J. Phys. Ther. Sci.

Original Article 27: 3767–3769, 2015

Foot pressure analysis of adults with flat and

normal feet at different gait speeds on an ascending
slope

Myoung-Kwon K im, PT, PhD1)

1) Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University: Jillyang,
Gyeongsan, Gyeongbuk 712-714, Republic of Korea

Abstract. [Purpose] This study was conducted to determine the difference in foot pressures between flat and nor-
mal feet at different gait speeds on an ascending slope. [Subjects] This study enrolled 30 adults with normal (n=15)
and flat feet (n=15), with ages from 21 to 30 years old, who had no history of neurological disorders or gait problems.
A treadmill was used for the analysis of kinematic features during gait, using a slope of 10%, and gait velocities of
slow, normal, and fast. [Methods] A foot pressure analyzer was used to measure changes in foot pressure. [Results]
Compared to the normal subjects, the foot pressure of the flatfoot subjects showed a significant increase in the 2–3rd
metatarsal region with increasing gait speed, whereas there were significant decreases in the 1st toe and 1st meta-
tarsal regions with increasing gait speed. [Conclusion] The body weight of adults with flatfoot was concentrated on
the 2–3rd metatarsal region during the stance phase and increased with walking speed on the ascending slope due
to weakening of function of the medial longitudinal arch.
Key words: Flatfoot, Foot pressure, Ascending slope
(This article was submitted Aug. 17, 2015, and was accepted Sep. 17, 2015)

INTRODUCTION
Gait is the most natural motion performed by humans in
their daily life and numerous musculoskeletal muscles and
nerves of the lower extremity respond together during gait1).
In normal gait, pronation of the foot occurs immediately
after the initial stance phase and helps to absorb shock re-
ceived by the foot in contact with the base of support during
the stance phase2). In addition, the medial longitudinal arch
also serves to distribute the weight of the body and absorb
shock3). Damage to the normal biomechanics of the foot,
caused by abnormal function of the subtalar joint and medial
longitudinal arch, can result in flatfoot4). In general, evalua-
tions of flatfoot can be categorized as visual non-quantitative
inspection, anthropometric measurement, footprint and
radiation assessments1). Studies of gait range from a basic
technological studies of the gait cycle to studies utilizing
sophisticated measurement tools and various mathematical
measurements5).
Comparison and analysis is needed in order to determine
the causes and problematic parts of patients who exhibit
pathological gait. In addition, the results from analysis of
normal gait and the types of gait of normal adults need to
Corresponding author. Myoung-Kwon Kim (E-mail:
skybird-98@hanmail.net)
©2015 The Society of Physical Therapy Science. Published by IPEC Inc.
This is an open-access article distributed under the terms of the Cre-
ative Commons Attribution Non-Commercial No Derivatives (by-nc-
nd) License <http://creativecommons.org/licenses/by-nc-nd/3.0/>.
be clarified.
A number of studies have performed kinematic analysis
of flatfoot. Kim et al.6) analyzed the features of gait of adults
with flatfoot on an ascending slope using a three dimensional
gait analysis system, and Kim et al.7) analyzed muscle activ-
ity on an ascending slope, level ground, and a descending
slope. Lee et al.8) analyzed the muscle activities of the lower
extremity during gait by adults with flatfoot on an ascending
slope.
The majority of adults with flatfoot exhibit muscle fatigue
of the lower extremity during gait on an ascending slope.
Accordingly, the present study was conducted to examine
the differences between the foot pressures of adults with
flat and normal feet at different gait speeds on an ascending
slope.
SUBJECTS AND METHODS
Thirty persons with normal (n=15) and flat (n=15) feet
with no neurological history, aged between 21 and 30, par-
ticipated in this study. Age was recorded, and weight and
height were measured for evaluation of the body character-
istic of the subjects.
Flatfoot was confirmed by posture analysis (GPS400,
Redbalance, Italy). As described by Clarke9), Strake’s line
and Marie’s line were used to confirm flatfoot.
Strake’s line is the line passing between the medial bor-
der of the forefoot and the medial border of the hindfoot,
and Marie’s line is the line passing between the center of
the 3rd toe and the center of the hindfoot. There is also a
bisector line between Strake’s line and Marie’s line. Subjects
3768 J. Phys. Ther. Sci. Vol. 27, No. 12, 2015

