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Flat Feet, Happy Feet? Comparison of the Dynamic Plantar Pressure Distribution and Static Medial Foot Geometry between Malawian and Dutch Adults.
Stolwijk NM, Duysens J, Louwerens JW, van de Ven YH, Keijsers NL. PLoS One. 2013;8(2)
In contrast to western countries, foot complaints are rare in Africa. This is remarkable, as many African adults walk many hours each day, often barefoot or with worn-out shoes. The reason why Africans can withstand such loading without developing foot complaints might be related to the way the foot is loaded. Therefore, static foot geometry and dynamic plantar pressure distribution of 77 adults from Malawi were compared to 77 adults from the Netherlands. None of the subjects had a history of foot complaints. The plantar pressure pattern as well as the Arch Index (AI) and the trajectory of the center of pressure during the stance phase were calculated and compared between both groups. Standardized pictures were taken from the feet to assess the height of the Medial Longitudinal Arch (MLA). We found that Malawian adults: (1) loaded the midfoot for a longer and the forefoot for a shorter period during roll off, (2) had significantly lower plantar pressures under the heel and a part of the forefoot, and (3) had a larger AI and a lower MLA compared to the Dutch. These findings demonstrate that differences in static foot geometry, foot loading, and roll off technique exist between the two groups. The advantage of the foot loading pattern as shown by the Malawian group is that the plantar pressure is distributed more equally over the foot. This might prevent foot complaints.
Re: Comparison of the Dynamic Plantar Pressure Distribution and Static Medial Foot Geometry between Malawian and Dutch Adults
I enjoyed reading this article. It was interesting that the Malawi subjects have increased loading area with more equal pressure distribution-don't most orthotics accomplish this?. The larger period of midfoot loading and shorter period of forefoot loading suggests a more efficient propulsion strategy in the Malawi subjects. However, they do not prove that this is attributable to more time spent barefoot walking and they do not prove that the Malawi walking strategy is superior. Also, they state or imply that foot pain is less prevalent in Africa, but do not back this up in the population groups they are studying. "Flat fee, happy feet?" is a catchy title.
I just don't know how this changes what we do in clinic tomorrow, but hope more studies will shed light on this subject.