{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T03:42:24Z","timestamp":1771904544504,"version":"3.50.1"},"reference-count":49,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Association of Danish Podiatrists"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["MPs"],"abstract":"<jats:p>Background: The health of children\u2019s lower extremities and feet is a focus area for caregivers and healthcare professionals such as doctors, school nurses, and podiatrists. Our study aims to investigate the general health status of Danish children\u2019s lower extremities and feet to identify anthropometric parameters that might be preconditions for pain and evaluate for foot diseases and whether they are associated with pain intensity and location, three-dimensional foot dimensions and foot pressure mapping, shoe dimensions, types and intensity of sports activity, quality of life, and foot health. The aim is that we will be able to identify parameters pre-dispositioning for pain, thus providing recommendations for sports activities in relation to the anthropometric conditions of a child as a potential preventive measure for pain. This analysis will be stratified by socioeconomic status on a group level, and this perspective will be able to provide preventative recommendations to prevent pain. Methods: This study is a cross-sectional examination of a thousand children in the first, fifth, and ninth grades in randomized selected Danish primary schools. We will perform a clinical examination of the lower extremities and feet for misalignments, deformities, and diseases as well as rotational status and range of motion. Moreover, we will evaluate their pain levels, sports activities, three-dimensional foot dimensions, plantar pressure, footwear, and patient-related outcome measures (PROMs) for foot health and quality of life. Results: We aim to provide an anthropometrical overview of the lower extremities and feet in children. The obtained basic understanding of healthy normal material in children will be analyzed for its relationships with pain level, sports activities, and socioeconomic status on a group level. This could potentially provide us with an understanding of the factors that impact lower extremity and foot diseases in children. In conclusion, examining children\u2019s lower extremities and feet in Danish primary schools is a step toward identifying areas of improvement in self-care and shoe fitting, mapping podiatry-related needs of care in children\u2019s feet, and providing parental recommendations for preventive actions on shoe fitting and the choice and intensity of sports activity concerning pain. Conclusions: The tenet of this study is a long-term follow-up to evaluate the long-term socioeconomic course on a group level, foot status, and sports activity, using patient-related outcome measures evaluating quality of life and other lifestyle factors such as emotional functioning, social functioning and interaction, and school functioning. Potentially, this will improve children\u2019s quality of life and prevent future diseases.<\/jats:p>","DOI":"10.3390\/mps6060115","type":"journal-article","created":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T03:58:02Z","timestamp":1701403082000},"page":"115","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Protocol Article: A Cross-Sectional Evaluation of Children\u2019s Feet and Lower Extremities"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3201-5827","authenticated-orcid":false,"given":"Christian","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Hvidovre, Denmark"},{"name":"Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina Ystr\u00f8m","family":"Bjerge","sequence":"additional","affiliation":[{"name":"The Association of Danish Podiatrists, 2300 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ales","family":"Jurca","sequence":"additional","affiliation":[{"name":"Volumental AB, 118 72 Stockholm, Sweden"},{"name":"Jozef Stefan International Postgraduate School, 1000 Ljubljana, Slovenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2324-6420","authenticated-orcid":false,"given":"Michael M\u00f8rk","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soren","family":"Boedtker","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Balslev-Clausen","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Copenhagen University Hospital, 2650 Hvidovre, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steen","family":"Harsted","sequence":"additional","affiliation":[{"name":"Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark"},{"name":"Medical Research Unit, Spine Center of Southern Denmark, University Hospital of Southern Denmark, 5500 Middelfart, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1093\/pch\/pxac067","article-title":"Medical Neglect: Working with Children, Youth, and Families","volume":"27","author":"Ward","year":"2022","journal-title":"Paediatr. Child. