{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:51:24Z","timestamp":1792047084044,"version":"4.4.0"},"reference-count":42,"publisher":"BMJ","issue":"4","funder":[{"name":"The University of Malaga through of Plan Propio de Investigacion and Fondo Europeo de Desarrollo Regional (FEDER) and Consejer\u00eda de Econom\u00eda e Infraestructura of the Junta de Extremadura"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,2,26]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The foot posture index (FPI) is an observational tool designed to measure the position of the foot. The objective of this study was to establish international reference data for foot posture across childhood, and influence of body mass index (BMI) on paediatric foot posture.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>The dataset comprised 3217 healthy children, aged from 3 to 15 years. Contributing data were acquired from Spain, UK and Australia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Foot posture was described by means and z-score of the FPI and the height and weight of each subject was measured and the BMI was calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The foot posture of 3217 children were reviewed. A pronated (FPI \u2265+6) foot posture was found in 960 (29.8%) children, a normal (FPI 0 to +6) foot posture in 1776 (55.2%) and a highly pronated (FPI +10) foot posture was found in 127 children (3.9%) (range \u22124 to +12 FPI). Less than 11% were found to have a supinated foot type (n=354). Approximately 20% of children were overweight\/obese, but correlation between BMI and FPI was weak and inverse (r=\u22120.066, p&lt;0.01), refuting the relationship between increased body mass and flatfeet.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study confirms that the \u2018flat\u2019 or pronated foot is the common foot posture of childhood, with FPI score of +4 (3) the average finding. Trend indicated a less flatfoot with age, although non-linear. A wide normal range of foot posture across childhood is confirmed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-023341","type":"journal-article","created":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T07:45:40Z","timestamp":1555314340000},"page":"e023341","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":41,"title":["International normative data for paediatric foot posture assessment: a cross-sectional investigation"],"prefix":"10.1136","volume":"9","author":[{"given":"Gabriel","family":"Gijon-Nogueron","sequence":"first","affiliation":[{"name":"Nursing and Podiatry, Universidad de Malaga, Malaga, Spain"},{"name":"Instituto de Investigaci\u00f3n Biom\u00e9dica de M\u00e1laga (IBIMA), Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Martinez-Nova","sequence":"additional","affiliation":[{"name":"Nursing and Podiatry, Universidad de Extremadura, Caceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Alfageme-Garcia","sequence":"additional","affiliation":[{"name":"Nursing and Podiatry, Universidad de Extremadura, Caceres, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesus","family":"Montes-Alguacil","sequence":"additional","affiliation":[{"name":"Nursing and Podiatry, Universidad de Malaga, Malaga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela Margaret","family":"Evans","sequence":"additional","affiliation":[{"name":"Podiatry, La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,14]]},"reference":[{"key":"2025121222320985000_9.4.e023341.1","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1093\/pch\/17.9.e93","article-title":"Physiological referrals for paediatric musculoskeletal complaints: A costly problem that needs to be addressed","volume":"17","author":"Carli","year":"2012","journal-title":"Paediatr Child Health"},{"key":"2025121222320985000_9.4.e023341.2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-2126"},{"key":"2025121222320985000_9.4.e023341.3","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/PEP.0000000000000337","article-title":"Reliability of the Arch Height Index as a Measure of Foot Structure in Children","volume":"29","author":"Drefus","year":"2017","journal-title":"Pediatr Phys Ther"},{"key":"2025121222320985000_9.4.e023341.4","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.clinbiomech.2005.08.002","article-title":"Development and validation of a novel rating system for scoring standing foot posture: the foot posture index","volume":"21","author":"Redmond","year":"2006","journal-title":"Clin Biomech"},{"key":"2025121222320985000_9.4.e023341.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-010-1330-4"},{"key":"2025121222320985000_9.4.e023341.6","doi-asserted-by":"crossref","first-page":"e115808","DOI":"10.1371\/journal.pone.0115808","article-title":"Flatfoot diagnosis by a unique bimodal distribution of footprint index in children","volume":"9","author":"Chang","year":"2014","journal-title":"PLoS One"},{"key":"2025121222320985000_9.4.e023341.7","first-page":"2","article-title":"The diagnosis and management of common childhood orthopedic disorders","volume":"41","author":"Nemeth","year":"2011","journal-title":"Curr Probl Pediatr Adolesc Health Care"},{"key":"2025121222320985000_9.4.e023341.8","doi-asserted-by":"crossref","unstructured":"Uden H , Scharfbillig R , Causby R . 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