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Characteristics of foot morphology and their relationship to gender, age, body

mass index and bilateral asymmetry in Japanese adults

Article  in  Journal of Back and Musculoskeletal Rehabilitation · November 2016

DOI: 10.3233/BMR-150501

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Journal of Back and Musculoskeletal Rehabilitation -1 (2016) 1–9 1

DOI 10.3233/BMR-150501
IOS Press

Characteristics of foot morphology and their

relationship to gender, age, body mass index
and bilateral asymmetry in Japanese adults
Xiaoguang Zhaoa,∗, Takehiko Tsujimotob , Bokun Kima , Yasutomi Katayamac and Kiyoji Tanakab
a
Doctoral Program in Sports Medicine, Graduate School of Comprehensive Human Sciences, University of
Tsukuba, Ibaraki, Japan
b
Faculty of Health and Sports Sciences, University of Tsukuba, Ibaraki, Japan
c
Faculty of Education, Kogakkan University, Mie, Japan

Abstract.
BACKGROUND: Different characteristics of foot morphology are commonly accompanied by altering lower extremity biome-
chanical characteristics and foot function. Clarifying what factors affect foot morphology is helpful in understanding the basis of
foot deformity and foot dysfunction.
OBJECTIVE: The aim of this study was to investigate characteristics of foot morphology and whether related factors such as
gender, age, body mass index (BMI) and bilateral asymmetry have an impact on foot morphology.
METHODS: One hundred and eighty adults without exercise habit were included in this cross-sectional study. Participants were
categorized by gender, age, BMI, and left and right foot respectively to compare foot morphology differences. The characteristics
of foot morphology were measured using a 3D foot scanner.
RESULTS: Compared with females, males had longer, larger and higher feet. In terms of age differences, older adults had shorter
and stiffer feet. Regarding BMI differences, the value of height and width parameters of foot was larger, and the value of height
of arch also larger in those with greater BMI. Regarding bilateral asymmetry, the right foot had a higher foot than the left foot.
Multiple linear regression models indicated that gender, age and BMI significantly affected length and girth parameters of foot
together.
CONCLUSIONS: This study showed that gender has a bigger impact on length, width, height and girth parameters of foot
than BMI or age. BMI has an impact on both arch height and stiffness. Besides, bilateral asymmetry affects values of height
parameters of foot and arch.

Keywords: Foot length, foot width, foot girth, foot arch, foot deformities

1 1. Introduction weight, maintaining balance and absorbing ground re- 6

action forces generated during activities or sports. Dif- 7

2 The human foot, as a complex structure in both ferent characteristics of foot morphology are com- 8
3 physiology and morphology, is considered a miracle of monly accompanied by altering plantar pressure dis- 9
4 design in engineering and mechanical efficiency [1].
tribution and conditions of the lower extremity bones, 10
5 The foot plays an essential role in supporting body
muscles, tendons and ligaments, which, in turn, affect 11

lower extremity biomechanical characteristics and foot 12

∗ Corresponding
author: Xiaoguang Zhao, Graduate School of function [2–5]. Therefore, clarifying which factors af- 13
Comprehensive Human Science, University of Tsukuba, 1-1-1 fect foot morphology may be helpful in understanding 14
Tennodai, Tsukuba, Ibaraki 305-8577, Japan. Tel.: +81 29 838
5600*8365; Fax: +81 29 838 2602; E-mail: xiaoguangzhao1985@ the basis of foot deformity and foot dysfunction and in 15

gmail.com. designing more comfortable footwear. 16

ISSN 1053-8127/16/$35.00 
c 2016 – IOS Press and the authors. All rights reserved
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2 X. Zhao et al. / Characteristics of foot morphology and their relationship to gender, age, BMI and bilateral asymmetry