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s13047-020-0372-8","article-title":"Symptomatic Pes Planus in Children: A Synthesis of Allied Health Professional Practices","volume":"13","author":"Morrison","year":"2020","journal-title":"J. Foot Ankle Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Br\u00f8nnum-Hansen, H., and Baadsgaard, M. (2012). Widening Social Inequality in Life Expectancy in Denmark. A Register-Based Study on Social Composition and Mortality Trends for the Danish Population. BMC Public. Health, 12.","DOI":"10.1186\/1471-2458-12-994"},{"key":"ref_4","unstructured":"Bharmal, N., Derose, K.P., Felician, M.F., and Weden, M.M. (2015). Understanding the Upstream Social Determinants of Health, RAND Corporation."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Fuglkj\u00e6r, S., Dissing, K.B., and Hestb\u00e6k, L. (2017). Prevalence and Incidence of Musculoskeletal Extremity Complaints in Children and Adolescents. A Systematic Review. BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-017-1771-2"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Fuglkj\u00e6r, S., Hartvigsen, J., Wedderkopp, N., Boyle, E., Jespersen, E., Junge, T., Larsen, L.R., and Hestb\u00e6k, L. (2017). Musculoskeletal Extremity Pain in Danish School Children\u2014How Often and for How Long? The CHAMPS Study-DK. BMC Musculoskelet. Disord., 18.","DOI":"10.1186\/s12891-017-1859-8"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Wakefield, M.K., Williams, D.R., Menestrel, S., and Le Flaubert, J.L. (2021). The Future of Nursing 2020\u20132030, National Academies Press.","DOI":"10.17226\/25982"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/AJP.0b013e318192bfb1","article-title":"Pain, Fatigue, and Health-Related Quality of Life in Children and Adolescents with Chronic Pain","volume":"25","author":"Gold","year":"2009","journal-title":"Clin. J. Pain."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Haraldstad, K., Christophersen, K.A., and Helseth, S. (2017). Health-Related Quality of Life and Pain in Children and Adolescents: A School Survey. BMC Pediatr., 17.","DOI":"10.1186\/s12887-017-0927-4"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1007\/s11832-014-0621-0","article-title":"Health-Related Quality of Life in Children with Flexible Flatfeet: A Cross-Sectional Study","volume":"8","author":"Kothari","year":"2014","journal-title":"J. Child. Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/03093640500199695","article-title":"A Cross-Sectional Study on the Development of Foot Arch Function of 2715 Chinese Children","volume":"29","author":"Leung","year":"2005","journal-title":"Prosthet Orthot Int"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.jos.2018.02.004","article-title":"Flexible Flatfoot of 6\u201313-Year-Old Children: A Cross-Sectional Study","volume":"23","author":"Yin","year":"2018","journal-title":"J. Orthop. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1016\/j.aott.2016.03.002","article-title":"Prevalence of Flatfoot among School Students and Its Relationship with BMI","volume":"50","author":"Pourghasem","year":"2016","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1053\/j.jfas.2005.07.023","article-title":"The Evolution of Foot Morphology in Children between 6 and 17 Years of Age: A Cross-Sectional Study Based on Footprints in a Mediterranean Population","volume":"44","author":"Stavlas","year":"2005","journal-title":"J. Foot Ankle Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13047-017-0218-1","article-title":"The Typically Developing Paediatric Foot: How Flat Should It Be? A Systematic Review","volume":"10","author":"Uden","year":"2017","journal-title":"J. Foot Ankle Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.gaitpost.2011.10.357","article-title":"Static and Dynamic Foot Characteristics in Children Aged 1-13 Years: A Cross-Sectional Study","volume":"35","author":"Carlsohn","year":"2012","journal-title":"Gait Posture"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.2522\/ptj.20150192","article-title":"Medial Longitudinal Arch Development of Children Aged 7 to 9 Years: Longitudinal Investigation","volume":"96","author":"Tong","year":"2016","journal-title":"Phys. