**6. Methodology**

**Study design:** Descriptive cross-sectional study.

**Setting:** Anthropometric section of department of Anatomy, ESIC Medical College and Hospital, Gulbarga, Karnataka.

**Duration of study:** 14 months; from 31 October 2017 to 31 December 2018. **Sample size:** 1000 participants included medical, dental and nursing students aged between 18 and 21 years of age.

**Inclusion criteria:** Medical, dental and nursing students aged between 18 and 21 years of age in ESIC Medical College, Gulbarga.

**Exclusion criteria:** Students of NRI quota and students with poorly defined wrist creases, deformities of vertebral column and limbs, contractures, missing limbs, history of trauma to hand and foot, with features suggestive of dysmorphic syndromes, chronic illness and hormonal therapy were excluded from the study.

**Sample selection:** Simple random sampling method [13] as we selected 1000 participants out of total 3000 medical, dental and nursing students in our institute satisfying the inclusion criteria. As subjects belonging to the first to third year, they were easily accessible and also represented the young adult age group.

#### **6.1 Data collection procedure**

**Foot length:** Each subject will stand on a calibrated foot board with his/her back against the wall in such a manner that the posterior most point of the heel will

*Effect of Foot Morphology and Anthropometry on Bipedal Postural Balance DOI: http://dx.doi.org/10.5772/intechopen.92149*

**Figure 1.** *Measurement of foot length.*

postural stability. Very few studies are available on correlation of foot parameters

As the age advances particularly after forties, the muscle mass goes on decreas-

A study was conducted in central population of northern Karnataka on 1000 young adult population in which foot anthropometry was measured and correlated

**Setting:** Anthropometric section of department of Anatomy, ESIC Medical

**Duration of study:** 14 months; from 31 October 2017 to 31 December 2018. **Sample size:** 1000 participants included medical, dental and nursing students

**Inclusion criteria:** Medical, dental and nursing students aged between 18 and

**Exclusion criteria:** Students of NRI quota and students with poorly defined wrist creases, deformities of vertebral column and limbs, contractures, missing limbs, history of trauma to hand and foot, with features suggestive of dysmorphic syndromes, chronic illness and hormonal therapy were excluded from the study. **Sample selection:** Simple random sampling method [13] as we selected 1000 participants out of total 3000 medical, dental and nursing students in our institute satisfying the inclusion criteria. As subjects belonging to the first to third year, they

**Foot length:** Each subject will stand on a calibrated foot board with his/her back

against the wall in such a manner that the posterior most point of the heel will

were easily accessible and also represented the young adult age group.

with stature, weight, body mass index and bipedal posture stability [21].

**Study design:** Descriptive cross-sectional study.

21 years of age in ESIC Medical College, Gulbarga.

College and Hospital, Gulbarga, Karnataka.

aged between 18 and 21 years of age.

**6.1 Data collection procedure**

**148**

ing so does the muscle strength. Muscle fatigue, which is a common condition affecting the elderly population, can result in mobility, postural and gait deficiencies. The state of mind can influence the activity of the muscular system, that is, the muscular tonus. The muscular activation or, in the contrary case, the muscular relaxation influences postures adopted by people. The body height and the lower limb length constitute partly to weight transfer strategy. The trunk-cephalic length does not correlate to the postural sway. Body mass is located above the hips, so it is not the main factor for the mediolateral sway. The weight transfer strategy for men depends on the size of the basis of support and their lean mass, while, for women, only the lengths (whole body and lower limbs) are important. Lower basis of supports leads to higher postural sway in the ML direction (Chiari et al. [11]; Chou et al., [20]), and to control the increase in body sway, it is necessary to increase the lean mass, probably and mainly the muscle mass to be able to generate more muscle force. The increase in body height affects the body mass and soft tissue mass (lean and fat masses) increases the postural sway. The increase in body mass indeed

with unipedal and bipedal postural balance [18].

enlarges the postural sway.