17 Certain factors such as gender, age, body mass in-

18 dex (BMI) and bilateral asymmetry may influence foot
19 morphology to some extent. Restricted from the tech-
20 nique, almost all previous studies have focused on arch
21 height and hallux valgus using callipers, footprint pa-
22 rameters and radiographic evaluation [6–9]. The emer-
23 gence and improvement of three-dimensional (3D)
24 imaging technology make the accurate measurement of
25 foot morphology (length, width, height and girth) be-
26 come possible [10]. However, to the best of our knowl-
27 edge, only one study has directly demonstrated how
28 gender influences foot morphology in older Japanese
29 adults using a 3D foot scanner [11]. It was reported
30 that gender differences were primarily in the instep
31 height, instep girth, forefoot girth and navicular height
32 by measuring the foot information of 151 men (74.5 Fig. 1. The 3D foot scanner.
33 ± 5.6 years) and 140 women (73.95 ± 5.1 years). Ac-
34 cording to their findings, the authors appealed to shoe est 0.1 cm using a wall-mounted stadiometer (YG-200; 62

35 manufacturers to consider gender differences when de- Yagami, Nagoya, Japan). Body weight was assessed 63

36 signing shoes for older adults. to the nearest 0.1 kg using a digital scale (TBF-551; 64

37 Although arch type and hallux valgus have been re- Tanita, Tokyo, Japan) as the participants wore light 65

38 ported to be associated with gender, age, body com- clothing and no shoes. BMI was computed as the body 66

39 position and bilateral asymmetry, to date, detailed sys- weight (kg) divided by body height squared (m2 ). 67

40 tematic studies are rare regarding characteristics of

2.3. Foot anthropometric measurement 68
41 foot morphology in different Japanese adult groups.
42 Therefore, the purpose of this study was to investigate A leaser 3D foot scanner (FSN-2100, Dream GP 69
43 characteristics of foot morphology and the influence of Inc., Osaka, Japan) was employed to measure foot 70
44 gender, age, body mass index and bilateral asymmetry morphology information (Fig. 1). A laser rotated on 71
45 on a range of foot morphology parameters in a large the rail around the foot computed approximately 30, 72
46 community sample of Japanese adults. 000 points, including length, width, height and girth of 73

foot, allowing the software to rebuild the exact shape 74

of the foot on the computer. Due to the higher accuracy 75

47 2. Materials and methods and high efficiency compared with conventional mea- 76

surement methods, the 3D imaging technology in foot 77

48 2.1. Participants measurement has been recommended to collect foot 78

anthropometric data [10,12]. In this research, both the 79

49 A total of 180 participants, 101 men and 79 women, left and right foot anthropometric data were measured 80

50 with an age range of 25 to 82 years, participated in for each participant in both the sitting and bipedal 81

51 this cross-sectional study. All of them had no exercise standing positions with bare feet. Each measurement 82

52 habits and volunteered for this study. Participants were was completed about in 15 seconds. 83

53 recruited through advertising in local newspapers in Foot morphology parameters were obtained auto- 84

54 Tsukuba City and Ise City, Japan in 2015. Prior to the matically using the 3D foot scanner analysis software. 85

55 start of the tests, the participants were asked to read and The descriptions of the major parameters of the foot 86

56 sign a written informed consent form. This study was morphology are shown as follows (Fig. 2). 87

57 approved by the Human Ethics board of the University 1) Foot length: the most posterior point of the calca- 88

58 of Tsukuba. neus to the anterior point of the most protruding 89

toe. 90

59 2.2. Anthropometry 2) Forefoot width: the distance between the most 91

medial point (protrusion) of the first metatar- 92

60 Before the foot anthropometric measurement, each sophalangeal (MTP) joint and the most lateral 93

61 participant’s body height was measured to the near- point (protrusion) of the fifth MTP joint. 94
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X. Zhao et al. / Characteristics of foot morphology and their relationship to gender, age, BMI and bilateral asymmetry 3

Hullax angle Digitus minimus angle

Instep height

Medial ball of foot length Lateral ball of foot length

55% foot length

Rearfoot width

Arch height index (AHI): instep height / medial ball of foot length
Arch stiffness index (ASI): AHI (standing) / AHI (sitting)

Fig. 2. The descriptions of the major indicators of foot structure.

