mass index: a regional study

BACKGROUND

The foot is an essential organ for human locomotion. Assessment of plantar pressure distribution could provide key clinical information on foot functions. However, the mechanism that links body mass index to injury is not clear. The aims of this study were (1) to analyze the feature of plantar pressure distribution in Chinese adolescents and (2) to estimate the prevalence of flatfoot.

METHODS

1,217 participants aged 17-23 years (756 males and 461 females) were enrolled in this study. Static and dynamic foot-related variables, including contact area and plantar pressure, were measured. Based on BMI, participants were stratified into three groups: the underweight group (BMI < 18.5 kg/m2), the norm weight group (18.5 ≤ BMI < 25 kg/m2), and the overweight group (BMI ≥ 25 kg/m2). Mann-Whitney U test was used to compare the three different BMI groups.

RESULTS

Overall, BMI had an impact on the contact area and plantar pressure at the 2nd to 4th metatarsal, 5th metatarsal, midfoot, and lateral heel, with greater pressure in these areas in the dynamic state. In particular, when shifting from the static phase to the dynamic phase, the plantar pressure of the forefoot shifted laterally. Moreover, the contact area, and plantar pressure at 2nd to 4th metatarsal, 5th metatarsal, middle foot, and lateral heel pressures were positively correlated with BMI. Among the 1217 participants, 67 adolescents were diagnosed with flatfoot.

CONCLUSIONS

This study confirms that BMI does influence plantar pressures and that each BMI classification displays unique plantar pressure characteristics in Chinese adolescents.

A cross-sectional study of medial longitudinal arch development in children with different BMI

Introduction

The influence of excess weight on the development of children's feet remains a subject of debate. To further elucidate whether this relation occurs, this study compared arch morphology and flexibility in three groups of children: underweight, normal, and overweight.

Methods

In total, 1,532 children (807 boys, 725 girls; age range 7-11 years) participated in the study. The researchers measured the participants' height and weight, calculated their body mass index, and categorized their weight status as underweight, normal weight, or overweight. A three-dimensional foot model was taken using a three-dimensional plantar scanner under non-weight-bearing and weight-bearing conditions to obtain arch morphometric indices (arch index and arch volume) and arch flexibility index (arch volume index).

Results

Analysis of the data showed that the arch index was higher in overweight children compared to underweight and normal weight children (p < 0.05), but the differences in arch volume and arch volume index in overweight children compared to underweight and normal weight children were not statistically significant (p > 0.05). All children were divided into flatfoot, normal, and pes cavus groups according to arch index, and the arch volume index was statistically significant (p < 0.01).

Conclusions

Overweight was not absolutely associated with arch structure and arch flexibility in children from a three-dimensional perspective. Arch development is a long-term process, and it is not clear whether being overweight has an effect on soft tissue or bone formation. Future studies will focus on the effects of long-term overweight on foot structure and arch flexibility in children.

Bare Foot and In-shoe Plantar Pressure in Diabetic Males and Females - Is There Difference?

Purpose

High plantar pressure is one of the factors associated with foot ulceration in diabetic patients. High-risk limbs could eventually be identified through this approach. The study was conducted to evaluate the difference in the barefoot and in-shoe plantar pressure among diabetic males and females.

Patients and Methods

A cross-sectional study was conducted and purposive sampling was employed for the recruitment of subjects in King Abdullah walking center. The dynamic plantar pressure generated by each subject was recorded using “novel footprint software” and up to five successful trials were collected for each subject of right and left foot.

Results

The mean age of female and male patients was 50.6 ± 13.4 and 46.07 ± 11.17, respectively. The mean difference between the weights was higher in males. The barefoot peak plantar pressure between gender in left limb was found significant. Moreover, the mean difference in plantar pressure at maximum concentration and maximum force of right and left limb between males and females was found statistically significant. The mean difference in in-shoe plantar pressure at maximum force of left limb between males and females was found statistically significant.