**5. Research study**

*Weight Management*

**6. Methodology**

**4.5 Effect of muscle strength and fatigue on postural balance**

gently touch the wall. A vertical stop was placed against the anterior most point of the foot. The distance between the posterior most point of the heel and the anterior most point of the foot was measured as the foot length [22] (**Figure 1**).

**Foot breadth:** It will be measured as distance between metatarsal tibiale (point projecting most medially on the head of the 1st metatarsal bone) and metatarsal fibulare (point projecting most laterally on the head of the 5th metatarsal bone) [23].

**Height:** Standing height will be measured to the nearest centimeters (cm) using a stadiometer with the subject standing erect on a horizontal resting plane bare footed having the palms of the hands turned inward and the fingers pointing downwards. The height will be measured from the sole of the feet to the vertex of the head as recommended by International Biological Program [23].

**Body weight:** It will be taken using the Mechanical Weighing Balance to the nearest kg according to the standard procedures A. Ibegbu, David et al. [24].

**Body mass index:** It will be calculated by dividing weight by height squared [weight/height squared (kg/m<sup>2</sup> )] David et al. [24].

#### **6.2 Data collection tools**

Vernier slide calipers, calibrated foot board, stadiometer, regular weight machine, questionnaire for collection of personal details, academic scores, lead pencils, stationary, etc. Data collected were tabulated, graphically represented and statistically analyzed.

#### **7. Observations**

In our study, mean foot length was observed as 24.34 cm on the right side and 24.32 cm on the left side. Mean body mass index was calculated as 20.97. Correlation between foot length and body mass index was done. No statistically significant correlation between BMI and foot length of the right and left sides (P > 0.05) was observed. For further details, refer to **Table 1**.

In the present study, mean foot breadth was observed as 8.95 cm on the right side and 8.96 cm on the left side. Mean body mass index was calculated as 20.97. Correlation between foot length and body mass index was done. There was a

statistically significant correlation between BMI and foot breadth of the right and left sides (P < 0.01). The observations in the study stated that foot breadth of both sides was considerably more in participants who had higher body mass index. Linear regression coefficient was derived. For further details, refer to **Table 2**, **Figure 2.**

**Variables Minimum Maximum Range Mean SD N Correlation r P value** Height (cm) 135.2 195.2 60.0 161.88 13.45 1000 — —

Height = 71.391 + 4.782 (foot length right)

*Effect of Foot Morphology and Anthropometry on Bipedal Postural Balance*

Height = 49.706 + 4.786 (foot length left)

21.0 28.9 7.9 24.34 1.54 1000 r = 0.428 P < 0.01

21.5 29.0 7.5 24.32 1.50 1000 r = 0.516 P < 0.01

HS

HS

Foot length right (cm)

Foot length left (cm)

Linear regression equation

Linear regression equation

*Correlation of foot length and human stature.*

*DOI: http://dx.doi.org/10.5772/intechopen.92149*

**Table 3.**

**Figure 3.**

**Figure 4.**

**151**

*Correlation between foot breadth and body mass index.*

*Measurement of foot breadth.*


#### **Table 1.**

*Correlation of foot length and body mass index.*


#### **Table 2.**

*Correlation of foot breadth and body mass index.*

**Figure 2.** *Correlation between foot length and body mass index.*

*Effect of Foot Morphology and Anthropometry on Bipedal Postural Balance DOI: http://dx.doi.org/10.5772/intechopen.92149*


#### **Table 3.**

statistically significant correlation between BMI and foot breadth of the right and left sides (P < 0.01). The observations in the study stated that foot breadth of both sides was considerably more in participants who had higher body mass index. Linear regression coefficient was derived. For further details, refer to **Table 2**,

**Variables Minimum Maximum Range Mean SD N Correlation r P value**

**Variables Minimum Maximum Range Mean SD N Correlation r P value**

BMI = 19.306 + 0.168 (foot breadth right)

BMI = 17.214 + 0382 (foot breadth left)

