BackgroundMore than 1000 scientific papers have been devoted to flatfoot issue. However, a bimodal distribution of flatfoot indices in school-aged children has never been discovered. The purposes of this study were to establish a new classification of flatfoot by characteristic in frequency distribution of footprint index and to endue the classification with discrepancy in physical fitness.Methods/Principal FindingsIn a longitudinal survey of physical fitness and body structure, weight bearing footprints and 3 physical fitness related tests were measured in 1228 school-aged children. Frequency distribution of initial data was tested by Kolmogorov-Smirnov test for normality and a unique bimodal distribution of footprint index was identified. The frequency distribution of footprint index manifests two distinct modes, flatfoot and non-flatfoot, by deconvolution and bootstrapping procedures. A constant intersection value of 1.0 in Staheli's arch index and 0.6 in Chippaux-Smirak index could distinguish the two modes of children, and the value was constant in different age, sex, and weight status. The performance of the one leg balance was inferior in flatfoot girls (median, 4.0 seconds in flatfoot girls vs. 4.3 seconds in non-flatfoot girls, p = 0.04, 95% CI 0.404–0.484).DiscussionThe natural bimodality lends itself to a flatfoot classification. Bimodality suggests development of the child's foot arch would be a leap from one state to another, rather than a continuous growth as body height and weight. The underlying dynamics of the human foot arch and motor development will trigger research prospects.

This study identifies the optimal crouched starting positions (elongated, medium, or bunched) from push-off to the first two steps. Seven elite sprinters were recruited as participants in this study (aged: 21[Formula: see text][Formula: see text][Formula: see text]2 years). A high-speed camera (250[Formula: see text]Hz) was used to collect motion-based images on a sagittal plane. Kwon3D (software) was used to analyze the center of mass (COM) movement, step length, foot linear velocity, take-off angle, and trunk angle. Participants were tested in a 60[Formula: see text]m sprint for bunched, medium, and elongated starting positions. A one-way analysis of variance (ANOVA) ([Formula: see text]) with repeated measures was performed to determine the difference in kinematics in the three crouched starting positions. The LSD comparison was applied to examine differences among pairs of means. Our results indicated that the medium starting position demonstrated a greater first step length and foot linear velocity when compared to the bunched starting position. In the first step toe-off, a lower COM vertical velocity was observed in the medium starting position when compared with the elongated starting position. This study concluded that the medium starting position was the ideal starting position.