Conclusion

As the prevalence of diabetes is increasing, the risk of plantar pressure also increasing simultaneously. The difference in plantar pressure among diabetic males and females is critically important as our study indicated that the bare foot and in-shoe plantar pressure was found higher in males than females as males had higher weight than females. Further longitudinal studies are required to be conducted in this context.

Effects of Overweight and Obesity on Running Mechanics in Children

PURPOSE

The purpose of this study is to determine differences in running mechanics between healthy weight (HW) children and children classified as OW/OB.

METHODS

Forty-two children (17 OW/OB, 25 HW) ran overground while kinematic and kinetic data were recorded using a motion capture system and force plate. Kinematic variables of interest included stance time, step length, and frontal and sagittal plane joint angles and excursions at the hip, knee, and ankle. Kinetic variables of interest included ground reaction forces and hip, knee, and ankle moments in the sagittal and frontal planes.

RESULTS

The OW/OB group spent more time in stance, took shorter steps, displayed less hip flexion during the first half of stance, had greater ankle inversion at foot strike, had greater knee abduction throughout stance, and had smaller knee flexion, knee adduction, and hip adduction excursions. In comparing unscaled ground reaction forces, the OW/OB group displayed greater peak vertical force, vertical impact peaks, and vertical loading rates. The OW/OB group also displayed greater unscaled plantar and dorsiflexion moments, knee flexion and extension moments, ankle inversion moments, and knee and hip abduction moments.

CONCLUSION

These data suggest that increased body weight in children is associated with changes in running mechanics. Higher joint moments and ground reaction forces may indicate increased injury risk or the development of joint degeneration among overweight/obese children.

Maturation of the postural control in adolescent girls: A 3-year follow-up study

BACKGROUND

Stable posture is a manifestation of the appropriate functioning of the neuromuscular system that is essential for proper motor development and control. Balance and stability of the erect posture are shaped during the entire childhood to culminate in its full efficiency in adolescent subjects.

METHODS

In this 3-year follow-up study, the process of the postural control maturation has been assessed in a group of 18 girls at the transition period between childhood to adolescence. Their balance and postural stability control were assessed using standard static posturography supplemented by two postural stability tests: the rising-on-toes (ROT), and the maximum forward lean (MFL), all performed with (EO) and without vision (EC). Balance control was analyzed with the sway vector (SV) and sway directional indices, whereas the anteroposterior trajectories of the center-of- pressure (COP) during forward-leaning and the raise-on-toes tests were used to determine changes in postural stability control.

RESULTS

The study documented that stability control in girls aged 11-13 is shaped according to their own pace of development. Their postural sway was characterized by the lower COP velocity but very sensitive to visual input. The directional sway measures remained at the same level for the entire period of observation. MFL and ROT tests provided similar information on postural stability and its dependence on visual input. These tests allow for more thorough assessment of postural stability to compare with quiet stance testing.

SIGNIFICANCE

Subtle changes in postural control in adolescents could be assessed based on the results of combined static and dynamic tests. In particular, the ROT test can be recommended for the assessment of postural stability.

Foot characteristics during walking in 6-14- year-old children

The main purpose of the study was to establish foot characteristics during walking in children. In this cross-sectional study, we recruited 1 284 primary-school students aged 6–14 years (714 boys and 570 girls) randomly selected from five schools in the city of Brno, Czech Republic. Children walked across a pressure platform (EMED-xl; Novel_GmbH, Munich, Germany) to collect the data for both left and right foot during three trials. After the procedure, the software generated several foot characteristic variables: (1) force-time integral, (2) pressure-time integral, (3) contact area, (4) contact time, (5) peak pressure and (6) average pressure for the total foot. Curves for the 5^th, 10^th, 25^th, 50^th, 75^th, 90^th and 95^th percentiles were calculated using the Lambda, Mu and Sigma (LMS) Chartmaker software. Our results showed that boys had longer force-time integral, higher contact area and contact time values, and higher peak plantar pressure, while no significant differences in pressure-time integral and average plantar pressure between sexes were observed. Older boys and girls had higher values in all measured variables. Our results provide for the first-time sex- and age-specific foot characteristics during walking in 6–14-year-old children.