95 3) Forefoot girth: the circumference over the first The ASI was developed by Richards et al. to assess 123

96 and fifth MTP joint. arch flexibility and was defined as the ratio of the 124

97 4) Rearfoot width: the widest section of the heel standing AHI divided by the sitting AHI [14]. A value 125

98 (calcaneus). for AHI close to 0 represents a lower arch, and a value 126

99 5) Medial ball of foot length: the most posterior for ASI close to 1 represents a stiffer arch. 127

100 point of the calcaneus on the foot end normal line

101 and the first MTP joint protrusion. 2.4. Statistical analysis 128

102 6) Lateral ball of foot length: the most posterior

103 point of the calcaneus to the ball of fifth MTP Except for bilateral asymmetric analysis, only right 129

104 joint. foot morphology information was analysed to sat- 130

105 7) Instep height: the highest point at the longitudinal isfy the independence of assumption of the statistical 131

106 section of 55-percent foot length. analysis [15]. Because the foot morphology parame- 132

107 8) Instep girth: the circumference of the longitudi- ters were observed to be normally distributed using 133

108 nal section of 55-percent foot length. the Shapiro-Wilks test, independent samples t-test was 134

109 9) Hallux angle: the angle between the big toe and used to determine the gender differences. If gender dif- 135

110 the ball of the first MTP joint. ferences were observed, ANCOVA was used to remove 136

111 10) Digitus minimus angle: the angle between the lit- compounding variables such as age and BMI. Both the 137

112 tle toe and the ball of the fifth MTP joint. age and BMI were divided into three groups according 138

113 11) Arch height index (AHI): instep height/medial to the domestic standards, and one-way ANOVA with 139

114 ball of foot length. the Bonferroni post hoc test was employed to examine 140
115 12) Arch stiffness index (ASI): AHI (standing)/AHI the age and BMI differences in foot morphology. Then, 141
116 (sitting). ANCOVA was executed to adjust for gender, age or 142

117 Among the many parameters of foot morphology BMI if differences were found. We applied paired sam- 143

118 mentioned above, both AHI and ASI are comprehen- ples t-test to detect bilateral asymmetry in the left and 144

119 sive parameters for assessing the arch and foot. The right foot morphology. Finally, multiple linear regres- 145

120 AHI was defined as the instep height divided by the sion models were employed using a range of foot mor- 146

121 medial ball of the foot length, which was introduced by phology parameters as dependent variables, and taking 147

122 Williams and McClay to evaluate the arch height [13]. gender, age and BMI as independent variables. Statis- 148
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4 X. Zhao et al. / Characteristics of foot morphology and their relationship to gender, age, BMI and bilateral asymmetry

149 tical Package for Social Sciences (SPSS) version 22.0 right arch and foot were higher (instep height, P = 198

150 was used for the analyses of the data. 0.001; AHI, P = 0.001) than the left arch and foot. In 199

addition, there was no other difference between the left 200

and right foot. 201

151 3. Results Multiple linear regression models showing gender, 202

age and BMI can account for 37% to 71% of the varia- 203
152 The anthropometric characteristics of all 180 partic- tion in the forefoot width, rearfoot width, instep height, 204
153 ipants are shown in Table 1. Table 2 exhibits the gen- foot length, forefoot girth, medial and lateral ball of 205
154 der differences in foot morphology. Except for the dig- foot length and instep girth (Table 6). Age could sig- 206
155 itus minimus angle and ASI, there were very signif- nificantly predict the foot length, forefoot girth, me- 207
156 icant gender differences in foot morphology parame- dial and lateral ball of foot length and instep girth 208
157 ters. Compared with females, males had longer feet (β = −0.23 to −0.10, all P < 0.05). Both gender 209
158 (foot length, medial and lateral ball of length; all P < and BMI were significant predictors of the foot length, 210
159 0.001), larger feet (forefoot girth and width, rearfoot forefoot girth and width, rearfoot width, medial and 211
160 width, and instep girth; all P < 0.001), higher arches lateral ball of foot length, instep height and girth (β = 212
161 and feet (AHI and instep height; both P < 0.001), 0.43 to 0.59, all P < 0.001 for gender; β = 0.16 to 213
162 and smaller hallux angle (P = 0.002). Although com- 0.39, all P < 0.01 for BMI). In addition, BMI could 214
163 pounding factors such as age and BMI were adjusted also remarkably predict AHI (β = 0.23, P < 0.003) 215
164 using ANCOVA, we only found that the hallux angle
and ASI (β = −0.19, P = 0.020). 216
165 difference (P = 0.087) disappeared between genders.
166 The age differences in foot morphology are shown in
167 Table 3. Most of the foot morphology parameters, apart
4. Discussion 217
168 from the digitus minimus angle and AHI, had signif-
169 icant differences among prime-aged, middle-aged and
The purpose of this study was to determine charac- 218
170 older adults applying one-way ANOVA. The feet in
teristics of foot morphology and whether gender, age, 219
171 older adults became shorter (foot length, medial and
172 lateral ball of length; all P < 0.001), narrower (fore- BMI and bilateral asymmetry impact a range of foot 220

