足功能指数在儿童和青少年扁平足中的信度和效度

doi:10.3969/j.issn.1006-9771.2025.06.014

摘要/Abstract

摘要：

目的明确足功能指数(FFI)应用于儿童和青少年扁平足患者的信度和效度。

方法 2023年1月至2024年6月，于上海交通大学医学院附属第九人民医院3D打印接诊中心就诊的7~18岁扁平足患者中，挑选符合要求的患者41例作为观察组，纳入同期体检健康、正常发育、无任何足部问题的儿童和青少年56例作为对照组。所有参与者均填写FFI问卷。采用Cronbach α来确定FFI问卷的内部一致性。通过验证性因子分析观察问卷的结构效度。

结果受试者的平均年龄为(12.99±3.19)岁。FFI的Cronbachs α系数为0.977，KMO值为0.914，模型拟合良好。总人群(7~18岁)、儿童组(7~13岁)、青少年组(14~18岁)主成分累计方差贡献率分别为93.967%、91.95%和96.91%。主成分分析得到3个主因子，所有条目的公因子方差均>0.70，因子载荷系数均> 0.40，每个公因子与变量之间有着较强关联性。

结论 FFI在评估儿童和青少年扁平足方面表现出良好的内部一致性信度和结构效度。

关键词: 儿童, 青少年, 扁平足, 足功能指数, 信度, 效度

Abstract:

Objective To determine the reliability and validity of foot function index (FFI) in children and adolescent with flatfeet.

Methods From January, 2023 to June, 2024, among the patients with flatfeet aged seven to 18 years who were treated at the 3D Printing Reception Center of the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 41 patients who met the requirements were selected as observation group, while 56 children and adolescents with healthy, normal development and no foot problems were selected as the control group. All participants filled out FFI questionnaire. Cronbach's α was used to determine internal consistency of FFI questionnaire. The structural validity of the questionnaire was observed by confirmatory factor analysis.

Results The mean age of the subjects was (12.99±3.19) years. The Cronbach's α coefficient of FFI was 0.977, and the KMO value was 0.914, showing a good fit of the model. The cumulative variance contribution rates of the principal component for the total population (seven to 18 years old), children group (seven to 13 years old), and adolescents group (14 to 18 years old) were 93.967%, 91.95% and 96.91%, respectively. Principal component analysis obtained three principal factors. The common factor variance of all items was > 0.70, and the factor loading coefficient was > 0.40, indicating a strong correlation between each common factor and the variable.

Conclusion FFI exhibited good internal consistency and construct validity in its application for assessing flatfoot in children and adolescents.

Key words: children, adolescent, flatfeet, foot function index, reliability, validity

中图分类号:

R682.1
R493

冯海洋. 足功能指数在儿童和青少年扁平足中的信度和效度[J]. 《中国康复理论与实践》, 2025, 31(6): 729-735.

FENG Haiyang. Reliability and validity of foot function index in flatfeet of children and adolescents[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(6): 729-735.