Correlates of sedentary time in young children: A systematic review

Background: Young children appear to spend large portions of their waking time being sedentary. Understanding the correlates of sedentary time would assist in developing effective interventions among young children. The purpose of this systematic review was to summarize the current literature on the correlates of objectively measured sedentary time in young children aged 1-5.99y. Methods: This review was registered with PROSPERO (registration no. CRD42017081374) and aligned with the PRISMA Statement for systematic reviews. Five electronic databases (MEDline, CINAHL Complete, PsycINFO, SportDiscus, Scopus) were searched up to October 26, 2017 for studies investigating correlates of sedentary time measured using objective devices. A semiquantitative approach was used to synthesize data. Results: Forty-five studies were retrieved comprising 13,430 participants, and 84 correlates of sedentary time in young children were evaluated. The associations between sex, sleep habits, daily patterns (childcare vs. non-childcare hours), childcare type and sedentary time were indeterminate. Thirty-nine correlates were consistently unrelated. Forty-one potential correlates were examined in too few studies (<4) to make confident conclusions. Parental sedentary behaviour was reported 3 times and maternal sedentary behaviour was reported once. Out of these four studies, three were positively associated with child sedentary time. Conclusions: Despite reviewing 45 studies that evaluated associations for 84 correlates, this review was unable to identify any consistent correlates of sedentary time in young children. Additional research is needed in this area to provide robust evidence of the correlates of sedentary time in young children, particularly for those examined in only a small number of studies.

More Time Spent in Sedentary Behaviors is Associated with Higher Plantar Pressures in Older Women

Background: Although obesity has been consistently correlated with higher plantar pressure during the lifespan, to date little evidence has been provided regarding of how domain-specific and total sedentary behaviors may be correlated with plantar pressures. Moreover, high peak plantar pressures have been consistently associated with foot pain and discomfort, which prevent individuals from being physically active. Therefore, the main purpose of the study was to explore the correlations between time spent in sedentary behaviors and plantar pressures. Methods: We recruited 120 older women aged ≥60 years. To assess the time spent in different domains of sedentary behavior, we used the Measure of Older Adults' Sedentary Time (MOST) questionnaire. Peak pressures beneath forefoot, midfoot and hindfoot were measured with a Zebris pressure platform. Results: In the unadjusted model, peak pressures were significantly correlated with almost all domain-specific sedentary behaviors (r = 0.15-0.41). Total time spent in sedentary behaviors was significantly correlated with forefoot (r = 0.40, p < 0.001), hindfoot (r = 0.31, p < 0.001) and total peak plantar pressure (r = 0.40, p < 0.001). In a model adjusted for age, the risk of falls, foot pain and gait velocity, similar significant correlations between sedentary behaviors and plantar pressures remained. Conclusions: Our study shows moderate correlation between domain-specific and total time spent in sedentary behaviors and plantar pressure beneath different foot regions in a sample of older women.

Effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity in women

PURPOSE

This study investigated the effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity participation in women living independently in the community.

METHODS

A total of 378 women were divided into 3 groups (Not Overweight: body mass index (BMI) = 22.5 ± 0.2 kg/m² (mean ± SE); Overweight: BMI = 27.4 ± 0.3 kg/m²; Obese: BMI = 35.4 ± 0.3 kg/m²). Outcome variables of breast volume (mL), thoracic flexion torque (N·m), thoracic kyphosis (degrees), upper torso musculoskeletal pain (score) and time spent in physical activity (min) were calculated and compared among the 3 groups, adjusting for between-group differences in age.

RESULTS

There was a significant main effect of BMI on all outcome variables. Participants classified as Obese displayed significantly larger breasts, had greater thoracic flexion torques and reported less time participating in physical activity relative to the participants who were classified as Not Overweight and Overweight. Participants in the Obese group also displayed significantly more thoracic kyphosis and reported significantly more upper torso musculoskeletal pain compared to their counterparts who were classified as Not Overweight.