173 foot girth and width, rearfoot width, and instep girth; morphology parameters. The results demonstrate that 221

174 all P < 0.001), and lower (instep height; P < 0.001). males generally had longer, larger and higher feet; the 222

175 Furthermore, older individuals were more likely to feet in older individuals were shorter and stiffer; the 223

176 have a larger hallux angle (P = 0.001) and a stiffer value of height and width parameters of foot in those 224

177 arch (ASI; P = 0.011). However, when gender and with higher BMI was larger, and the value of height of 225

178 BMI were considered, there were no age differences in arch was also larger; the right foot had a higher foot 226

179 the forefoot girth, forefoot width, rearfoot width, instep and arch than the left foot. Gender, age and BMI could 227

180 height and girth, and hallux angle. impact length and girth parameters of foot together. 228

181 Except for the hallux angle, digitus minimus an- The gender differences in foot morphology reported 229

182 gle and ASI, significant differences were found among here are consistent with those in previous studies, in- 230

183 the three BMI groups in Table 4. Compared with the dicating that men had longer, higher and larger feet 231

184 normal-weight adults, the feet in overweight and obese than women. Castro et al. investigated older Brazil- 232

185 individuals were longer (foot length, medial and lateral ians using callipers and footprints, and reported that 233

186 ball of length; all P < 0.001), larger (forefoot girth the values of instep height and forefoot and rearfoot 234

187 and width, rearfoot width, and instep girth; all P < width were significantly lower in women than that in 235

188 0.001), and higher (instep height; P < 0.001). More- men [16]. Furthermore, using a 3D foot scanner that 236

189 over, adults with higher BMI had a higher arch than measured 291 older adults, more recent investigators 237

190 those with lower BMI (AHI; P = 0.008). When con- reported that older men had significantly greater val- 238

191 founding factors such as gender and age were consid- ues of length, width, height and girth parameters of 239

192 ered, we still found BMI differences in width, circum- foot than women with the exception of the hallux an- 240

193 ference and height parameters such as forefoot girth gle, which was smaller in men [11]. We obtained simi- 241

194 and width, rearfoot width, instep girth and height and lar results in our study, indicating that men had longer, 242

195 AHI. higher and larger feet than women, even when com- 243

196 Regarding the bilateral asymmetry, the instep height pounding factors such as age and BMI were adjusted. 244

197 and AHI were different (Table 5). We observed that the However, regarding the hallux angle, the gender dif- 245
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X. Zhao et al. / Characteristics of foot morphology and their relationship to gender, age, BMI and bilateral asymmetry 5

Table 1
Characteristics of the study participants
Variables Prime-aged adults Middle-aged adults Older adults Total = 180
(25–44 years) (45–64 years) (more than 64 years)
Mean SD Mean SD Mean SD Mean SD
Number (women) 23 (10) − 98 (41) − 59 (28) − 180 (79) −
Age (years) 37.39 4.25 55.00 5.84 70.76 3.90 57.92 11.78
Height (cm) 171.78 5.98 165.60 9.00 156.40 8.01 163.37 9.84
Weight (kg) 89.49 27.63 71.12 14.14 56.04 9.73 68.52 18.56
BMI (kg/m2 ) 30.25 8.95 25.79 3.94 22.80 2.83 25.38 5.12