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参考文献 41

[1]	FADLE A A, KHALIFA A A, BAHY A, et al. Joint preservation surgery for correcting adolescents' spasmodic flatfoot deformity: early results from a specialized North African foot and ankle unit[J]. Int Orthop, 2024, 48(6): 1543-1552.
[2]	SHI C, LI M, ZENG Q, et al. Subtalar arthroereisis combined with medial soft tissue reconstruction in treating pediatric flexible flatfoot with accessory navicular[J]. J Orthop Surg Res, 2023, 18(1): 55.
[3]	MICKLE K J, STEELE J R, MUNRO B J. The feet of overweight and obese young children: are they flat or fat?[J]. Obesity (Silver Spring), 2006, 14(11): 1949-1953.
[4]	MARTÍN-CASADO L, ALDANA-CABALLERO A, BARQUÍN C, et al. Foot morphology as a predictor of hallux valgus development in children[J]. Sci Rep, 2023, 13(1): 9351.
[5]	LONGO U G, PAPALIA R, DE SALVATORE S, et al. Trends in hospitalization for paediatric flatfoot: an Italian nationwide study from 2001 to 2016[J]. BMC Pediatr, 2022, 22(1): 83.
[6]	姜雅文, 刘明威, 肖青霞, 等. 青少年扁平足患者足底压力、下肢平衡与冠状位躯干平衡的相关性研究[J]. 医用生物力学, 2024, 39(S1): 484.
[7]	何双庆, 张雪伊, 郑志艺, 等. 中国3-18岁儿童和青少年扁平足发生率的Meta分析[C]// 中国体育科学学会. 第十三届全国体育科学大会论文摘要集——专题报告(体质与健康分会). 北京: 北京体育大学,安踏(中国)有限公司, 2023: 3.
[8]	KOTHARI A, DIXON P C, STEBBINS J, et al. Are flexible flat feet associated with proximal joint problems in children?[J]. Gait Posture, 2016, 45: 204-210. doi: 10.1016/j.gaitpost.2016.02.008 pmid: 26979907
[9]	SAKR S A, ZAYDA A I, MESREGAH M K, et al. Tibialis anterior rerouting combined with calcaneal lengthening osteotomy as a single-stage reconstruction of symptomatic flexible flatfoot in children and adolescents[J]. J Orthop Surg Res, 2023, 18(1): 429.
[10]	KERR C M, ZAVATSKY A B, THEOLOGIS T, et al. Kinematic differences between neutral and flat feet with and without symptoms as measured by the Oxford foot model[J]. Gait Posture, 2019, 67: 213-218. doi: S0966-6362(18)30251-0 pmid: 30368208
[11]	PATIL M, KULKARNI M S, SINHA A, et al. Biomechanical variations in patients with flatfoot deformity: impact of gender, age and BMI on foot kinetics and kinematics[J]. J Orthop, 2024, 57: 90-97.
[12]	SHAPOURI J, AGHAALI M, AGHAEI M, et al. Prevalence of lower extremities' postural deformities in overweight and normal weight school children[J]. Iranian J Pediatr (Eng ed), 2019, 29(5): 6.
[13]	FUJISHITA H, IKUTA Y, MAEDA N, et al. Effects of rearfoot eversion on foot plantar pressure and spatiotemporal gait parameters in adolescent athletes[J]. Healthcare (Basel), 2023, 11(13): 1842.
[14]	CHANG C H, YANG W T, WU C P, et al. Would foot arch development in children characterize a body maturation process? A prospective longitudinal study[J]. Biomed J, 2022, 45(5): 828-837.
[15]	BAKER K M, WANG M, CAO K, et al. Biomechanical system for the evaluation of walker-assisted gait in children: design and preliminary application[C]// Proceedings of the 25th Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Cat, 2003: 1851-1854.
[16]	GONUL Y, YUCEL O, EROGLU M, et al. Ultrasonographic evaluation of Achilles tendon in children with flatfoot: a case-control morphometric study[J]. Diagn Interv Imaging, 2016, 97(9): 907-913.
[17]	FENG Z Y, SHE J Y, HU X Y, et al. Exploring flatfeet morphology in children aged 6-12 years: relationships with body mass and body height through footprints and three-dimensional measurements[J]. Eur J Pediatr, 2024, 183(4): 1901-1910.
[18]	BUDIMAN-MAK E, CONRAD K J, ROACH K E. The Foot Function Index: a measure of foot pain and disability[J]. J Clin Epidemiol, 1991, 44(6): 561-570.
[19]	CERVERA-GARVI P, GALAN-HURTADO M H, ORTEGA-AVILA A B, et al. Measurement properties of the Foot Function Index (FFI) questionnaire: a systematic review[J]. Clin Rehabil, 2024, 38(9): 1226-1237.
[20]	BUDIMAN-MAK E, CONRAD K J, MAZZA J, et al. A review of the foot function index and the foot function index-revised[J]. J Foot Ankle Res, 2013, 6(1): 5.
[21]	SIEREVELT I N, ZWIERS R, SCHATS W, et al. Measurement properties of the most commonly used Foot- and Ankle-Specific Questionnaires: the FFI, FAOS and FAAM. A systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(7): 2059-2073.
[22]	ANAFOROGLU KULUNKOGLU B, CELIK D. Reliability and validity of the Turkish Version of Foot and Ankle Ability Measure for patients with chronic ankle disability[J]. J Foot Ankle Surg, 2019, 58(1): 38-41. doi: S1067-2516(18)30283-7 pmid: 30448187
[23]	YAGCI G, EREL S, OKUNAKOL V. Validation of the Turkish version of the Revised Foot Function Index for patients with foot and ankle disorders[J]. Foot Ankle Surg, 2020, 26(6): 624-629. doi: S1268-7731(19)30134-1 pmid: 31431327
[24]	BOVONSUNTHONCHAI S, THONG-ON S, VACHALATHITI R, INTIRAVORANONT W, et al. Thai version of the Foot Function Index: a cross-cultural adaptation with reliability and validity evaluation[J]. BMC Sports Sci Med Rehabil, 2020, 12: 56. doi: 10.1186/s13102-020-00206-8 pmid: 32944253
[25]	NAAL F D, IMPELLIZZERI F M, HUBER M, et al. Cross-cultural adaptation and validation of the Foot Function Index for use in German-speaking patients with foot complaints[J]. Foot Ankle Int, 2008, 29(12): 1222-1228. doi: 10.3113/FAI.2008.1222 pmid: 19138487
[26]	AGUDIEZ-CALVO S, BALLESTEROS-FRUTOS J, CABEZAS-GARCÍA H R, et al. Cross-cultural adaptation and validation of the Pain Scale for Plantar Fasciitis to Spanish[J]. J Foot Ankle Surg, 2021, 60(2): 247-251.
[27]	KHAN S, FAULKNER S, ALGARNI F S, et al. Foot Function Index for Arabic-speaking patients (FFI-Ar): translation, cross-cultural adaptation and validation study[J]. J Orthop Surg Res, 2022, 17(1): 212.
[28]	RICHIE D H Jr. Biomechanics and clinical analysis of the adult acquired flatfoot[J]. Clin Podiatr Med Surg, 2007, 24(4): 617-644.
[29]	KODITHUWAKKU ARACHCHIGE S N K, CHANDER H, KNIGHT A. Flatfeet: biomechanical implications, assessment and management[J]. Foot (Edinb), 2019, 38: 81-85. doi: S0958-2592(18)30153-6 pmid: 30844660
[30]	PAVONE V, TESTA G, VESCIO A, et al. Diagnosis and treatment of flexible flatfoot: results of 2019 flexible flatfoot survey from the European Paediatric Orthopedic Society[J]. J Pediatr Orthop B, 2021, 30(5): 450-457. doi: 10.1097/BPB.0000000000000849 pmid: 33399292
[31]	FULLER R M, KIM J, AN T W, et al. Assessment of flatfoot deformity using digitally reconstructed radiographs: reliability and comparison to conventional radiographs[J]. Foot Ankle Int, 2022, 43(7): 983-993.
[32]	SHIN H S, LEE J H, KIM E J, et al. Flatfoot deformity affected the kinematics of the foot and ankle in proportion to the severity of deformity[J]. Gait Posture, 2019, 72: 123-128. doi: S0966-6362(19)30226-7 pmid: 31195311
[33]	熊怒, 王旭, 黄加张, 等. 儿童柔韧性扁平足的矫形鞋垫治疗研究进展[J]. 中国矫形外科杂志, 2022, 30(7): 630-634.
[34]	WU S H, LIANG H W, HOU W H. Reliability and validity of the Taiwan Chinese version of the Foot Function Index[J]. J Formos Med Assoc, 2008, 107(2): 111-118.
[35]	SAAG K G, SALTZMAN C L, BROWN C K, et al. The Foot Function Index for measuring rheumatoid arthritis pain: evaluating side-to-side reliability[J]. Foot Ankle Int, 1996, 17(8): 506-10. doi: 10.1177/107110079601700814 pmid: 8863033
[36]	BENNETT P J, PATTERSON C, WEARING S, et al. Development and validation of a questionnaire designed to measure foot-health status[J]. J Am Podiatr Med Assoc, 1998, 88(9): 419-428. doi: 10.7547/87507315-88-9-419 pmid: 9770933
[37]	KUYVENHOVEN M M, GORTER K J, ZUITHOFF P, et al. The Foot Function Index with verbal rating scales (FFI-5pt): a clinimetric evaluation and comparison with the original FFI[J]. J Rheumatol, 2002, 29(5): 1023-1028. pmid: 12022318
[38]	BUDIMAN-MAK E, CONRAD K, STUCK R, et al. Theoretical model and Rasch analysis to develop a revised Foot Function Index[J]. Foot Ankle Int, 2006, 27(7): 519-527.
[39]	AGUILAR E J, BARBOSA V C. Shape complexity in cluster analysis[J]. PLoS One, 2023, 18(5): e0286312.
[40]	DENG X, LIU Y, XIONG Y. Analysis on the development of digital economy in Guangdong province based on improved entropy method and multivariate statistical analysis[J]. Entropy (Basel), 2020, 22(12): 1441.
[41]	KAISER H F. A second generation little jiffy[J]. Psychometrika, 1970, 35(4): 401-415.