CONCLUSION

This study is the first to demonstrate that increased obesity levels were associated with compromised kyphosis and loading of the thoracic spine, as well as increased symptoms of upper torso musculoskeletal pain and reduced time spent in physical activity in women living in the community. We recommend further research to determine whether evidence-based interventions designed to reduce the flexion torque generated on the thoracic spine can improve these symptoms of upper torso musculoskeletal pain and the ability of women with obesity to participate in physical activity.

Association between the levels of physical activity and plantar pressure in 6-14-year-old children

BACKGROUND

The main purpose of the study was to determine whether lower levels of physical activity were associated with higher plantar pressure generated under each foot.

METHODS

In this cross-sectional study, we recruited 641 children aged 6-14 years (agemean ± SD = 9.7  ± 2.4 years; heightmean ± SD = 143.6  ± 15.3 cm, weightmean ± SD = 37.6  ± 13.4 kg; body-mass indexmean ± SD = 17.6  ± 3.2 kg/m2; 44.2% girls). We used EMED -XL pressure platform to measure force time integral, pressure-time integral, contact-time and contact area, peak plantar pressure and mean plantar pressure of the right and the left foot during the gait analysis. The level of physical activity was measured by using The Physical Activity Questionnaire for Older Children (PAQ-C). The associations were calculated by using generalized estimating equations with linear regression models.

RESULTS

Lower levels of physical activity were associated with higher force- and pressure-time integrals, longer contact time and higher peak and mean plantar pressures in both feet.

CONCLUSION

Our study shows that the level of physical activity is strongly and inversely associated with plantar pressure in a sample of 6-14 year olds.

Stumbling prediction based on plantar pressure distribution

BACKGROUND

Stumbles are common accidents that can result in falls and serious injuries, particularly in the workplace where back and forth movements are involved and in offices where high heels are imperative. Currently, the characteristics of plantar pressure during a stumble and the differences between stumbling and a normal gait remain unclear.

OBJECTIVE

This paper is aimed at providing insights into the feasibility of the data mining technique for interventions in stumble-related occupational safety issues.

METHODS

The characteristics of plantar pressure distribution during stumbling and normal gait were analyzed by using the power spectrum density (PSD) and the Support Vector Machine (SVM). The PSD, a novel pattern recognition feature, was used to mathematically describe the image signal. The SVM, a powerful data mining technique, was used as the classifier to recognize a stumble. Dynamic plantar pressures were measured from twelve healthy participants as they walked.

RESULTS

The plantar pressures of the stumbling gaits had significantly different patterns compared to the normal ones, from either a qualitative or quantitative perspective. The mean recognition accuracy of the proposed method reached 96.7%.

CONCLUSIONS

This study helps better understand stumbles and provides a theoretical basis for stumble-related occupational injuries. In addition, the stumble is the precursor of a fall and the research on stumble recognition would be of value to predict and provide warnings of falls and to design anti-fall devices for potential victims.

Gait Pattern, Impact to the Skeleton and Postural Balance in Overweight and Obese Children: A Review

The article reviews the biomechanical factors that may cause overweight/obese children to reduce their level of physical activity, while increasing their risk of overuse injuries and exercise-related pain. Recommendations would be to screen those children for any gait or postural impairments before they join any exercise program, and to provide them with specific gait treatments and/or physical exercise programs, in order to decrease their risk for future musculoskeletal injuries and pain.

Impact of foot pronation on postural stability: An observational study

OBJECTIVE

To investigate the effect of foot pronation on the postural stability through measuring the dynamic balance including overall stability index (OAI), anteroposterior stability index (APSI) and mediolateral stability index (MLSI).

