{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:58:19Z","timestamp":1776351499103,"version":"3.51.2"},"reference-count":27,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Flatfeet involve a collapse of the medial longitudinal arch, hindfoot valgus, and forefoot abduction. Flexible flatfoot is the most common type and can often be corrected with physiotherapy or orthotics. While some individuals remain asymptomatic, others develop symptoms for reasons that are not fully understood. This cross-sectional study compared plantar pressure distributions in 16 adults with asymptomatic and 16 with symptomatic flexible flatfeet (FPI-6 &gt; 6; navicular drop &gt; 5 mm), using a resistive-sensor-equipped pressure plate during walking and heel-strike running. During walking, symptomatic participants showed significantly higher total and peak forces at metatarsal 5 (p \u2264 0.003), and the midfoot (p \u2264 0.02146). The medial heel had significantly lower peak force (p = 0.00147), and metatarsal 4 showed higher peak force (p = 0.02539). Force ratios indicated a more lateralized pressure distribution in the symptomatic group. During heel-strike running, the symptomatic group exhibited higher total and peak forces at the fifth metatarsal, the midfoot, and the first metatarsal, with shorter time to peak force in the midfoot and the medial part of the heel. No significant ratio differences were found during running. Symptomatic individuals adopted a lateralized pressure distribution pattern, contrasting the traditional expectation of medial overload in flatfoot conditions.<\/jats:p>","DOI":"10.3390\/s26082451","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:05:36Z","timestamp":1776348336000},"page":"2451","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differences in Plantar Pressure Distribution Between Adults with Asymptomatic and Symptomatic Flexible Flatfeet During Walking and Heel-Strike Running"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7510-7844","authenticated-orcid":false,"given":"Nicolas","family":"Haelewijn","sequence":"first","affiliation":[{"name":"Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, 8200 Brugge, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iris","family":"Deknudt","sequence":"additional","affiliation":[{"name":"Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, 8200 Brugge, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Vanhaelewyn","sequence":"additional","affiliation":[{"name":"Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, 8200 Brugge, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1569-6333","authenticated-orcid":false,"given":"Filip","family":"Staes","sequence":"additional","affiliation":[{"name":"Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evie","family":"Vereecke","sequence":"additional","affiliation":[{"name":"Department of Development & Regeneration, Campus Kulak, KU Leuven, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6559-6237","authenticated-orcid":false,"given":"Kevin","family":"Deschamps","sequence":"additional","affiliation":[{"name":"Musculoskeletal Rehabilitation Research Group, Department of Rehabilitation Sciences, KU Leuven, Spoorwegstraat 12, 8200 Brugge, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/S1083-7515(03)00084-6","article-title":"Biomechanics and pathophysiology of flat foot","volume":"8","author":"Sangeorzan","year":"2003","journal-title":"Foot Ankle Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/s13047-014-0055-4","article-title":"Foot posture as a risk factor for lower limb overuse injury: A systematic review and meta-analysis","volume":"7","author":"Neal","year":"2014","journal-title":"J. Foot Ankle Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"700","DOI":"10.2519\/jospt.2013.4225","article-title":"Association between foot type and lower extremity injuries: Systematic literature review with meta-analysis","volume":"43","author":"Tong","year":"2013","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/j.1600-0838.2010.01144.x","article-title":"Risk factors and prognostic indicators for medial tibial stress syndrome","volume":"22","author":"Moen","year":"2012","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"585","DOI":"10.2165\/00007256-200636070-00004","article-title":"The pathomechanics of plantar fasciitis","volume":"36","author":"Wearing","year":"2006","journal-title":"Sports Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.gaitpost.2018.03.005","article-title":"Foot posture is associated with plantar pressure during gait: A comparison of normal, planus and cavus feet","volume":"62","author":"Buldt","year":"2018","journal-title":"Gait Posture"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"910","DOI":"10.3113\/FAI.2008.0910","article-title":"The correlation between pes planus and anterior knee or intermittent low back pain","volume":"29","author":"Kosashvili","year":"2008","journal-title":"Foot Ankle Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.foot.2019.02.004","article-title":"Flatfeet: Biomechanical implications, assessment and management","volume":"38","author":"Chander","year":"2019","journal-title":"Foot"},{"key":"ref_9","first-page":"LC22","article-title":"Flat Foot in a Random Population and its Impact on Quality of Life and Functionality","volume":"11","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.fcl.2015.07.011","article-title":"Painful Flexible Flatfoot","volume":"20","author":"Feldman","year":"2015","journal-title":"Foot Ankle Clin."