Association between Flat Foot Severity and Low Back Pain Recurrence among Pre-Clinical Medical Students: A Cross-Sectional Study

Auteurs

  • Annisa Ummi Hafizhah Arif Fiyanto Faculty of Medicine, Pelita Harapan University, Tangerang, Banten, Indonesia
  • Vonny Fibrianty Goenawan Department of Neurology, Faculty of Medicine, Pelita Harapan University & Siloam Hospital Lippo Village, Tangerang, Banten, Indonesia

DOI:

https://doi.org/10.19166/lijn.v1i2.10280

Trefwoorden:

Low back pain, Flat foot, Clarke’s Angle, Medical students, Recurrence, Flat foot severity

Samenvatting

Background: Low back pain (LBP) affects over 619 million people globally and is highly prevalent among medical students. Flat foot (pes planus), a biomechanical alteration involving the collapse of the medial longitudinal arch, may contribute to spinal stress and LBP recurrence, yet remains underexplored in young adult populations.

Methods: This cross-sectional study involved 67 pre-clinical medical students aged 19–23 years with a history of recurrent LBP in the past year. LBP frequency was assessed using the Nordic Musculoskeletal Questionnaire and Numeric Rating Scale (NRS). Foot arch structure was evaluated via Clarke’s Angle, classifying flat foot severity into mild (35°–41°), moderate (30°– 34.9°), and severe (<30°). Data were analysed using Chi-square tests, with significance set at p < 0.05.

Results: LBP was reported by 80.6% of participants, with flat foot classified as mild in 43.3%, moderate in 37.3%, and severe in 19.4%. A significant association was found between flat foot severity and LBP recurrence (p < 0.001). Students with mild or moderate flat foot had a lower odd of experiencing moderate-frequency LBP compared to those with severe flat foot (OR = 0.152 95% CI: 0.048–0.483).

Discussion: These findings support the notion that structural abnormalities of the foot, particularly flat foot, may contribute to the recurrence and persistence of LBP by influencing spinal posture, altering mechanical load distribution, and affecting neuromuscular stability.

Conclusion: Flat foot severity is significantly associated with the recurrence of LBP in medical students. Early identification and foot posture assessment may help inform preventive and corrective interventions for recurrent LBP.

 

Referenties

1. Balagué F, Mannion AF, Pellisé F, et al. Non-specific low back pain. The Lancet 2012;379(9814):482–491. https://doi.org/10.1016/S0140-6736(11)60610-7

2. Ferreira ML, De Luca K, Haile LM, et al. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023;5(6):e316–e329. https://doi.org/10.1016/S2665-9913(23)00098-X

3. Muñoz Laguna J. Global Burden of Disease Estimates of Low Back Pain: Time to Consider and Assess Certainty? Int J Public Health 2024;69. https://doi.org/10.3389/ijph.2024.1606557

4. Makkiyah FA, Sinaga TA, Khairunnisa N. A Study from a Highly Populated Country : Risk Factors Associated with Lower Back Pain in Middle-Aged Adults. J Korean Neurosurg Soc 2023;66(2):190–198. https://doi.org/10.3340/jkns.2021.0278

5. Alwashmi AH. Prevalence of Low Back Pain and Associated Factors Among Qassim University Medical Students: A Cross-Sectional Study. Cureus 2023; https://doi.org/10.7759/cureus.44596

6. Sany SA, Tanjim T, Hossain MI. Low back pain and associated risk factors among medical students in Bangladesh: a cross-sectional study. F1000Res 2022;10:698. https://doi.org/10.12688/f1000research.55151.3

7. AlShayhan FA, Saadeddin M. Prevalence of low back pain among health sciences students. European Journal of Orthopaedic Surgery & Traumatology 2018;28(2):165–170. https://doi.org/10.1007/s00590-017-2034-5

8. Samudra E, Kalumpiu JF. Factors Associated with Low Back Pain in Pre-Clinical Students in the Faculty of Medicine at Pelita Harapan University: Original Research. Medicinus 2024;13(3):145 https://doi.org/10.19166/med.v13i3.8881

9. Medeni V, Tokatlı Doğan M, Medeni İ, et al. Low back pain, work overload, and associated factors among hospital caregivers. Work 2024;78(1):167–179. https://doi.org/10.3233/WOR-230524

10. Shiri R, Falah‐Hassani K, Heliövaara M, et al. Risk Factors for Low Back Pain: A Population‐Based Longitudinal Study. Arthritis Care Res (Hoboken) 2019;71(2):290–299. https://doi.org/10.1002/acr.23710

11. Chen S-M, Liu M-F, Cook J, et al. Sedentary lifestyle as a risk factor for low back pain: a systematic review. Int Arch Occup Environ Health 2009;82(7):797–806. https://doi.org/10.1007/s00420-009-0410-0

12. Taha YA, Al Swaidan HA, Alyami HS, et al. The Prevalence of Low Back Pain Among Medical Students: A Cross-Sectional Study From Saudi Arabia. Cureus 2023. https://doi.org/10.7759/cureus.38997