METHODS

Forty participants from both sexes were selected from the Faculty of Physical Therapy, Cairo University, with a mean age of 23.55 ± 1.74 years. Subjects were divided into two groups: group A (8 males and 12 females) with foot pronation, and group B (9 males and 11 females) with normal feet. The Navicular Drop Test (NDT) was used to determine if the feet were pronated and Biodex Balance System was used to assess dynamic balance at level 8 and level 4 for both groups.

RESULTS

No significant difference was found in dynamic balance, including OAI, APSI and MLSI at stability level 8 (p> 0.05) but, there was a significant difference at stability level 4 (p< 0.05) between the two groups with lower stability in group A.

CONCLUSION

Foot pronation affects the postural stability at stability level four and not affects stability level eight compared with those in the control group.

Obesity is Associated With Altered Plantar Pressure Distribution in Older Women

Increased plantar pressure has been found to be related with greater risk of falling. Although there is evidence suggesting that obesity is linked to foot disorders, the association between obesity and plantar pressure of older adults has been poorly investigated. The purpose of this study was to examine the association between obesity and plantar pressure distribution and to explore its relationship with body fat distribution. Two hundred and eleven older women took part in this cross-sectional study. Body mass index was taken for obesity classification. Whole body, android, and gynoid fat percentage was assessed using dual-energy x-ray absorptiometry. Peak plantar pressure was evaluated during gait using an Emed AT-4 pressure platform. Obese volunteers generated greater peak pressure at midfoot (187.26 kPa) compared to both normal weight (128.52 kPa, p < .001) and overweight (165.74 kPa, p < .001). Peak plantar pressure at midfoot was also greater in overweight compared to normal weight (p < .001). At forefoot, peak pressure was higher in the obese (498.15 kPa) compared to normal weight volunteers (420.41 kPa, p = .007). Additionally, whole body, android, and gynoid fat percentage were significantly associated with peak pressure at midfoot and forefoot. Therefore, clinicians dealing with falls should consider the effect of increased body weight on plantar pressure.

Impact of Generalized Joint Laxity on Plantar Loading Patterns in Young Females

BACKGROUND

Generalized joint laxity is often associated with gait deviations. The aim of this study was to investigate the static and dynamic loading pattern of the foot with increasing joint mobility and to discuss the potential impact of this condition on the plantar loading patterns.

METHODS

Seventy female participants between ages of 18 and 30 were included in this cross-sectional survey. The Beighton-Horan Joint Mobility Index scores were assessed and participants divided into 3 categories: no hypermobility (NH) group, scores 0 to 2; moderate hypermobility (MH) group, scores 3 to 4; distinct hypermobility (DH) group, scores 5 to 9. Pedobarographic analysis was performed both in static and walking conditions. Dynamic foot loading examined in 10 anatomic zones. Contact areas of forefoot, midfoot, and rearfoot were recorded.

RESULTS

In the dynamic pedobarographic analysis, individuals with distinct joint hypermobility displayed higher peak pressure and maximum force values under the hallux, compared with other groups ( P < .05). The maximum force value of the second metatarsal was higher in the DH group than in the MH group ( P < .05).

CONCLUSION

Our study results suggest that plantar loading pattern differs with increasing degrees of the hypermobility score.

CLINICAL RELEVANCE

Differences in plantar loading parameters in people with severe joint mobility scores may be useful in interpreting the foot pathologies of these individuals.

Physical Activity During the Early Years: A Systematic Review of Correlates and Determinants

CONTEXT

Being physically active during the early years (age 0-6 years) is vital for healthy development. Identifying correlates and determinants of physical activity (PA) is crucial to guide effective interventions. This systematic review synthesized studies investigating potential correlates and determinants of PA during the early years, accounting for different types of PA assessment.

EVIDENCE ACQUISITION

Nine electronic databases were searched from inception year (1900) until September 2014; data were analyzed/interpreted in April 2015. The following inclusion criteria were used: written in English, published in peer-reviewed journals, participants not in statutory/school education, and an observational design investigating associations between an exposure/variable, and a quantitative measure of PA. Correlates/determinants of total, moderate to vigorous, and light PA were reported using an ecologic model.