12.22 40.61 28.39 20.97 4.66 1000 — —

21.0 28.9 7.9 24.34 1.54 1000 r = 0.073 P > 0.05

21.5 29.0 7.5 24.32 1.50 1000 r = 0.024 P > 0.05

12.22 40.61 28.39 20.97 4.66 1000 — —

7.5 10.9 3.4 8.95 0.78 1000 r = 0.124 P

7.7 11.5 3.8 8.96 0.68 1000 r = 0.115 P

NS

NS

< 0.05 S

< 0.05 S

**Figure 2.**

Body mass index (kg/m<sup>2</sup> )

*Weight Management*

Foot length right (cm)

Foot length left (cm)

Body mass index (kg/m<sup>2</sup> )

Foot breadth right (cm)

Foot breadth left (cm)

Linear regression equation

Linear regression equation

**Table 2.**

**Figure 2.**

**150**

*Correlation of foot length and body mass index.*

*Correlation of foot breadth and body mass index.*

*Correlation between foot length and body mass index.*

**Table 1.**

*Correlation of foot length and human stature.*

**Figure 3.** *Measurement of foot breadth.*

**Figure 4.** *Correlation between foot breadth and body mass index.*


#### **Table 4.**

*Correlation of foot breadth and human stature.*

We also observed foot length on both sides. Mean foot length on the right side was observed as 24.34 cm, and on the left side, it was 24.32 cm. Correlation of foot length was conducted with human stature. Linear regression equation was derived for both sides. Statistically highly significant positive correlation was observed between height and foot length of both sides (P < 0.01). **Table 3** reveals that foot length of both sides was also significantly more among those having more height (**Figures 3** and **4**).

Foot breadth was observed on both sides. Mean foot breadth on the right side was observed as 8.95 cm, and on the left side, it was 8.96 cm. Correlation of foot breadth was conducted with human stature. Linear regression equation was derived

for both sides. Statistically highly significant positive correlation was observed between height and foot breadth of both sides (P < 0.01). **Table 4** reveals that foot breadth of the right or left side was significantly more in those participants whose

Postural sway was measured in the participants both male and female in anteroposterior and mediolateral direction (**Figure 9**). Correlation of postural sway with foot length and foot breadth was conducted. Mediolateral postural sway

amplitude was the same, that is, 0.3 cm in both males and females.

Gender-wise comparison of observations was done. We observed very highly significant difference in foot length, foot breadth, height and weight among males and females. The foot length, foot breadth, height and weight were significantly more in males compared to females, whereas body mass index was significantly more in females as compared to males. The observations have been tabulated in

**Female (N = 500) Mean SD**

Foot length right (cm) 25.18 1.32 23.39 1.19 Z = 30.07 P < 0.001, VHS Foot length left (cm) 25.31 1.16 23.19 0.96 Z = 31.19 P < 0.001, VHS

Foot breadth left (cm) 9.35 0.59 8.52 0.47 Z = 23.21 P < 0.001, VHS Height (cm) 169.28 11.75 153.42 9.75 Z = 22.26 P < 0.001, VHS Weight (kg) 58.21 11.91 50.14 9.85 Z = 11.21 P < 0.001, VHS

) 20.58 4.94 21.41 4.27 Z = 2.53 P < 0.05, S

**Z-test value**

9.39 0.71 8.45 0.52 Z = 22.97 P < 0.001, VHS

**P value and significance**

height was more (**Figures 5** and **6**).

*Gender-wise comparison of parameters.*

**Table 5, Figures 7** and **8**.

**Figure 6.**

*Correlation between foot length and stature.*

**Variables Male**

Foot breadth right

(cm)

BMI (kg/m2

**Table 5.**

**153**

**(N = 500) Mean SD**

*Effect of Foot Morphology and Anthropometry on Bipedal Postural Balance*

*DOI: http://dx.doi.org/10.5772/intechopen.92149*

*NS, not significant; S, significant; HS, highly significant; VHS, very highly significant.*

**Figure 5.** *Measurement of human stature.*

*Effect of Foot Morphology and Anthropometry on Bipedal Postural Balance DOI: http://dx.doi.org/10.5772/intechopen.92149*

