postural deformities in lower extremities among school children

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POSTURAL DEFORMITIES IN LOWER EXTREMITIES AMONG SCHOOL CHILDREN ARTICLE · MARCH 2014

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1 AUTHOR: Ramananda Ningthoujam Manipur University 10 PUBLICATIONS 0 CITATIONS SEE PROFILE

Available from: Ramananda Ningthoujam Retrieved on: 10 July 2015

POSTURAL DEFORMITIES IN LOWER EXTREMITIES AMONG SCHOOL CHILDREN Ramananda Ningthoujam* ABSTRACT The purpose of this research was to find out the number of students suffering from Pes Planus or Flat Foot Deformities (FFD), Genu Valgum or Knock Knees Deformities (KKD) and Genu Varum or Bow Legs Deformities (BLD). Seven hundred and forty nine (N=749) school children of 5th grade of Marathi medium and English medium schools were assessed for Flat Foot, Bow Legs (BW) and Knock Knees (KK) at Wanawadi, Pune with the help of Plumb Line Test (PLT), and Wet Foot Print Test (WFPT). Harris and Beath (1947) as describe by Rose, Welton and Marshall (1985) method of grading foot print was used. Out of 749 students, 396 were boys and 353 girls and they were aged between 9-13 years of age. Descriptive analysis was used as the method of analysis and the number of students suffering from Postural Deformities was represented in percentage. Result: As a result of the survey, out of the 749 students, 40 (5.3%) students are found to be suffering from selected Postural Deformities. The degree of deviation was slight deformities. Conclusion: Students wearing flat sole shoes had higher chances of suffering from flat foot deformity as the study reveals that the majority of students suffering from this deformity are those who wear flat sole shoes. Keywords: Bow Legs; Flat Foot; Wet Foot print Test; Knock Knee; Plumb Line INTRODUCTION Postural deformities in children are one of the common problems prevalent in today’s society. From an early stage, children are often subjected to this deformity due to distortion in their posture or alignment as a result of their exposure to Television, video entertainment, motorized transportation, fast food and lack of regular physical activity. And thus, it can be referred to as a behavioural outcome. It must be noted that the working efficiency and ability of men depend upon good posture. It conveys the impression of his well being and reflects activeness, agility and wholesomeness of an individual’s personality. According to the study nearly 32.5 per cent of the population of Pune lives in slums, a recent study has revealed. The study also found that the 477 slum pockets *Department of Physical Education and Sports Science, Manipur University, Canchipur (Manipur) India

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in the city lie on just about 2.34 per cent of the total land area of the Pune Municipal Corporation (PMC). NGO Mashal has prepared a ‘Slum Atlas of Pune City, which shows that 11,50,000 people (2,11,423 families) reside in slums in the city. The study was conducted from 2008 by actual mapping of slums and doing a ground survey. The findings were presented before the Pune Municipal Corporation (PMC). Pune formerly known as Poona, is the eighth largest metropolis in India and the second largest in the state of Maharashtra. Schools in Pune are either run by the Pune Municipal Corporation (PMC), in which case they are called public schools, or privately by trusts and individuals. Private schools have been preferred by a majority of city residents because of better facilities, and in some cases, for the use of English language as the medium of instruction. A number of Marathi medium schools are more than a century old. All schools are affiliated either with the Maharashtra state SSC board or the all-India Indian Certificate of Secondary Education (ICSE), CBSE or NIOS boards. More interestingly, most of the children from slums take admission in Marathi medium schools. And children from high class family prefer English medium school because of the better facilities. MATERIALS AND METHODS Subjects were selected from the school children of 5th standard of Wanawadi area. Seven hundred and forty nine (749) students from Marathi and English Medium schools had undergone the Plumb Line test (PLT) and Wet Foot print test (WFPT). 396 were boys and 353 girls and they were aged between 9-13 years of age. The student of Marathi medium schools uses flat sole shoes without arc and leather shoes. The students of English medium schools uses leather shoes and rebook jogging shoes as their uniform. Flat sole shoes may be referred to those shoes without an arch and the leather shoes has arch. Those students who use different footwear were not considered. VARIABLES The following variables were selected for the purpose of this study. The test items and tools are shown in Table 1. TABLE 1 : Test Item and Tools Test

