Prevalence of Flat Feet Among Female and its Association with the Use of Flat-Soled Footwear -A Cross Sectional Study

Abstract

Background: Flat feet (pes planus) is a common condition in which the arch of the foot becomes flattened. Many females preferred wearing flat-soled shoes such as slippers, sandals, or pumps, which did not provide proper arch support. Wearing such shoes for long hours put pressure on the feet and could cause changes in the arch over time. Due to fashion, daily routines, and prolonged standing hours, young females were at higher risk. Studying this condition helped to create awareness and guide people to choose better footwear for maintaining healthy feet. Objective:  To identify the prevalence of flat feet (pes planus) among females who habitually wore flat-soled footwear and to evaluate medial longitudinal arch function using the Navicular Drop Test, while also exploring how the frequency, duration, and type of flat footwear used were related to the development of flatfoot. Methodology: This was a cross-sectional study that included female students aged 18–25 years who wore flat-soled shoes at least four days per week. A total of 109 participants were selected through convenience sampling from Indus University and Jinnah Sindh Medical University. Basic information such as age, BMI, and footwear habits was recorded. The Navicular Drop Test was used to assess foot posture and identify flat feet. Data were analyzed using SPSS version 26, and results were presented in graphs and tables as frequencies and percentages. Result: A total of 109 female participants were included in the study. Most participants were above 20 years of age (89%) and had a BMI greater than 20 kg/m² (64.2%). The majority were right-foot dominant (77.1%) and reported moderate physical activity levels. Flat-soled footwear was commonly used among participants, with many reporting regular use for more than five years. The Navicular Drop Test (NDT) demonstrated marked navicular drop (≥10 mm) in 40.4% of right feet and 37.6% of left feet, indicating excessive pronation. Foot posture assessment showed that 70% of right feet and 65% of left feet had pronated or flatfoot posture. Higher BMI, increasing age, and prolonged use of flat-soled footwear were associated with greater navicular drop and altered foot posture. A statistically significant association was observed between the use of flat-soled footwear and the prevalence of flat feet among participants (p < 0.05), while most participants did not report foot pain, recurrent ankle discomfort, or use of orthotic supports. Conclusion: The present study highlights the importance of the medial longitudinal arch in maintaining foot stability, balance, and normal gait. Alterations in foot arch structure, influenced by factors such as body weight, lifestyle, and prolonged use of flat-soled footwear, may lead to flatfoot and changes in foot posture. In this study, a high prevalence of flatfoot and pronated posture was observed among female participants, with marked navicular drop more common in the right foot. Most participants were above 20 years of age, had higher BMI, and demonstrated right-foot dominance. Although foot pain, ankle discomfort, and orthotic use were low, dominant foot showed a significant association with NDT outcomes. The findings emphasize the need for awareness regarding appropriate footwear, early screening, and preventive strategies to improve foot health and reduce future musculoskeletal complications among females.