EVIDENCE SYNTHESIS

Of 22,045 identified studies, 130 were included. All took place in high-income countries and few (6%) were of high quality. Correlates of total PA were sex (male, ++); parental PA (+); parental support (+); and time outdoors (+). Determinants of total PA were sex (+) and time spent playing with parents (+). The only correlate of moderate to vigorous PA was sex (male, ++). No determinants of moderate to vigorous or light PA were found. PA correlates/determinants were relatively consistent between objective and subjective PA measures.

CONCLUSIONS

Numerous studies investigated potential correlates and determinants of PA, but overall quality was low. A small number of demographic/biological and social/cultural factors were associated with PA. There is a need for high-quality studies exploring correlates/determinants across all domains of the ecologic model.

The influence of monocular vision on the plantar pressure distribution

BACKGROUND

Although the influence of monocular vision to upper limb biomechanics has been well documented, data about lower extremity biomechanics are limited. The objective of the present study was to demonstrate pedobarographic differences between both feet of the individuals with monocular vision in static and dynamic conditions.

METHODS

Pedobarographic analysis of twenty-four participants with monocular vision was performed. Relative static pressure load (%) and dynamic peak plantar pressure (N/cm(2)), force (N) distributions and contact area percentages (%) were recorded under both low vision and normal vision side foot.

FINDINGS

The results showed that relative static pressure loads did not differ between low vision and normal vision foot. Under midfoot of low vision side, a significant increment was found in peak plantar pressures (2.42 (SD 1.09) N/cm(2)) and forces (136.77 (SD 64.96) N) compared to normal vision side foot (1.87 (SD 0.96) N/cm(2); 106.94 (SD 65.03) N). No difference in contact area percentages was detected.

INTERPRETATION

These results indicate that there are differences in plantar pressure measurements between feet of individuals with monocular vision. These pedobarographic differences reported here appear to support the assumption that individuals with monocular vision have adaptive gait strategies such as, decreased walking speed, limited ankle motion and postural compensations.

Obese older adults suffer foot pain and foot-related functional limitation

There is evidence to suggest being overweight or obese places adults at greater risk of developing foot complications such as osteoarthritis, tendonitis and plantar fasciitis. However, no research has comprehensively examined the effects of overweight or obesity on the feet of individuals older than 60 years of age. Therefore we investigated whether foot pain, foot structure, and/or foot function is affected by obesity in older adults. Three hundred and twelve Australian men and women, aged over 60 years, completed validated questionnaires to establish the presence of foot pain and health related quality of life. Foot structure (anthropometrics and soft tissue thickness) and foot function (ankle dorsiflexion strength and flexibility, toe flexor strength, plantar pressures and spatiotemporal gait parameters) were also measured. Obese participants (BMI >30) were compared to those who were overweight (BMI=25-30) and not overweight (BMI <25). Obese participants were found to have a significantly higher prevalence of foot pain and scored significantly lower on the SF-36. Obesity was also associated with foot-related functional limitation whereby ankle dorsiflexion strength, hallux and lesser toe strength, stride/step length and walking speed were significantly reduced in obese participants compared to their leaner counterparts. Therefore, disabling foot pain and altered foot structure and foot function are consequences of obesity for older adults, and impact upon their quality of life. Interventions designed to reduce excess fat mass may relieve loading of the foot structures and, in turn, improve foot pain and quality of life for older obese individuals.

Plantar pressure distribution in patients with ankylosing spondylitis

BACKGROUND

Ankylosing spondylitis is one of the most common inflammatory rheumatic diseases and is associated with alterations in posture. The aim of this study was to investigate the pedobarographic changes among ankylosing spondylitis patients, in an attempt to understand whether the alterations in the posture affect the plantar pressure distribution.