Item

Tools

Wet Foot Print Test

Flat Foot

Water and scale

Plumb Line Test

Knock Knees and Bow Legs

Scale, Measuring Tape, Plumb

FLAT FOOT (FF), KNOCK KNEES (KK), BOW LEGS (BL) The methods used to conduct the research are described below: Plumb Line Test Plumb line Test (PLT) was conducted for diagnosis of bow Legs (BL) and knock knees (KK) deformities [Table 2]. The legs were categories as Bow legs, Straight legs or knock VOLUME : 03, ISSUE : 01, MARCH 2014

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knees. The subject is positioned behind the plumb line so that the plumb line bisected by the body. The plumb line was suspended from hip in front of the knee. In the plumb line test (PLT), the plumb line lies between the medial side of the foot for knock knees (KK) and the lateral side of the foot for Bow legs (BL). TABLE 2 : Test for Bow Legs And Knock knees Knock Knees To identify the knock kneed, stand naturally with bare legs together. If there is knocking kneed, the knees should rotate slightly inwards until they touch, with the ankles separated

Straight Legs To identify the straight legged, stand naturally with bare legs together. If there are straight legs the knees will not rotate either way, the ankles and knees will be equal distance apart

Bow Legs To identify the bow legged; stand naturally with bare legs together. If there are bow legged, the knees may rotate slightly outwards while the ankles will be close together

Finger Test Able to place two or more fingers between the ankles but not between the knees.

Finger Test Unable to place two fingers between both the ankles and knees.

Finger Test Able to place two or more fingers between the knees but not between the ankles.

Plumb line test Plumb Line Test The line lies inside the medial It falls over the middle of side of the foot. the foot

Plumb Line Test The line falls outside the lateral side of the foot

The degree of deviation for bow legs and knock knees was classified as slight, mild and severe [Table 3]. For KKD the distance was measured between the medial side of two ankles and for the BLD it was measured between the medial sides of two knees. TABLE 3 : Deviation chart Degree Severity

Slight

Mild

Severe

Deviation

0< > 5 cm

> 5 cm

> 10 cm

Wet Foot Print Test Wet Foot Print test (WFPT) is used for the diagnosis of flat foot (FF). It is performed by wetting the feet in colour water and then standing on a smooth, level surface. Harris and Beath (1947) as describe by Rose, Welton and Marshall (1985) method of grading foot print was used. The footprints were classified as normal, high arched or normal [Figure 1]. STATISTICAL METHOD USED Descriptive statistic was used for the survey research and the method used for statistical analysis is percentage method. It is as given below. P ═ n × 100 ⁄ N

Where, P= Percentage

n= Number of Deformities Student N = Total Student [80] International Journal of Physical Education, Health & Sports Sciences


RESULTS The analysis of the data on the survey work of Flat Foot, Knock Knees and bow Legs of school going children’s at Wanawadi area which was made on the basis of the data collected from the subject are as follows: It was found that 3.33% of students were suffering from Flat Foot Deformities (FFD), which means 25 students out of 749 students suffering from this deformity. 709 students were found normal (94.64%) The percentage of students suffering from Bow Leg Deformity (BLD) is 1.86% which means 14 out 749 students are suffering from BLD. The percentage of students suffering from Knock Knees Deformities (KKD) was found to be quite low with only 0.13%. This means that there was only 1 student out of 749 who was suffering from KKD (as presented in Table 4). TABLE 4 : Postural Deformities students Deformities

Number of deformities

Percentage (%)

Boys

Total Number of deformities Girls (n)

Boys

Girls

Flat Foot

12

13

25

3.03

3.68

3.33

Bow Legs

11

3

14

2.786

0.85

1.86

1

1

-

0.28

0.13

Knock Knees -

Total (%)

Subject

Boys

Girls

396

353

Total Subject (N)

749

3.03% of boys i.e. 12 out of 396 boys were suffering from FFD. The percentage of boys suffering from BLD is 2.78% which means there are 11 boys out 396, suffering from this deformity. No KKD are found among the boys (see Table 5). VOLUME : 03, ISSUE : 01, MARCH 2014


TABLE 5 : Boys Postural Deformities students Variables

Number (n)

Percentage (%)