Table 2
Gender differences in foot morphology by independent samples t-test and ANCOVA (adjusted for age and BMI)
Variables Men = 101 Women = 79 t-test ANCOVA
Mean SD Mean SD P values P values
Foot length (mm) 251.11 12.32 229.98 9.85 < 0.001 < 0.001
Forefoot girth (mm) 243.33 12.28 224.05 10.49 < 0.001 < 0.001
Forefoot width (mm) 99.72 5.34 92.60 5.50 < 0.001 < 0.001
Rearfoot width (mm) 66.00 4.23 59.93 3.72 < 0.001 < 0.001
Medial ball of foot length (mm) 180.52 8.98 164.73 6.98 < 0.001 < 0.001
Lateral ball of foot length (mm) 157.94 7.86 143.97 6.20 < 0.001 < 0.001
Instep height (mm) 63.04 4.62 55.08 4.31 < 0.001 < 0.001
Instep girth (mm) 251.29 13.00 224.87 10.38 < 0.001 < 0.001
Hallux angle (degrees) 9.66 4.68 12.87 8.79 0.002 0.087
Digitus minimus angle (degrees) 14.56 5.05 14.30 5.29 0.740 0.498
Arch height index (ratio) 0.350 0.029 0.335 0.027 < 0.001 0.002
Arch stiffness index (ratio) 0.917 0.035 0.914 0.043 0.660 0.143

Table 3
Age differences in foot morphology by one-way ANOVA and ANCOVA (adjusted for gender and BMI)
Variables Prime-aged adults = 23 Middle-aged adults = 98 Older adults = 59 ANOVA ANCOVA
(Aged 25 to 44) (Aged 45 to 64) (Aged more than 65)
Mean SD Mean SD Mean SD P values P values
Foot length (mm) 256.04a,b 13.07 243.62c 14.01 233.33 13.45 < 0.001 0.017
Forefoot girth (mm) 249.30a,b 15.25 235.98c 12.90 227.39 13.55 < 0.001 0.135
Forefoot width (mm) 101.85a,b 5.95 96.91c 5.75 94.02 6.49 < 0.001 0.258
Rearfoot width (mm) 68.05a,b 4.74 63.71c 4.73 60.88 4.05 < 0.001 0.202
Medial ball of foot length (mm) 184.22a,b 9.57 174.88c 10.30 167.31 9.74 < 0.001 0.012
Lateral ball of foot length (mm) 161.19a,b 8.37 152.94c 9.14 146.28 8.55 < 0.001 0.014
Instep height (mm) 64.00a,b 6.08 60.31c 5.26 56.54 5.65 < 0.001 0.527
Instep girth (mm) 256.15a,b 18.72 242.27c 15.58 229.00 14.00 < 0.001 0.111
Hallux angle (degrees) 8.25a 5.87 10.19c 4.26 13.63 9.75 0.001 0.067
Digitus minimus angle (degrees) 13.47 4.65 14.60 5.08 14.58 5.46 0.624 0.757
Arch height index (ratio) 0.348 0.033 0.345 0.028 0.338 0.028 0.222 0.633
Arch stiffness index (ratio) 0.919 0.037 0.908c 0.037 0.927 0.039 0.011 0.016
Note: a represents significant differences between prime-aged and older adults. b represents significant differences between prime-aged and
middle-aged adults. c represents significant differences between middle-aged and older adults.

246 ference disappeared when considering compounding index (the arch index was calculated by dividing the 256

247 factors. Smaller body size in women may lead to the narrowest part of the midfoot by the widest part of 257

248 shorter, lower and narrower foot than that in men. Ad- the forefoot) [18]. However, another study, defining the 258

249 ditionally, compared to men, women generally have AHI similar to ours, found that no statistically signifi- 259

250 more internal valgus knees and more pronated an- cant relationship was observed between increased age 260

251 kles [17], which may induce a lower arch in women. and AHI [9]. Our research supported the latter state- 261

252 Concerning the relationship between age and arch ment. It is very likely because we used the same de- 262

253 morphology, one previous study stated that older adults termination method for assessing arch. Regarding foot 263

254 (80.2 ± 5.7 years) exhibited a trend toward flatter feet morphology, to the best of our knowledge, only one 264