Table 1. General characteristics of each group Table 2. Comparison of average forces on each contact area at
the different walking speeds on the 10% slope (psi)
EG (n=15) CC (n=15)
Number of individuals Group Slow Normal Fast
5/10 7/8
(Male / Female) EG 0.4±0.3 3.6±0.7 4.4±1.5
Age (years) 21.7±1.5 22.0±2.1 T1*
CG 0.9±0.3 3.7±2.1 5.9±1.9
Height (cm) 165.1±0.7 164.2±6.5 EG 0.3±0.2 2.6±0.8 3.3±0.6
Body Weight (kg) 55.8±6.2 54.2±4.2 T2
CG 0.2±0.2 2.2±0.9 3.0±0.9
Foot length (cm) 25.5±1.1 25.3±0.5 EG 1.4±0.4 2.4±0.8 3.5±0.9
Ankle width (cm) 7.8±0.3 7.6±0.5 F1*
CG 1.5±0.3 3.0±0.5 5.1±1.3
Values are expressed as mean±SD EG 5.3±0.6 7.5±0.9 9.2±1.1
EG: flatfoot group; CG: normal foot group F2*
CG 4.6±0.3 6.3±0.7 7.8±1.5
EG 4.6±0.3 6.3±0.7 7.8±1.5
F3
CG 4.9±0.8 7.0±0.6 8.0±1.4
were included in the normal foot group if their medial soles
EG 2.7±0.6 4.0±0.6 5.6±1.1
passed to the lateral side of Marie’s line, and the flat foot M
group if their medial soles passed between the bisector line CG 2.5±0.4 3.6±0.5 5.3±1.8
and Strake’s line. EG 11.7±0.8 13.3±0.7 15.6±1.4
H1
A treadmill (AC5000M, SCIFIT, UK) was used to CG 10.3±0.8 13.6±0.7 15.9±1.3
examine kinematic features during gait. The average gait EG 8.5±1.1 8.5±0.5 8.2±0.7
H2
velocities of the male subjects at slow, normal, and fast CG 8.5±1.1 8.4±1.0 7.6±1.1
walking speeds were 3, 4, and 5 km/h, respectively, on EG: flatfoot group, CG: normal foot group, *Significant differ-
a slope of 10%, and those of women were 2.7, 3.7, and ence in gains between groups, p<0.05, T1: Toe1, T2: Toe2–5, F1:
4.7 km/h respectively, on a slope of 10%7). Subjects walked 1st metatarsal, F2: 2–3rd metatarsal, F3: 4–5th metatarsal, M:
for one minute to determine their natural gait velocity before Midfoot, H1: Medial heel, H2: Lateral heel
the experiment, and all subjects walked barefoot for five
minutes on the treadmill. Foot pressure analysis (FSA, Vista
medical, Canada) was performed to measure the changes in ing gait speed, whereas there were significant decreases in
foot pressure. The thickness of the pressure measurement the 1st toe, and 1st metatarsal regions with increasing gait
pad was 0.88 mm. It held 128 pressure sensors, with a size speed (Table 2).
of 9×16 mm, arranged in an of 8×16 array. Pressure was
sampled at 3,072 Hz, and the pressure measurement range DISCUSSION
was 0–30 psi. The sizes of the pressure measurement pads
were 230×100 mm, 250×100 mm, and 270×100 mm, and This study was conducted to examine the differences in
an appropriately sized pad was chosen according to subjects the foot pressures of adults with flat and normal feet during
foot size, and fitted as an insole gait on an ascending slope, a task which they face in daily
The foot was divided into eight areas for analysis of the life.
pressure differences: two toe regions (1st toe, 2–5th toe re- The center of pressure of a normal foot tends to move to
gions), three forefoot regions (1st metatarsal, 2–3rd metatar- the inside of the forefoot with increase of speed of gait on
sal, and 4–5th metatarsal regions), midfoot region and two an ascending slope. The pressure moves particularly in the
heel region (medial heel, lateral heel)10). Average pressures direction of the big toe.
of each region were measured during gait trials. In contrast, the body weight of adults with flatfoot was
The homogeneity of the general characteristic of subjects concentrated on 2–3rd metatarsal region during the stance
(age, height, and weight) was tested using the independent t phase with increase of walking speed on the ascending slope
test. Pressure data in each group were analyzed by one-way due to weakening of the function of the medial longitudinal
repeated measuring analyses using SPSS for Windows (ver- arch, and body weight did not move well to the big toe dur-
sion 17.0) and a post-hoc Duncan test was used to determine ing the terminal stance phase.
the statistical significance of results. In subjects with flatfoot, eversion of the subtalar joint
The differences between groups were determined using occurred due to weakening of the function of the medial
the independent t test. Statistical significance was accepted longitudinal arch during gait. Therefore, the contact area
for values of p < 0.05. of the medial longitudinal arch with the floor increased.
This is consistent with the finding reported by Van Boerum
RESULTS and Sangeorzan11), that the medial longitudinal arch of the
foot descends faster as the load on the center of the body
A summary of the clinical and demographic features of increases, therefore the contact area of the midfoot area
the sample (n = 30) is shown in Table 1. There were no sig- increases during the stance phase.
nificant differences in the baseline characteristics of the flat The main reason for the high level of pressure distribu-
and normal foot groups (p>0.05). Compared to the normal tion on the 2–3rd metatarsal head of flatfoot subjects may be
subjects, foot pressure of the flatfoot subjects showed a sig- eversion of the hindfoot. Since the flatfoot subjects showed
nificant increase in the 2–3rd metatarsal region with increas- a higher level of eversion of the hindfoot with increase in

walking speed. From this result, the change in the movement
of the hindfoot has been reported to influence the movement
of the tibia as well as the knee joint12).
Flatfoot exhibited 2° greater of hindfoot eversion than
normal foot during 60% of the stance phase of gait. Lev-
inger et al.13) performed kinematic analysis of flatfoot using
the Oxford foot model. Flatfoot exhibited a higher level of
plantar flexion, abduction of the forefoot, a higher level of
internal rotation of the hindfoot, and a higher level of inter-
nal rotation of the tibia. The major cause of the higher level
of pressure distribution on the 2–3rd metatarsal bone head
found in this study would be the influence of the valgus of
the hindfoot. In addition, flatfoot subjects exhibited a higher
level of hindfoot eversion with increase in walking speed on
the ascending slope; therefore, a higher body weight load
would be placed on the interior part during the terminal
stance.
This study had some limitations. The small sample size
may have influenced certain variables and impacted the
results. Therefore, these results cannot be generalized to all
subjects with flatfoot.
ACKNOWLEDGEMENT
This study was financially supported by a Daegu Univer-
sity Research Grant, 2015.
3769
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