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"24730114241231245","DOI":"10.1177\/24730114241231245","article-title":"Comparison of Foot Kinematics Between Normal Arch and Flexible Flatfoot Using the Oxford Foot Model: A Matched Case-Control Study","volume":"9","author":"Vijittrakarnrung","year":"2024","journal-title":"Foot Ankle Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1097\/BPO.0b013e31821723ce","article-title":"Flexible flatfoot: Differences in the relative alignment of each segment of the foot between symptomatic and asymptomatic patients","volume":"31","author":"Moraleda","year":"2011","journal-title":"J. Pediatr. Orthop."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1111\/sms.13512","article-title":"Differences in foot muscle morphology and foot kinematics between symptomatic and asymptomatic pronated feet","volume":"29","author":"Zhang","year":"2019","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.gaitpost.2018.02.026","article-title":"The relationship between foot posture and plantar pressure during walking in adults: A systematic review","volume":"62","author":"Buldt","year":"2018","journal-title":"Gait Posture"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Oerlemans, L.N.T., Peeters, C.M.M., Munnik-Hagewoud, R., Nijholt, I.M., Witlox, A., and Verheyen, C. (2023). Foot orthoses for flexible flatfeet in children and adults: A systematic review and meta-analysis of patient-reported outcomes. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-022-06044-8"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106990","DOI":"10.1016\/j.dib.2021.106990","article-title":"Comparison of flatfeet and normal feet using data of the gait cycle, contact area, and foot pressure","volume":"36","author":"Takata","year":"2021","journal-title":"Data Brief"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Badby, A.J., Mundy, P.D., Comfort, P., Lake, J.P., and McMahon, J.J. (2023). The Validity of Hawkin Dynamics Wireless Dual Force Plates for Measuring Countermovement Jump and Drop Jump Variables. Sensors, 23.","DOI":"10.3390\/s23104820"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/j.gaitpost.2013.01.028","article-title":"Reliability of plantar pressure platforms","volume":"38","author":"Hafer","year":"2013","journal-title":"Gait Posture"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.gaitpost.2013.04.003","article-title":"Pattern description and reliability parameters of six force-time related indices measured with plantar pressure measurements","volume":"38","author":"Deschamps","year":"2013","journal-title":"Gait Posture"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1080\/10255842.2010.527837","article-title":"One-dimensional statistical parametric mapping in Python","volume":"15","author":"Pataky","year":"2012","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1126\/science.8036513","article-title":"Variable gearing during locomotion in the human musculoskeletal system","volume":"265","author":"Carrier","year":"1994","journal-title":"Science"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/107110078900900607","article-title":"Shock absorbency of factors in the shoe\/heel interaction--with special focus on role of the heel pad","volume":"9","year":"1989","journal-title":"Foot Ankle"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s11832-010-0239-9","article-title":"Flexible flatfoot in children and adolescents","volume":"4","author":"Mosca","year":"2010","journal-title":"J. Child. Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/BPB.0000000000001324","article-title":"Plantar pressures in symptomatic and asymptomatic flexible flatfeet: How do they differ?","volume":"35","author":"Blackwood","year":"2026","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.gaitpost.2017.11.018","article-title":"Differences in pattern of variability for lower extremity kinematics between walking and running","volume":"60","author":"Estep","year":"2018","journal-title":"Gait Posture"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"161","DOI":"10.37190\/ABB-01652-2020-02","article-title":"The effects of gait speed on plantar pressure variables in individuals with normal foot posture and flatfoot","volume":"22","author":"Kirmizi","year":"2020","journal-title":"Acta Bioeng. Biomech."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"9867","DOI":"10.1038\/s41598-026-40771-5","article-title":"Effects of conservative interventions on plantar pressure in individuals with flat foot: A systematic review and meta-analysis","volume":"16","author":"Mahmoudiyan","year":"2026","journal-title":"Sci. Rep."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/8\/2451\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:06:57Z","timestamp":1776348417000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/8\/2451"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":27,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["s26082451"],"URL":"https:\/\/doi.org\/10.3390\/s26082451","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}