255 than younger adults (20.9 ± 2.6 years) using the arch study has investigated the relationship between age and 265
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6 X. Zhao et al. / Characteristics of foot morphology and their relationship to gender, age, BMI and bilateral asymmetry

Table 4
BMI differences in foot morphology by one-way ANOVA and ANCOVA (adjusted for age and gender)
Variables BMI  24.9 25.0 < BMI < 30.0 BMI  30.0 ANOVA ANCOVA
(n = 91) (n = 66) (n = 23)
Mean SD Mean SD Mean SD P values P values
Foot length (mm) 237.20a,b 14.55 245.19 14.68 250.56 15.12 < 0.001 0.320
Forefoot girth (mm) 228.45a,b 13.03 239.76 12.81 246.23 16.33 < 0.001 < 0.001
Forefoot width (mm) 94.41a,b 5.98 98.50 5.90 99.78 6.98 < 0.001 0.020
Rearfoot width (mm) 61.14a,b 4.49 64.82c 4.06 67.79 5.08 < 0.001 < 0.001
Medial ball of foot length (mm) 170.23a,b 10.70 175.99 10.81 180.03 10.97 < 0.001 0.359
Lateral ball of foot length (mm) 148.81a,b 9.49 153.96 9.48 157.50 9.59 < 0.001 0.324
Instep height (mm) 57.38a,b 5.42 60.99 5.35 64.00 6.28 < 0.001 0.001
Instep girth (mm) 231.40a,b 15.05 245.72c 14.69 255.24 18.63 < 0.001 < 0.001
Hallux angle (degrees) 11.89a 7.66 11.02 6.57 7.99 3.77 0.055 0.382
Digitus minimus angle (degrees) 15.31 5.21 13.67 5.06 13.27 4.67 0.072 0.051
Arch height index (ratio) 0.337a 0.025 0.347 0.033 0.356 0.028 0.008 0.032
Arch stiffness index (ratio) 0.920 0.039 0.915 0.036 0.901 0.041 0.104 0.145
Note: a represents significant differences between BMI  24.9 and BMI  30.0. b represents significant differences between BMI  24.9 and
25.0 < BMI < 30.0. c represents significant differences between 25.0 < BMI < 30.0 and BMI  30.0.

Table 5
Bilateral asymmetry in foot morphology by paired samples t-test
Variables Left foot = 180 Right foot = 180 P values
Mean SD Mean SD
Foot length (mm) 242.34 15.11 241.83 15.41 0.073
Forefoot girth (mm) 234.34 15.08 234.87 14.97 0.205
Forefoot width (mm) 96.39 6.41 96.60 6.46 0.279
Rearfoot width (mm) 63.24 4.95 63.34 5.01 0.586
Medial ball of foot length (mm) 174.04 11.09 173.59 11.31 0.023
Lateral ball of foot length (mm) 152.83 12.59 151.81 9.98 0.088
Instep height (mm) 59.03 6.05 59.62 5.91 0.001
Instep girth (mm) 239.02 17.77 239.70 17.73 0.095
Hallux angle (degrees) 11.21 6.40 11.07 6.96 0.681
Digitus minimus angle (degrees) 13.91 4.78 14.45 5.14 0.097
Arch height index (ratio) 0.340 0.027 0.344 0.029 0.001
Arch stiffness index (ratio) 0.920 0.038 0.916 0.038 0.143

266 foot morphology. Tomassoni et al. divided age into the children more commonly had flat and robust feet than 285

267 young (20–25 years), adult (35–55 years) and old (65– underweight children [24]. Similar to the result in chil- 286

268 70 years) males and indicated that foot circumferences dren, the association between flat feet and obesity was 287

269 were most influenced by age-related differences [19]. also found in adult Australians (52.6 ± 8.0 years) and 288

270 Although the division of age was different, our results Americans (38.2 ± 13.3) [23,25]. However, Atamturk 289

271 showed that age differences were not only found in foot et al. stated that there were no associations between the 290

272 circumferences but also in other foot morphology such presence of flat feet or a high arch and body weight 291

273 as the foot length and arch stiffness. Even when gen- or BMI in Turkish individuals (17.6–82.5 years) [26]. 292

274 der and BMI were considered, the foot length, medial In the present study, AHI, which assesses arch height, 293

