Pes Planus Foot among the First and Second Year Medical Students of a Medical College: A Descriptive Cross-sectional Study

ABSTRACT Introduction: Foot is a complex segmented structure formed by the articulation of 26 different bones which are held together by multiple ligaments, extrinsic tendons and the intrinsic muscles of the feet. The assessment of median longitudinal arch serves as an important reference in determining the degree of pes planus or pes cavus. This study aims to find the prevalence of pes planus among the undergraduate medical students of a medical college. Methods: A descriptive cross-sectional study was carried out in the first- and second-year undergraduate medical students of a teaching hospital after taking ethical approval from Institutional Review Committee. The study was conducted from 15th November 2019 to 14th November 2020. Eighty-seven participants were involved in study using the random sampling technique. Foot prints were collected from the participants in the A4 size paper after applying ink over plantar surface of the foot. Measurements were done using the Autodesk Autocad software. Statistical Package for the Social Sciences was used. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of the total subjects, 14 (8.04%) (5.14-10.94 at 95% Confidence Interval) presented with flat foot. Similarly, high arched foot was seen in 29 (16.67%) of subjects whereas normal arched foot was seen in 131 (75.29%) subjects. Conclusions: From the current study we conclude that the prevalence of pes planus was slightly higher than that compared with the similar studies.


INTRODUCTION
Foot is a complex segmented structure formed by the articulation of 26 different bones held together by multiple ligaments. 1 The skeleton of foot is arched in such a way that both longitudinal and transverse arches are formed within the foot with the concavity directed towards the plantar surface of the foot. 2 Pes planus (flat foot) and pes cavus (high arched foot) are the most frequently seen foot problems. 3 These conditions can by determined by assessment of median longitudinal arch (MLA).
Not much of attention is given to the foot health status in the developing countries like Nepal. Studies have shown that the injuries pattern may vary upon the type of foot arch. 4  Thus, a total of 87 participants were involved in the study following the random sampling technique.
Foot prints were collected from the participants in the A4 size paper after applying ink over the plantar surface of the foot. To reduce the errors due to distortion while scanning the images of the foot prints, a 5cm line was drawn at the corner of the page. Measurements were done using the Autodesk AutoCAD software 2020.
Foot axis was drawn from the center of the heel to the tip of the 2nd toe and then the foot print was divided into three equal thirds excluding the toes. Using the Autodesk AutoCAD software 2020 the areas of A, B & C were calculated and then the arch index was calculated for the individual foot using the formula AI= B/A+B+C Where A is the area of the forefoot, B is the area of midfoot and C is the area of the heel region of the foot.
AI scores were then used to classify the foot prints into three different categories: high (≤0.21), normal (0.21 to 0.28), low (≥0.28). 6 Subjects who were not known to any foot disease or deformities were included in the study.
Subjects who have undergone any foot surgeries or who are known cases of any foot disease were excluded from the study.
Statistical Package for the Social Sciences software was used for the data analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.
High arched foot was seen in 17 (19.77%) of female subjects and 11 (13.64%) of males. High arched foot was seen in the right foot in 12 (13.79%) of cases and 19.54% in the left foot. Only 8.04% of the subjects were identified with flat foot (Pes Planus) out of which 2 (2.27%) were male subjects and 12 (13.95%) were female subjects. Most of the subjects were identified with flat foot on the right side (10.34%).
Eighty-seven participants were involved in the study out of which 43 were females (49.4%) and 44 were males (50.6%).  The objective of the study was to determine the prevalence of pes planus in the Undergraduate Medical students of Nobel Medical College.
From the present study we found that flat foot was present in 8.04% of subjects. The results were similar and comparable to the results of many authors who from their respective studies reported 5.1%, 11.25%, 10%, 13.6%0, 16 12 A study carried on the Iranian students showed a very high incidence of flat foot i.e 74%. 13 A Srilankan study reported the incidence of flat foot in 51.6% of subjects. 14 These results were comparatively much higher than what we found from the present study.
We also found that 16 Pes cavus may arise due to some neurological disorder such as Charcot-Marie-Tooth disease, diastematomyelia, poliomyelitis etc. 15 A large sample size can be taken in order to see the prevalence of flat foot among the Nepalese population followed by the clinical evaluation in order to establish the cause of flat foot and accordingly plan for the possible remedies/treatment for its correction.
Free Full Text Articles are Available at www.jnma.com.np CONCLUSIONS From the current study we conclude that the prevalence of pes planus was slightly higher than that compared with the similar studies.