Flat Foot

12

3.03

Bow Legs

11

2.786

Knock Knees

-

-

Total Subject 396

3.68% girls were suffering from FFD i.e. about 13 out of 353 girls students suffered from this deformity. 0.85% girls suffered from BLD. This means that out of 353 girls’ students, only 3 students suffered from this deformity. Only 1 KKD was found in girls’ students which is 0.28% (as shown in Table 6). TABLE 6 : Girls Postural Deformities students Variables

Number (n)

Percentage (%)

Flat Foot

13

3.68

Bow Legs

3

0.85

Knock Knees

1

0.28

Total Subject 353

The degree of deformities for BL and KK was slight deviation [Table 7]. TABLE 7 : Degree of Deformities Variables

School

Number (n)

Degree

English Medium

Marathi Medium

Bow Legs

11

3

14

Slight

Knock Knees

1

0

1

Slight

Total Subject (N)

749

Overall percentage of Flat Foot, Bow Legs and Knock Knees for boys and girls students can be seen from Figure 2.

Fig. 2 Overall % of FF, BL and KK [82] International Journal of Physical Education, Health & Sports Sciences


Comparatively, the case of FF was higher in girls (3.68%) than the boys (3.03%). In case of BL it was higher in boys (2.78%) as compared to the girls (0.58%). Where KKD is concerned, the percentage was very low with only (0.28%) in girls. No KKD was found in boys students. DISCUSSION It was found that students wearing flat sole shoes had higher chances of suffering from flat foot deformity. Out of 25 students suffering from FFD, 16 of them were wearing flat sole shoes. Most of the flat foot children were from Marathi medium schools [Table 8]. TABLE 8 : Flat Foot students using Flat Sole and Leather shoes Variables Flat Foot

Shoes

Percentage (%)

Flat sole

Leather

Flat sole

Leather

16

8

64

32

Total Subject 25

Cross-sectional study also suggests that shoe-wearing in early childhood is detrimental to the development of a normal or a high medial longitudinal arch (UB Rao and B Joseph, 1992). Further research is recommended in this area. Research for 25 years has been aimed at elucidating this problem by identifying and evaluating a series of signs and tests. The tests allow the recognition of the abnormal foot as early as possible, when efficient treatment is likely to be most effective. Previous survey on Flat foot by UB Rao and B Joseph also found that it was 12.1% among children attending English-speaking schools and 3.5% in those at Kannada-speaking schools. CONCLUSION Students wearing flat sole shoes had higher chances of suffering from flat foot deformity as the study reveals that the majority of students suffering from this deformity are those who wear flat sole shoes. Further research is recommended in this area. It has been observed that most of the schools in Wanawadi areas organized regular annual health check up which includes the eyes, teeth and general check up. But the children were never checked for their postural deformities, which is also essential for the development of the students’ personalities. No medical records of the students were maintained. Moreover, most of the school authorities lacked the awareness about postural deformities and shoes mechanism. REFERENCES Dr. Soti Shivendra Chandra & Krishan Puri. 1999. Health education & Physical Education. p. a6.3 Dekel, Y. 1996. An exploratory study on the relationship between postural deformities and body-image and self-esteem in adolescents: the mediating role of physical activity: International Journal of Sport Psychology. vol. 27 no. 2 pp. 183-196



Min Woo Chung, Shock absorption mechanism for shoes. Publication number and date: US 6553692 B1, Apr 29, 2003 Neha Kaura (Sep 4, 2010), Are you choosing the right shoes for your physical activities , Times of India Publications - mPaper N. Miyakoshi E. Itoi , M. Kobayashi , H. Kodama. 2003. The impact of postural deformities and spinal mobility on quality of life in patients with spinal osteoporosis. Osteoporos Int 2003;14(12):1007-1012 Ramin Espandar Md. 2009. Angular deformities of the lower limb in children. Asian J Sports Med, 2010 March; 1 (1):pp 46-53. Sandra J. Shultz, PhD, ATC, CSCS, FNATA, Peggy A. Houglum, PhD, ATC, PT, and David H. Perrin, PhD, ATC, Examination of Musculoskeletal Injuries, Third Edition: Correctly examine posture (Nov 10, 2009) UB Rao and B Joseph. 1992. The influence of footwear on the prevalence of flat foot: A survey of 2300 children. J Bone Joint Surg Br. 1992 Jul;74(4):525-7.

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