#### **Figure 6.**

We also observed foot length on both sides. Mean foot length on the right side was observed as 24.34 cm, and on the left side, it was 24.32 cm. Correlation of foot length was conducted with human stature. Linear regression equation was derived for both sides. Statistically highly significant positive correlation was observed between height and foot length of both sides (P < 0.01). **Table 3** reveals that foot length of both sides was also significantly more among those having more height

**Variables Minimum Maximum Range Mean SD N Correlation r P value** Height (cm) 135.2 195.2 60.0 161.88 13.45 1000 — —

Height = 106.01 + 6.240 (foot breadth right)

Height = 96.843 + 7.253 (foot breadth left)

7.5 10.9 3.4 8.95 0.78 1000 r = 0.364 P < 0.01

7.7 11.5 3.8 8.96 0.68 1000 r = 0.367 P < 0.01

HS

HS

Foot breadth was observed on both sides. Mean foot breadth on the right side was observed as 8.95 cm, and on the left side, it was 8.96 cm. Correlation of foot breadth was conducted with human stature. Linear regression equation was derived

(**Figures 3** and **4**).

Foot breadth right

*Weight Management*

Foot breadth left

Linear regression equation

Linear regression equation

*Correlation of foot breadth and human stature.*

(cm)

(cm)

**Table 4.**

**Figure 5.**

**152**

*Measurement of human stature.*

*Correlation between foot length and stature.*


#### **Table 5.**

*Gender-wise comparison of parameters.*

for both sides. Statistically highly significant positive correlation was observed between height and foot breadth of both sides (P < 0.01). **Table 4** reveals that foot breadth of the right or left side was significantly more in those participants whose height was more (**Figures 5** and **6**).

Gender-wise comparison of observations was done. We observed very highly significant difference in foot length, foot breadth, height and weight among males and females. The foot length, foot breadth, height and weight were significantly more in males compared to females, whereas body mass index was significantly more in females as compared to males. The observations have been tabulated in **Table 5, Figures 7** and **8**.

Postural sway was measured in the participants both male and female in anteroposterior and mediolateral direction (**Figure 9**). Correlation of postural sway with foot length and foot breadth was conducted. Mediolateral postural sway amplitude was the same, that is, 0.3 cm in both males and females.

**Figure 7.** *Correlation between foot breadth and stature.*

Anteroposterior sway amplitude was .95 cm in females and .10 cm in males. **It was observed that men exhibited more postural sway compared to females in anteroposterior direction**. The findings were statistically signifi-

**Variables Foot length (cm) r(p) Foot breadth (cm) Angle (°**

*Effect of Foot Morphology and Anthropometry on Bipedal Postural Balance*

*DOI: http://dx.doi.org/10.5772/intechopen.92149*

Mediolateral sway (cm) 0.01 (0.88) 0.01 (0.80) 0.01 (0.89) Mediolateral ampl sway (cm) 0.05 (0.54) 0.01 (0.82) 0.03 (0.70) Anteroposterior sway (cm) 0.07 (0.43) 0.05 (0.53) 0.12 (0.21) Anteroposterior ampl sway (cm) 0.09 (0.35) 0.11 (0.25) 0.95 (0.35) Sway velocity (cm/s) 0.05 (0.56) 0.12 (0.22) 0.11 (0.25)

Mediolateral sway (cm) 0.32 (0.00) 0.02 (0.84) 0.04 (0.68) Mediolateral ampl sway (cm) 0.27 (0.00) 0.02 (0.83) 0.03 (0.69) Anteroposterior sway (cm) 0.29 (0.00) 0.00 (0.94) 0.11 (0.24) Anteroposterior ampl sway (cm) 0.27 (0.00) 0.06 (0.52) 0.10 (0.31) Sway velocity (cm/s) 0.15 (0.13) 0.08 (0.42) 0.09 (0.37)

) 0.67 (0.50) 0.24 (0.80) 0.12 (0.22)