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.fas.2019.05.017","article-title":"Does the Long-Term Use of Medial Arch Support Insole Induce the Radiographic Structural Changes for Pediatric Flexible Flat Foot?\u2014A Prospective Comparative Study","volume":"26","author":"Choi","year":"2020","journal-title":"Foot Ankle Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"623","DOI":"10.5435\/JAAOS-22-10-623","article-title":"Flatfoot Deformity in Children and Adolescents: Surgical Indications and Management","volume":"22","author":"Bouchard","year":"2014","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-Elena, M.L., Castro-M\u00e9ndez, A., C\u00f3rdoba-Fern\u00e1ndez, A., and Cohe\u00f1a-Jim\u00e9nez, M. (2021). Relationship of the Use of Short Footwear with the Development of Hallux Valgus in a Sample of Andalusian Schoolchildren. Int. J. Environ. Res. Public. Health, 18.","DOI":"10.3390\/ijerph182111244"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Puszcza\u0142owska-Lizis, E., Zarzyczna, P., and Miku\u013e\u00e1kov\u00e1, W. (2020). Impact of Footwear Fitting on Foot Shape in Primary Schoolgirls. Acta Bioeng. Biomech., 22.","DOI":"10.37190\/ABB-01425-2019-02"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13047-018-0281-2","article-title":"Big Issues for Small Feet: Developmental, Biomechanical and Clinical Narratives on Children\u2019s Footwear","volume":"11","author":"Morrison","year":"2018","journal-title":"J. Foot Ankle Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1177\/0309364613497047","article-title":"Footwear Suitability in Turkish Preschool-Aged Children","volume":"38","author":"Yurt","year":"2014","journal-title":"Prosthet. Orthot. Int."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez Elena, M.L., and C\u00f3rdoba-Fern\u00e1ndez, A. (2019). Footwear Fit in Schoolchildren of Southern Spain: A Population Study. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2591-3"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S130","DOI":"10.1080\/19424280.2019.1606117","article-title":"Children\u2019s Foot Size versus Children\u2019s Shoe Size When They Return to Store","volume":"11","author":"Haley","year":"2019","journal-title":"Footwear Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.apmr.2004.05.014","article-title":"Measuring Standing Hindfoot Alignment: Reliability of Goniometric and Visual Measurements","volume":"86","author":"Haight","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1097\/00003086-198910000-00010","article-title":"Torsion-Treatment Indications","volume":"247","author":"Staheli","year":"1989","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1016\/j.pain.2011.07.005","article-title":"Validity of Four Pain Intensity Rating Scales","volume":"152","author":"Jensen","year":"2011","journal-title":"Pain"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1302\/0301-620X.97B3.34355","article-title":"Validation of the Translated Oxford Ankle Foot Questionnaire in 82 Danish Children Aged between Five and 16 Years","volume":"97-B","author":"Martinkevich","year":"2015","journal-title":"Bone Jt. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"800","DOI":"10.2106\/00004623-198971060-00002","article-title":"Corrective Shoes and Inserts as Treatment for Flexible Flatfoot in Infants and Children","volume":"71","author":"Wenger","year":"1989","journal-title":"J. Bone Jt. Surg. Ser. A"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/S0268-0033(99)00028-5","article-title":"Ects of Foot Orthoses on Skeletal Motion during Running","volume":"15","author":"Stacoff","year":"2000","journal-title":"Clin. Biomech."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Puszczalowska-Lizis, E., Zarzyczna, P., Mikulakova, W., Migala, M., and Jandzis, S. (2020). Influence of Footwear Fitting on Feet Morphology in 9 Year Old Girls. