The association of foot structure and footwear fit with disability in children and adolescents with Down syndrome

Abstract

BackgroundFoot deformity, flat feet, and the use of ill-fitting footwear are common in children and adolescents with Down syndrome (DS). The aim of this study was to determine whether these observations are associated with foot-specific disability in this group.MethodsA cross-sectional study design. Foot structure (foot posture determined using the Arch Index, presence of hallux valgus and lesser toe deformities) and footwear fit (determined by length and width percentage differences between the participant’s foot and footwear) were assessed in 50 participants with DS (22 females, 28 males) aged five to 18 with a mean (SD) age of 10.6 (3.9) years. Foot-specific disability was determined using the parent-reported Oxford Ankle Foot Questionnaire for Children (OxAFQ-C). Associations between foot structure and footwear fit with the four domains (Physical, School and play, Emotional and Footwear) of the OxAFQ-C were determined using multivariate regression modelling.ResultsThe mean (SD) Arch Index was 0.29 (0.08), and the prevalence of flat feet, hallux valgus and lesser toe deformities was 76%, 10% and 12% respectively. Few participants wore footwear that was too short (10%), but the use of footwear that was too narrow was common (58%). The presence of hallux valgus was significantly associated with increased disability for the OxAFQ-C School and play domain scores. The use of narrow-fitting footwear was significantly associated with increased levels of disability for the OxAFQ-C Physical, School and play, and Emotional domains. However, these variables only explained between 10% to 14% of the variance in the OxAFQ-C domain scores. There were no significant associations between foot structure and footwear fit with the OxAFQ-C Footwear domain scores.ConclusionsFlatter feet and lesser toe deformities are not associated with foot-specific disability in children and adolescents with DS. Hallux valgus is associated with foot-specific disability during school and play activities. Ill-fitting footwear (too narrow) is common and is associated with foot-specific disability. Further research is required to identify if the relationship between narrow-fitting footwear and foot-specific disability is causal, and to identify other factors associated with foot-specific disability in children and adolescents with DS.

Foot care needs for children and young people with intellectual and developmental disabilities

“…Appropriate footwear choices through the lifespan are important to protect the feet as well as provide support for the body during functional activities (Morrison et al, ), and these data add to an existing concern. Previous work in a sample of 50 children with Down syndrome identified that poorly fitting footwear was a source of pain and associated with increased levels of foot‐specific disability (Lim et al, ) and reduced physical activity levels (Shields et al, ). Poorly fitting footwear has also been implicated in the development of mechanical skin injury (e.g., blisters, and callus) and nail complications (Jenkins, Cooper, O'Connor, Watanabe, & Wills, ).…”

“…The functional effects of foot problems are equally complex with gait changes (Galli et al, ) resulting in complex biomechanical movement characteristics which requires careful consideration during clinical consultation. Footwear has an important role in supporting the foot during weight‐bearing; yet, findings suggest that footwear problems are a frequent concern in children (Kennedy, McGinley, Paterson, Ryan, & Carroll, ; Lim et al, ; Morrison, Price, McClymont, & Nester, ; Prasher, Robinson, Krishnan, & Chung, ). Poor footwear fit can affect gait and balance (Kennedy et al, ; Wegener, Hunt, Vanwanseele, Burns, & Smith, ) and has been reported to be associated with increased levels of foot‐specific disability in children with Down syndrome (Lim et al, ) and reduced physical activity levels (Shields et al, ).…”

Assessment of Foot Shape in Children and Adolescents with Intellectual Disability: A Pilot Study

“…In recent years, more and more studies have focused on assessment of body posture in children with intellectual disability [ 1 , 2 , 4 , 10 – 14 , 17 – 20 ]. Some publications have discussed foot shapes in children and adolescents with intellectual disability associated with Down syndrome [ 11 – 14 ], but there are few reports related to parameters of longitudinal and transverse foot arch in children and adolescents with intellectual disability treated globally, without differentiation into specific disease entities [ 2 , 10 ]. This observation inspired the present study.…”

“…Currently available publications provide a variety of data pertaining to postural defects in children with intellectual disability. There is evidence showing that postural defects related to feet and knees dominate among children and adolescents with intellectual disability, linked with Down syndrome, and the most common problems include flat feet and knock knees [ 11 – 13 ]. It has also been suggested that there is no relationship between the degree of intellectual disability and flat feet in adolescents with Down syndrome [ 14 ].…”

Foot Structure in Boys with Down Syndrome

“…According to the authors, flat feet is one of the most common symptoms of excessive joint laxity, and most changes occur within the most movable joints: the talocalcaneal and calcaneonavicular joints. Lim et al [ 18 ] analyzed the correlation of foot structure and footwear fitting with disability (determined using the parent-reported Oxford Ankle Foot Questionnaire for Children) in 50 Australian children and adolescents. The group consisted of 22 females and 28 males, aged 5 to 18 years, with DS.…”