) 0.36 (0.00) 0.02 (0.78) 0.10 (0.32)

**)**

Few studies have worked on the relationship of foot anthropometry with balance. Clarke [25] analyzed the angle of foot. Swanenburg et al., [26] examined static posturography using the center of pressure (COP) oscillation on a force platform.

stabilometric parameters only in the male group. Our study observations matched with those of Alonso et al. [27], Kejonen et al., [19] and Molikova et al., [13]. Previous studies by Alonso et al*.*, [3] and Chou et al., [20] also demonstrated that an

Our study states that neither the foot length nor the foot width influences postural balance. These observations matched with Alonso et al., [28], but they had

contradicted with those of Chiari et al.[12] in which foot width showed positive correlation with postural balance. They conducted the study by bipedal standing balance task. They stated that the increase in lean mass correlates to the decrease of the amplitude of the postural sway. They added that the percentage of fat mass explains part of the anteroposterior postural sway in men, but not in women.

Mainenti et al. [29] showed that elderly women with more fat mass had larger balance sway and Winters and Snow [30] reported that 31% of postural sway variability in premenopausal women was caused by the fat mass. Hence, it can be concluded that the effect of fat mass on the postural control is age dependent.

Our study suggested association between greater foot length and higher

conducted the study using unipedal standing balance task. Our findings

increase in the size of the support base can improve the balance.

cant. Refer to **Table 6** for details.

*Spearman's correlation, \*ρ* ≤ *0.05. ampl, amplitude.*

*Correlation between foot anthropometric measurements and postural balance.*

**8. Discussion**

**155**

**Female**

Sway area (cm<sup>2</sup>

Sway area (cm<sup>2</sup>

**Table 6.**

**Male**

**Figure 8.** *Multiple bar diagram represents gender-wise comparison of variables.*

**Figure 9.** *Gender-wise comparison of parameters.*


*Effect of Foot Morphology and Anthropometry on Bipedal Postural Balance DOI: http://dx.doi.org/10.5772/intechopen.92149*

#### **Table 6.**

**Figure 7.**

*Weight Management*

**Figure 8.**

**Figure 9.**

**154**

*Gender-wise comparison of parameters.*

*Correlation between foot breadth and stature.*

*Multiple bar diagram represents gender-wise comparison of variables.*

*Correlation between foot anthropometric measurements and postural balance.*

Anteroposterior sway amplitude was .95 cm in females and .10 cm in males. **It was observed that men exhibited more postural sway compared to females in anteroposterior direction**. The findings were statistically significant. Refer to **Table 6** for details.

#### **8. Discussion**

Few studies have worked on the relationship of foot anthropometry with balance. Clarke [25] analyzed the angle of foot. Swanenburg et al., [26] examined static posturography using the center of pressure (COP) oscillation on a force platform. Our study suggested association between greater foot length and higher stabilometric parameters only in the male group. Our study observations matched with those of Alonso et al. [27], Kejonen et al., [19] and Molikova et al., [13]. Previous studies by Alonso et al*.*, [3] and Chou et al., [20] also demonstrated that an increase in the size of the support base can improve the balance.

Our study states that neither the foot length nor the foot width influences postural balance. These observations matched with Alonso et al., [28], but they had conducted the study using unipedal standing balance task. Our findings contradicted with those of Chiari et al.[12] in which foot width showed positive correlation with postural balance. They conducted the study by bipedal standing balance task. They stated that the increase in lean mass correlates to the decrease of the amplitude of the postural sway. They added that the percentage of fat mass explains part of the anteroposterior postural sway in men, but not in women.

Mainenti et al. [29] showed that elderly women with more fat mass had larger balance sway and Winters and Snow [30] reported that 31% of postural sway variability in premenopausal women was caused by the fat mass. Hence, it can be concluded that the effect of fat mass on the postural control is age dependent.

The increase in body height indeed increases the postural sway. Hence, in our study, the greater height in the male group may have been the reason for the greater influence of this parameter on COP in comparison to the female participants.

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