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

Abstract

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

CLC Number:

R682.1
R493

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.

Figures/Tables 5

Table 1

Table 2

Figure 1

Table 3

Table 4

References 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

Reliability and validity of foot function index in flatfeet of children and adolescents

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 5

References 41

Related Articles 15

Metrics

Comments

Recommended 0

[1]	SHAO Xueyun. Physical activity, functioning and psycho-behavioral health in obese children: policy framework and health behavior intervention model [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(6): 642-649.
[2]	WU Dang, ZHANG Qing, WU Jiaming, JIA Wenrong, WU Aihong, WU Jian. Support system for children with special needs participating in physical activity in an inclusive education context [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(6): 650-657.
[3]	ZHOU Tiantian, ZHANG Tong, ZHANG Qi, LIANG Yanhua, ZHANG Yanqing, YUE Qing, LI Sijia. Effect of Lokomat robotic-assisted gait training on lower limb motor function in children with hemiplegia [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(6): 711-720.
[4]	ZHOU Bo, SHE Wanbin, XIANG Songbai. Application of artificial intelligence in diagnosis and intervention for children with autism spectrum disorder: a bibliometric analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(5): 573-580.
[5]	YI Ling, ZHOU Jing, CHEN Xuefen, CHEN Chuanfan, CHEN Keyi, DONG Huifan. Characteristics and intervention of speech function impairments and communication limitation in children with intellectual disabilities based on ICF [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(4): 398-405.
[6]	ZHANG Yong, CAI Zeng, XU Fengping, LIU Dan, CHANG Hongjuan. Effect of music therapy on children with autism spectrum disorder: a meta-analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(4): 423-430.
[7]	LIU Fangchao, ZHANG Yuanmingfei, WU Meiqi, ZHOU Mouwang, LI Tao. Validity of key points detection technology of artificial intelligence in gait kinematics analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(3): 249-253.
[8]	DUAN Guanting, XIAO Xue, HOU Huisheng, JIANG Yunqiao, LIU Yuge, SHI Wenxia. Relationship between physical activity and mental health in children with autism spectrum disorder: the mediating role of social response [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 150-157.
[9]	XIANG Songbai, ZHOU Wenhui, WANG Chonggao. Application of robots in rehabilitation of children with autism spectrum disorder from 2004 to 2024: a bibliometrics analysis [J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(2): 158-164.
[10]	YANG Wenrui, CUI Sidong, ZENG Li. Effect of virtual and augmented reality on cognition, emotion and adaptive behavior in children and adolescents with autism spectrum disorder: a systematic review [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1026-1033.
[11]	YU Boyang, YANG Yanyan, MA Ao, LI Tao, LIU Xiaoxie, LI Zhengyang, DUAN Yajing, LIU Jiaqi, XIE Yuxiao, WANG Cui, HUANG Zhen, ZHANG Lining, LIU Xinyi, JIA Zishan, ZHOU Mouwang. Reliability and validity of assessment tools of Brief ICF Core Sets for Arthroplasty of Knee Osteoarthritis in Perioperative Period [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(9): 1053-1059.
[12]	YANG Yuran, WANG Qian, CHEN Cuicui, DU Xiaoxin. Effect of different interventions on joint attention in children aged three to six years with mild to moderate autism spectrum disorder [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 888-893.
[13]	ZHOU Jing, ZHANG Xiaoxiao, DING Zhongbing, CHEN Jianchao, WEI Xingxing, LIN Shuqi. Effect of speech and language rehabilitation on children with intellectual and developmental disabilities: a systematic review [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 894-902.
[14]	LÜ Qianqian, WANG Mengmeng, WU Yiling, YANG Xiaozhen, MA Lingling, ZHAO Yaping, XIAO Yao, SANG Gao. Effect of neurofeedback training based on early start Denver model on children with autism spectrum disorder: a randomized controlled trial [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 914-921.
[15]	ZHOU Jing, YI Ling, CHEN Jianchao, CHEN Xuefen, WEI Xingxing, CHEN Jingjing. Speech and language rehabilitation services for children with hearing impairment based on ICF: theoretical framework and service system [J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(7): 745-751.