Prevalence of Flatfoot in School-Going Children, Lahore

Main Article Content

Adan Ateeque
Sidrah Shabbir
Taha Nadeem
Hira Zubair
Zainab Khizar


Background: Flatfoot is characterized by a reduced medial longitudinal arch height and can be flexible or fixed, congenital, or acquired. It can influence physical activity and mood in children, and its prevalence varies widely among different populations.

Objective: To determine the prevalence of flatfoot among school-going children aged 7-15 years in Lahore, Pakistan, and to assess its distribution across different age groups and genders.

Methods: A cross-sectional study was conducted over six months at Dar-e-Arqam School, Westwood campus, Lahore. The sample size of 106 was calculated using the formula { n = Z^2 P(1-P) / d^2 } with a 16% expected prevalence, 7% precision, and Z value of 1.96. Non-probability sampling was used. Inclusion criteria were children aged 7-15 years of both genders, excluding those with fractures, congenital deformities, or a history of ankle sprain. Footprints were obtained using ink-impregnated pads, and the Chippaux-Smirak index (CSI) was used to diagnose and grade flatfoot. Data were analyzed using SPSS version 25, with descriptive statistics presented as frequencies and percentages.

Results: The prevalence of flatfoot among the children was 40.6%, with 4 cases of unilateral flatfoot (3.8%) and 39 cases of bilateral flatfoot (36.7%). Normal arches were found in 62 children (58.5%), and 1 child (0.9%) had a high arch. Among those with flatfoot, 17 had grade 1 flatfoot (16.0%), 12 had grade 2 flatfoot (11.3%), and 14 had grade 3 flatfoot (13.2%). The highest prevalence of flatfoot was observed in the 7-9 years age group (23 cases), while the 13-15 years group had the highest number of normal arches (29 cases). There was no significant difference in the prevalence of flatfoot between genders.

Conclusion: Flatfoot is relatively common among children in Lahore, with a prevalence of 40.6%. The condition's prevalence decreases with age, and no significant gender differences were observed. Further research should include a larger sample size, random sampling, and assessment of symptomatic aspects to enhance understanding.

Article Details

How to Cite
Ateeque, A., Shabbir, S., Nadeem, T., Zubair , H., & Khizar, Z. (2024). Prevalence of Flatfoot in School-Going Children, Lahore. Journal of Health and Rehabilitation Research, 4(2), 745–749.
Author Biographies

Adan Ateeque, Akhtar Saeed Medical and Dental College Lahore Pakistan.

Akhtar Saeed Medical and Dental College Lahore, Pakistan.

Sidrah Shabbir, Akhtar Saeed Medical and Dental College Lahore Pakistan.

Assistant Professor of the physiotherapy department, Akhtar Saeed Medical and Dental College Lahore, Pakistan.

Taha Nadeem, Akhtar Saeed Medical and Dental College Lahore Pakistan.

Akhtar Saeed Medical and Dental College Lahore, Pakistan.

Hira Zubair , Akhtar Saeed Medical and Dental College Lahore Pakistan.

Akhtar Saeed Medical and Dental College Lahore, Pakistan.

Zainab Khizar, Akhtar Saeed Medical and Dental College Lahore Pakistan.

Akhtar Saeed Medical and Dental College Lahore, Pakistan.


Alsancak S, Guner S, Güven E, Özgün AK, Akkaş Y, Alkıs N. Paediatric flat foot and foot dimension in Central Anatolia. BMC pediatrics. 2021;21(1):200.

Ueki Y, Sakuma E, Wada I. Pathology and management of flexible flat foot in children. Journal of orthopaedic science. 2019;24(1):9-13.

Kane K. Foot orthoses for pediatric flexible flatfoot: evidence and current practices among Canadian physical therapists. Pediatric Physical Therapy. 2015;27(1):53-9.

Michaudet C, Edenfield KM, Nicolette GW, Carek PJ. Foot and Ankle Conditions: Pes Planus. FP essentials. 2018;465:18-23.