组别	n	性别 (男/女)/n	年龄/岁	身高/cm	体质量/kg	BMI/ (kg·m^-2)	FFI-疼痛	FFI-残疾	FFI-活动受限	FFI总分
对照组	56	20/36	13.18±3.04	159.71±16.06	53.34±14.59	20.50±3.17	0	0	0	0
观察组	41	20/21	12.73±3.40	150.87±28.81	50.88±17.60	20.50±3.74	25.72±11.45	25.69±11.11	18.76±10.04	70.18±31.79
t/χ²值		1.959	0.680	1.927	0.752	-0.064
P值		0.162	0.498	0.057	0.454	0.949

FFI问卷	总人群(n = 97)	儿童(n = 53)	青少年(n = 44)
FFI-疼痛	0.933	0.929	0.937
FFI-残疾	0.966	0.955	0.976
FFI-活动受限	0.771	0.753	0.785
FFI总分	0.977	0.973	0.980

分组	n	χ²	Df	P值	RMSEA	累计方差贡献率
总人数	97	1284.94	171	< 0.001	0.283	93.97%
儿童	53	740.01	149	< 0.001	0.276	91.95%
青少年	44	536.66	149	< 0.001	0.246	96.91%

因子	条目		因子载荷系数		公因子方差
因子	条目	1 (疼痛)	2 (残疾)	3 (活动受限)	公因子方差
疼痛	条目 1	0.763			0.965
	条目 2	0.446			0.959
	条目 3	0.458			0.872
	条目 4	0.585			0.945
	条目 5	0.572			0.923
	条目 6	0.590			0.965
	条目 9	0.563			0.899
残疾	条目 10		0.686		0.954
	条目 11		0.597		0.952
	条目 12		0.780		0.924
	条目 13		0.633		0.904
	条目 14		0.620		0.960
	条目 15		0.680		0.928
	条目 16		0.473		0.938
	条目 17		0.412		0.948
	条目 18		0.715		0.961
活动受限	条目 21			0.458	0.946
	条目 22			0.477	0.959
	条目 23			0.790	0.950