Abstract
Background: Flexible flatfoot is a common musculoskeletal alteration in people with diabetes. Increased body mass index (BMI) and weakness of intrinsic foot muscles may contribute to medial longitudinal arch collapse. However, limited evidence exists on their association with flexible flatfoot in diabetic populations. The purpose of this study was to determine the association of flexible flatfoot with BMI and intrinsic foot muscle strength in patients with diabetes.
Methods: A cross-sectional study was conducted among 286 diabetic patients aged 35–55 years recruited from tertiary care hospitals in Peshawar. Participants with neuropathy or neuromuscular disorders were excluded. BMI was categorized using Asian cut-offs. The navicular drop test (≥10 mm) was used to assess flexible flatfoot. The intrinsic muscles of the foot; Tibialis posterior and abductor hallucis muscle strength was measured using manual muscle testing. Data were analyzed with chi-square tests in SPSS v.27, with significance value set at p < 0.05.
Results: The mean age of participants was 48.4 ± 6.4 years; 46.2% were male & females 53.8%. Based on BMI, 44.1% were normal weight and 55.9% overweight; underweight and obese patients were excluded. Flexible flatfoot was observed in 52.4% of participants. Muscle strength grading showed 29.4% of tibialis posterior and 40.6% of abductor hallucis at grade 3 strength. Chi-square analysis demonstrated significant associations of flexible flatfoot with BMI (p < 0.001), tibialis posterior strength (p < 0.001), and abductor hallucis strength (p < 0.001).
Conclusion: Flexible flatfoot is highly prevalent among diabetic patients and is significantly associated with higher BMI and reduced intrinsic foot muscle strength.