Dabholkar T, Agarwal A. Quality of life in Adult Population with Flat feet. International Journal of Health Sciences and Research. 2020;10(2):193-200.

Evans AM, Rome K, Carroll M, Hawke F. Foot orthoses for treating paediatric flat feet. Cochrane Database of Systematic Reviews. 2022(1).

Turner C, Gardiner MD, Midgley A, Stefanis A. A guide to the management of paediatric pes planus. Australian journal of general practice. 2020;49(5):245-9.

Banwell HA, Mackintosh S, Thewlis D. Foot orthoses for adults with flexible pes planus: a systematic review. Journal of foot and ankle research. 2014;7(1):1-18.

Bok S-K, Kim B-O, Lim J-H, Ahn S-Y. Effects of custom-made rigid foot orthosis on pes planus in children over 6 years old. Annals of rehabilitation medicine. 2014;38(3):369-75.

Atbaşı Z, Erdem Y, Kose O, Demiralp B, Ilkbahar S, Tekin H. Relationship between hallux valgus and pes planus: real or fiction? The Journal of Foot and Ankle Surgery. 2020;59(3):513-7.

Yalfani A, Ahmadi M, Asgarpoor A, Ahmadi AH. Effect of foot orthoses on dynamic balance in taekwondo athletes with flexible flatfoot: A randomized controlled trial. The Foot. 2023;56:102042.

Hegazy F, Aboelnasr E, Abuzaid M, Kim I-J, Salem Y. Comparing validity and diagnostic accuracy of Clarke’s angle and foot posture index-6 to determine flexible flatfoot in adolescents: A cross-sectional investigation. Journal of Multidisciplinary Healthcare. 2021:2705-17.

Toyooka S, Shimazaki N, Yasui Y, Ando S, Saho Y, Nakagawa T, et al. Validity of a simple footprint assessment board for diagnosing the severity of flatfoot: a prospective cohort study. BMC Musculoskeletal Disorders. 2021;22(1):1-9.

Zhao X, Gu Y, Yu J, Ma Y, Zhou Z. The influence of gender, age, and body mass index on arch height and arch stiffness. The Journal of Foot and Ankle Surgery. 2020;59(2):298-302.

Naing L, Nordin RB, Abdul Rahman H, Naing YT. Sample size calculation for prevalence studies using Scalex and ScalaR calculators. BMC Medical Research Methodology. 2022;22(1):1-8.

Chibuzom CN, Egele CS, Ndukwu CU. The Prevalence of Flat Foot among School-aged Children in a Nigerian Population: Prevalence of Flat Foot among School-aged Children in a Nigerian. Tropical Journal of Medical Research. 2022;21(1):113-20.

Bogut I, Popović Ž, Tomac Z, Matijević V, Radmilović G. Prevalence of foot deformities in young schoolchildren in Slavonia. Acta Clinica Croatica. 2019;58(2.):288-94.

Sadeghi-Demneh E, Melvin JM, Mickle K. Prevalence of pathological flatfoot in school-age children. The foot. 2018;37:38-44.

Ibrahim S, Khan MS, Asif M, Hussain F. Prevalence of Flat Feet among School Children. Website: www ijpot com. 2019;13(3):214.

Ibeabuchi M, Obun C, Olabiyi O, Oluwabusola E, Adebayo A. Prevalence of flat foot among 6-15-year-old Nigerian school children resident in Lagos. J Anatom Sci. 2020;11(2):153-8.

Yin J, Zhao H, Zhuang G, Liang X, Hu X, Zhu Y, et al. Flexible flatfoot of 6–13-year-old children: A cross-sectional study. Journal of Orthopaedic Science. 2018;23(3):552-6.

Yasin MS, Al-Labadi GaM, Alshrouf MA, AlRaie BA, Ibrahim RA, AlRaie LA. Pediatric and Adolescent Flatfoot: A Questionnaire Based Middle East and North Africa Study. International Journal of General Medicine. 2023:2055-61.

Most read articles by the same author(s)