METHODS

The study population consisted of 38 patients with ankylosing spondylitis and 33 healthy volunteers. The static and dynamic pedobarographic measurements were performed to determine the plantar pressure distribution. Moreover, the Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life Questionnaire and Bath Ankylosing Spondylitis Metrology Index were used to assess the clinical state of the patients.

RESULTS

The static pedobarographic measurements did not reveal any intergroup difference. There were differences between the groups in the results of dynamic peak pressure measurements under the metatarsal areas and under the midfoot region. The percentage of the midfoot in the dynamic plantar contact area was higher in ankylosing spondylitis patients in comparison to the controls. No clinically significant correlation was found between the clinical scores and static pedobarographic measurements. The plantar pressures under the metatarsal heads, medial and lateral heel regions declined with increasing disease activity according to the Bath Ankylosing Spondylitis Disease Activity Index scores. The lower peak pressures on the forefoot and rearfoot, were associated with the higher Bath Ankylosing Spondylitis Metrology Index scores of the patients.

INTERPRETATION

The alterations in the posture may have effects on the plantar pressures in patients with ankylosing spondylitis, especially during dynamic activities.

A review of preschool children's physical activity and sedentary time using objective measures

CONTEXT

Identifying current physical activity levels and sedentary time of preschool children is important for informing government policy and community initiatives. This paper reviewed studies reporting on physical activity and time spent sedentary among preschool-aged children (2-5 years) using objective measures.

EVIDENCE ACQUISITION

Databases were searched for studies published up to and including April 2013 that reported on, or enabled the calculation of, the proportion of time preschool children spent sedentary and in light- and moderate to vigorous-intensity physical activity. A total of 40 publications met the inclusion criteria for physical activity and 31 met the inclusion criteria for sedentary time. Objective measures included ActiGraph, Actiwatch, Actical, Actiheart, and RT3 accelerometers, direct observation, and Quantum XL telemetry heart rate monitoring. Data were analyzed in May 2013.

EVIDENCE SYNTHESIS

Considerable variation in prevalence estimates existed. The proportion of time children spent sedentary ranged from 34% to 94%. The time spent in light-intensity physical activity and moderate to vigorous-intensity physical activity ranged from 4% to 33% and 2% to 41%, respectively.

CONCLUSIONS

The considerable variation of prevalence estimates makes it difficult to determine the "true" prevalence of physical activity and sedentary time in preschool children. Future research should aim to reduce inconsistencies in the employed methodologies to better understand preschoolers' physical activity levels and sedentary behavior.

Foot loading patterns in normal weight, overweight and obese children aged 7 to 11 years

Background

Childhood obesity is thought to predispose to structural foot changes and altered foot function. Little is currently understood about whether similar changes occur in overweight children. The aim of this study was determine foot loading characteristics in obese, overweight and normal weight children aged 7 to 11 years during level walking.

Methods

Dynamic plantar pressures were measured in 22 obese, 22 overweight and 56 normal weight children recruited from local primary and secondary schools in East London. Peak pressure, peak force, normalised peak force, pressure–time and force-time integrals were analysed at six regions of the plantar foot: lateral heel, medial heel, midfoot, 1st metatarsophalangeal joint, 2nd-5th metatarsophalangeal joint and hallux. A one-way ANOVA was used to test for significant differences in variables across the groups. Where differences existed Tukey post-hoc tests were used to ascertain the location of the difference.

Results

Children who were obese and overweight demonstrated significantly (p<0.05) higher peak pressures and peak forces as well as significantly higher force-time and pressure–time integrals under the midfoot and 2nd-5th metatarsal regions. After normalisation of peak force, similar trends existed where the obese and overweight children demonstrated significantly (p<0.05) greater loading at the midfoot and 2nd-5th metatarsals.

Conclusion

Findings from this study indicated that overweight children, as young as seven, displayed differences in foot loading during walking, when compared with normal weight children. These findings were consistent with loading patterns of children who were obese and suggest that early assessment and intervention may be required in overweight children to mitigate against the development of musculoskeletal complications associated with excessive body mass.