275 ball of foot length and arch stiffness were still associ- was found to be higher in those with greater BMI. The 294

276 ated with ageing. One possible explanation may be that appearance of such results may be related to higher and 295

277 ageing is generally accompanied by loss of bone and larger feet. The values of higher and larger foot param- 296

278 muscle mass, and reduction of strength (e.g. sarcope- eters, such as forefoot girth, forefoot width, rearfoot 297

279 nia and osteoporosis) [20], which lead to the different width, instep height and instep girth, were significantly 298

280 characteristics of foot morphology. greater in those with higher BMI. 299

281 Several previous studies have shown that being over- Bilateral asymmetry is a common phenomenon in 300

282 weight and obese negatively influence foot morphol- other anatomical morphology [27,28]. The present 301

283 ogy and function in both children and adults [21–23]. study investigated the difference in foot morphology 302

284 The Mauch research group showed that overweight between the left and right foot across all participants. 303
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X. Zhao et al. / Characteristics of foot morphology and their relationship to gender, age, BMI and bilateral asymmetry 7

Table 6
Multiple linear regression analysis using foot morphology parameters as dependent variables respectively, and age, gender and BMI as indepen-
dent variables
Variables B SE (B) β t P R2
Foot length (mm) gender 16.54 1.75 0.53 9.48 < 0.001 0.55
age −0.30 0.08 −0.23 −3.97 < 0.001
BMI 0.50 0.17 0.17 2.99 0.003
Forefoot girth (mm) gender 14.59 1.70 0.49 8.59 < 0.001 0.55
age −0.15 0.07 −0.12 −2.04 0.042
BMI 1.01 0.16 0.35 6.24 < 0.001
Forefoot width (mm) gender 5.61 0.87 0.43 6.48 < 0.001 0.37
age −0.06 0.04 −0.11 −1.57 0.119
BMI 0.30 0.08 0.23 3.56 < 0.001
Rearfoot width (mm) gender 4.51 0.59 0.45 7.69 < 0.001 0.52
age −0.04 0.03 −0.08 −1.40 0.164
BMI 0.38 0.06 0.39 6.79 < 0.001
Medial ball of foot length (mm) gender 12.48 1.26 0.55 9.90 < 0.001 0.57
age −0.22 0.06 −0.23 −3.99 < 0.001
BMI 0.36 0.12 0.16 2.94 0.004
Lateral ball of foot length (mm) gender 11.10 1.11 0.55 9.99 < 0.001 0.57
age −0.19 0.05 −0.22 −3.87 < 0.001
BMI 0.32 0.11 0.17 3.03 0.003
Instep height (mm) gender 6.76 0.70 0.56 9.68 < 0.001 0.53
age −0.01 0.03 −0.02 −0.37 0.714
BMI 0.35 0.07 0.30 5.27 < 0.001
Instep girth (mm) gender 20.83 1.63 0.59 12.79 < 0.001 0.71
age −0.15 0.07 −0.10 −2.16 0.032
BMI 1.30 0.16 0.38 8.35 < 0.001
Hallux angle (degrees) gender −1.95 1.13 −0.14 −1.72 0.087 0.09
age 0.09 0.05 0.15 1.83 0.069
BMI −0.12 0.11 −0.09 −1.09 0.277
Digitus minimus angle (degrees) gender 0.59 0.87 0.06 0.68 0.498 0.01
age 0.00 0.04 0.00 0.05 0.962
BMI −0.10 0.08 −0.10 −1.21 0.227
Arch height index (ratio) gender 0.02 0.01 0.25 3.21 0.002 0.12
age 0.00 0.00 0.15 1.81 0.072
BMI 0.00 0.00 0.23 2.98 0.003
Arch stiffness index (ratio) gender 0.01 0.01 0.12 1.47 0.143 0.05
age 0.00 0.00 0.07 0.85 0.396
BMI 0.00 0.00 −0.19 −2.34 0.020

304 The results exhibited that the left foot had a larger me- three factors on foot morphology. In our study, we 322

305 dial ball of foot length, a lower instep height and AHI found that gender, age and BMI could impact length 323