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-02245-z"},{"key":"ref_33","first-page":"241","article-title":"Evaluation of the Medial Longitudinal Arch: A Comparison between the Dynamic Plantar Pressure Measurement System and Radiographic Analysis","volume":"44","author":"Esen","year":"2010","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e17074","DOI":"10.1097\/MD.0000000000017074","article-title":"The Effect of Insoles on Symptomatic Flatfoot in Preschool-Aged Children: A Prospective 1-Year Follow-up Study","volume":"98","author":"Chen","year":"2019","journal-title":"Medicine"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Klein, C., Groll-Knapp, E., Kundi, M., and Kinz, W. (2009). Increased Hallux Angle in Children and Its Association with Insufficient Length of Footwear: A Community Based Cross-Sectional Study. BMC Musculoskelet. Disord., 10.","DOI":"10.1186\/1471-2474-10-159"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s11832-010-0297-z","article-title":"Normal Development of the Knee Angle in Healthy Indian Children: A Clinical Study of 215 Children","volume":"4","author":"Saini","year":"2010","journal-title":"J. Child. Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"714","DOI":"10.3346\/jkms.2008.23.4.714","article-title":"Development of Tibiofemoral Angle in Korean Children","volume":"23","author":"Jae","year":"2008","journal-title":"J. Korean Med. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1097\/01241398-200103000-00027","article-title":"Normal Development of the Tibiofemoral Angle in Children: A Clinical Study of 590 Normal Subjects from 3 to 17 Years of Age","volume":"21","author":"Arazi","year":"2001","journal-title":"J. Pediatr. Orthop."},{"key":"ref_39","unstructured":"(2023, October 07). R Core Team. R: A Language and Environment for Statistical Computing [Internet]. Vienna, Austria: R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"630","DOI":"10.2340\/16501977-1160","article-title":"Test-Retest and Inter-Rater Reliability of a Method to Measure Wrist and Finger Spasticity","volume":"45","author":"Sandgren","year":"2013","journal-title":"J. Rehabil. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.sapharm.2012.04.004","article-title":"Interrater Agreement and Interrater Reliability: Key Concepts, Approaches, and Applications","volume":"9","author":"Gisev","year":"2013","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"De Vet, H., Terwee, C., Mokkink, L., and Knol, D. (2011). Measurement in Medicine: A Practical Guide. Measurement in Medicine: A Practical Guide, Cambridge University Press.","DOI":"10.1017\/CBO9780511996214"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","article-title":"A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research","volume":"15","author":"Koo","year":"2016","journal-title":"J. Chiropr. Med."},{"key":"ref_44","unstructured":"(2023, October 07). Measuring Agreement in Method Comparison Studies, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/10501650\/."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12998-016-0122-y","article-title":"Association between Sports Type and Overuse Injuries of Extremities in Children and Adolescents: A Systematic Review","volume":"24","year":"2016","journal-title":"Chiropr. Man. Therap"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e012606","DOI":"10.1136\/bmjopen-2016-012606","article-title":"Leisure-Time Sport and Overuse Injuries of Extremities in Children Age 6-13, a 2.5 Years Prospective Cohort Study: The CHAMPS-Study DK","volume":"7","author":"Jespersen","year":"2017","journal-title":"BMJ Open"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Wedderkopp, N., Jespersen, E., Franz, C., Klakk, H., Heidemann, M., Christiansen, C., M\u00f8ller, N.C., and Leboeuf-Yde, C. (2012). Study Protocol. The Childhood Health, Activity, and Motor Performance School Study Denmark (The CHAMPS-Study DK). BMC Pediatr., 12.","DOI":"10.1186\/1471-2431-12-128"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1249\/MSS.0000000000000604","article-title":"Motor Performance as Predictor of Physical Activity in Children: The CHAMPS Study-DK","volume":"47","author":"Larsen","year":"2015","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00223-018-0466-5","article-title":"Bone Mass Development in Childhood and Its Association with Physical Activity and Vitamin D Levels","volume":"104","author":"Heidemann","year":"2019","journal-title":"CHAMPS-Study DK. Calcif. Tissue Int."}],"container-title":["Methods and Protocols"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2409-9279\/6\/6\/115\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:35:41Z","timestamp":1760132141000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2409-9279\/6\/6\/115"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,1]]},"references-count":49,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["mps6060115"],"URL":"https:\/\/doi.org\/10.3390\/mps6060115","relation":{},"ISSN":["2409-9279"],"issn-type":[{"value":"2409-9279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,1]]}}}