13. Kodithuwakku Arachchige SNK, Chander H, Knight A. Flatfeet: Biomechanical implications, assessment and management. The Foot 2019;38:81–85. https://doi.org/10.1016/j.foot.2019.02.004

14. Lulupoy FAI, Pradhana TM, Siahaan YMT. Flat Foot and Its Association with Mechanical Low Back Pain: A Case-Control Study Utilizing Clarke’s Angle Measurement. World Journal of Clinical Medicine Research 2025;5(1):34–39. https://doi.org/10.31586/wjcmr.2025.6048

15. Kosashvili Y, Fridman T, Backstein D, et al. The Correlation between Pes Planus and Anterior Knee or Intermittent Low Back Pain. Foot Ankle Int 2008;29(9):910–913. https://doi.org/10.3113/FAI.2008.0910

16. González-Martín C, Pita-Fernández S, Seoane-Pillado T, et al. Variability between Clarke’s angle and Chippaux-Smirak index for the diagnosis of flat feet. Colomb Med 2017;48(1):25–31. http://dx.doi.org/10.25100/cm.v48i1.1947

17. Chairani A. Validity And Reliability Test of The Nordic Musculoskeletal Questionnaire with Formal and Informal Sector Workers. In: Childhood Stunting, Wasting, and Obesity, as the Critical Global Health Issues: Forging Cross-Sectoral Solutions Masters Program in Public Health, Universitas Sebelas Maret; 2020; pp. 100–106. https://doi.org/10.26911/the7thicph-FP.05.06

18. Hegazy F, Aboelnasr E, Abuzaid M, et al. Comparing Validity and Diagnostic Accuracy of Clarke’s Angle and Foot Posture Index-6 to Determine Flexible Flatfoot in Adolescents: A Cross-Sectional Investigation. J Multidiscip Healthc 2021;Volume 14:2705–2717. https://doi.org/10.2147/JMDH.S317439

19. Kola I, Kola S, Frroku E, et al. Prevalence and Management of Nonspecific Low Back Pain in Physiotherapy Students. Journal of Medical - Clinical Research & Reviews 2021;5(10). http://dx.doi.org/10.33425/2639-944X.1237

20. Zahari Z, Arnuin NA, Mohd Fuhad AM, et al. Type of Sitting Posture and Low Back Pain among University Students. Environment-Behaviour Proceedings Journal 2023;8(24):247–252. https://doi.org/10.21834/ebpj.v8i24.4683

21. Smith DR, Leggat PA. Prevalence and Distribution of Musculoskeletal Pain Among Australian Medical Students. J Musculoskelet Pain 2007;15(4):39–46. https://doi.org/10.1300/J094v15n04_05

22. Yao W, Mai X, Luo C, et al. A Cross-Sectional Survey of Nonspecific Low Back Pain Among 2083 Schoolchildren in China. Spine (Phila Pa 1976) 2011;36(22):1885–1890. https://doi.org/10.1097/brs.0b013e3181faadea

23. Khamis S, Yizhar Z. Effect of feet hyperpronation on pelvic alignment in a standing position. Gait Posture 2007;25(1):127–134. https://doi.org/10.1016/j.gaitpost.2006.02.005

24. Yazdani F, Razeghi M, Karimi MT, et al. The influence of foot hyperpronation on pelvic biomechanics during stance phase of the gait: A biomechanical simulation study. Proc Inst Mech Eng H 2018;232(7):708–717. https://doi.org/10.1177/0954411918778077

25. Jentzsch T, Geiger J, Bouaicha S, et al. Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine. BMC Med Imaging 2013;13(1):34. https://doi.org/10.1186/1471-2342-13-34

26. Goradia R, Shimpi A. Factors contributing to low back pain in workers involved in prolonged standing occupational requirements. International Journal of Occupational and Environmental Safety 2023;7(1):1–13. https://doi.org/10.24840/2184-0954_007-001_001904

27. Almutairi AF, BaniMustafa A, Bin Saidan T, et al. The Prevalence and Factors Associated with Low Back Pain Among People with Flat Feet. Int J Gen Med 2021;Volume 14:3677– 3685. https://doi.org/10.2147/IJGM.S321653

28. Amoozadeh F, Kazemian G, Rasi AM, et al. Surveying The Relationship Between Flatfoot and Chronic Mechanical Low Back Pain. 2015. 5(1). https://www.researchgate.net/publication/323826266

29. Moezy A, Malai S, Dadgostar H. The correlation between mechanical low back pain and foot overpronation in patients referred to Hazrat Rasool Hospital. Pars of Jahrom University of Medical Sciences 2016;14(4):51–61. https://doi.org/10.29252/JMJ.14.4.51

##submission.downloads##

Gepubliceerd

2025-08-30

Citeerhulp

Fiyanto, A. U. H. A., & Goenawan, V. F. (2025). Association between Flat Foot Severity and Low Back Pain Recurrence among Pre-Clinical Medical Students: A Cross-Sectional Study. Lumina : Indonesian Journal of Neurology, 1(2), 52–59. https://doi.org/10.19166/lijn.v1i2.10280