306 than the right foot, indicating that the right foot had and girth parameters of foot together, and could ex- 324

307 a higher arch and foot than the left foot. The reason plain 37% to 71% of the variation. In them, gender was 325

308 for this result may stem from foot dominant because a bigger predictor of the length, width, height and girth 326

309 the overwhelming majority of the population is right parameters of foot (β = 0.43 to 0.59, all P < 0.001) 327

310 foot dominant. The research from Zifchock et al. pro- than age or BMI. As to the arch, BMI was a signif- 328

311 vides evidence for our assumption, and they noted that icant predictor of AHI (β = 0.23, P = 0.003) and 329

312 the arch height of the dominant foot was significantly ASI (β = −0.19, P = 0.020). Similar to our findings, 330

313 greater than that of the non-dominant foot [9]. In light Wearing et al. [29] also noted that BMI could predict 331

314 of these results, it is indicated that bilateral asymmetry arch height in adults (β = 0.39, P = 0.04). Based on 332

315 of the foot can affect the height of the arch and foot. these findings, BMI seems to be one of the most im- 333

316 Theoretically, the development of certain foot mor- portant factors that affect the foot arch. 334

317 phology should be influenced to some extent by several In conclusion, this study showed that the develop- 335

318 related factors together. Although gender, age and BMI ment of foot morphology is a result of combined effect 336

319 have been documented separately to affect foot and of several related factors such gender, age and BMI. 337

320 arch morphology in previous studies [6–9], there are In them, gender has a greater impact on length, width, 338

321 few papers which studied the combined effect of these height and girth parameters of foot than age or BMI. 339
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8 X. Zhao et al. / Characteristics of foot morphology and their relationship to gender, age, BMI and bilateral asymmetry

340 Compared BMI with age, BMI has a more influence on [10] Telfer S, Woodburn J. The use of 3D surface scanning for the 390

341 width, height and girth parameters of foot, while age measurement and assessment of the human foot. J Foot Ankle 391
Res. 2010; 3: 19. DOI: 10.1186/1757-1146-3-19. 392
342 has a more effect on length parameters of foot. BMI [11] Saghazadeh M, Kitano N, Okura T. Gender differences of foot 393
343 also has an impact on both AHI and ASI. Additionally, characteristics in older Japanese adults using a 3D foot scan- 394
344 bilateral asymmetry affects values of height parameters ner. J Foot Ankle Res. 2015; 8: 29. DOI: 10.1186/s13047- 395

345 of foot and arch. 015-0087-4. 396

[12] Lee YC, Lin G, Wang MJ. Comparing 3D foot scanning with 397
conventional measurement methods. J Foot Ankle Res. 2014; 398
7(1): 44. DOI: 10.1186/s13047-014-0044-7. 399
346 Acknowledgements [13] Williams DS, McClay IS. Measurements used to character- 400
ize the foot and the medial longitudinal arch: reliability and 401

347 We would like to acknowledge the Pigeon Company validity. Phys Ther. 2000; 80(9): 864–871. 402
[14] Richards C, Card K, Song J, Hillstrom H, Butler R, Davis I. A 403
348 which provided a 3D foot scanner to our research, and novel arch height index measurement system (AHIMS): intra- 404
349 Ms. Kaori Itagaki who guided us to operate the device. and inter-rater reliability. Paper presented at: Proceedings of 405

350 We also would like to acknowledge all the participants American Society of Biomechanics Annual Meeting Toledo; 406

351 and staffs in Tanaka Laboratory. 2003. 407

[15] Menz HB. Two feet, or one person? Problems associated with 408
statistical analysis of paired data in foot and ankle medicine. 409
The Foot. 2004; 14(1): 2–5. DOI: 10.1016/S0958-2592(03) 410
352 Conflict of interest 00047-6. 411
[16] Paiva de Castro A, Rebelatto JR, Aurichio TR. The effect of 412
gender on foot anthropometrics in older people. J Sport Reha- 413
353 The authors have no conflict of interest to report. bil. 2011; 20(3): 277–286. 414
[17] Kernozek TW, Torry MR, Van Hoof H, Cowley H, Tanner S. 415
Gender differences in frontal and sagittal plane biomechan- 416

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