Flexible pes planus in adolescents: body mass index, body height, and gender--an epidemiological study

Foot Ankle Int. 2013 Jun;34(6):811-7. doi: 10.1177/1071100712472327. Epub 2013 Jan 24.


Background: Most studies on the prevalence of flexible pes planus (FPP) have been conducted in pediatric populations and older adults. There is limited comparable information on these parameters for the adolescent age group. The purpose of this study was to report the prevalence of FPP and its association with body mass index (BMI), body height, and gender among healthy and fit adolescents.

Methods: The data for this study were derived from a medical database containing records of 17-year-old males and females before their recruitment into mandatory military service. Information on the disability codes associated with FPP according to the Regulations of Medical Fitness Determination was retrieved. Logistic regression models were used to assess the association between BMI, body height, and gender to various grades of FPP severity.

Results: The study cohort included 825 964 adolescents (467 412 males and 358 552 females). The prevalence was 12.4% for mild FPP and 3.8% for severe FPP among the males and 9.3% and 2.4%, respectively, for the females. An increased BMI was associated with FPP in both males (overweight: odds ratio [OR] 1.385, confidence interval [CI] 1.352-1.419, P < .001; obese: OR 1.765, CI 1.718-1.813, P < .001) and females (overweight: OR 1.408, CI 1.365-1.620, P < .001; obese: OR 1.549, CI 1.481-1.620, P < .001). Body height was associated with a decreased risk of FPP when the highest height quintile was compared with the lowest height quintile in both males (OR 0.782, CI 0.762-0.802, P < .001) and females (OR 0.730, CI 0.707-0.754, P < .001) for all FPP severity grades.

Conclusions: There was a greater prevalence of FPP among males compared with females in a general healthy adolescent age group. FPP was associated with increased BMI and shorter body height for all grades of FPP severity.

Level of evidence: Level II, diagnostic study.

Keywords: body mass index; flatfoot; flexible pes planus; height.

MeSH terms

  • Adolescent
  • Body Height*
  • Body Mass Index*
  • Cross-Sectional Studies
  • Databases, Factual
  • Female
  • Flatfoot / epidemiology*
  • Humans
  • Israel / epidemiology
  • Male
  • Prevalence
  • Severity of Illness Index
  • Sex Factors