Document Type : systematic review


1 Assistant Professor of Orthopaedics, School of Medicine, Emam Khomeini Hospital, Ilam University of Medical sciences

2 Assistant Professor of Surgery of the Knee, Department of Orthopedics, School of Medicine, Mobility Impairment Research Center, Health Research Institute Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran


Background: Flatfoot (FF) is one of the most common deformities in children, which is divided into two flexible or rigid types. Given the prevalence of FF and the importance of orthopedic diseases, this meta-analysis was conducted to determine the prevalence of FF in children and adolescents in Iran.
Methods:  This study has extracted data related to the prevalence of FF in people under 18 years of age by a meta-analysis of articles published in ISI-PUBMED-SCOPUS-EMBASE-SID-MAGIRA-GOOGLE SCHOOL databases. Original studies published in Persian or English reporting the prevalence of FF in the Iranian population were included in the study. If there was no access to the full file of the article for any reason, it was excluded from the study. Data was analyzed by CMA 3.
Results: It was revealed that the prevalence of FF in girls was equal to 20.8%, and 20.3% in boys. The total prevalence of FF was equal to 20.1%. The prevalence of unilateral FF was equal to 3.9%. The prevalence of bilateral FF was 6.1%. The prevalence of FF was 17.7% for mild FF, 14.2% for moderate FF and 2.8% for severe FF.
Conclusion: Given the high prevalence of FF in Iran, it is suggested that necessary measures be taken to prevent FF while training parents about different effective and risk factors


  1. dorr taj e, alizadeh m, abbasi h, Shirzad Iraqi E: effect of fatigue on spatial and temporal parameters of gait in normal and flexible flat foot. Studies in Sport Medicine 2020, 12(27):17-34.
  2. Mohammadpour M, Yazdi H, Bagherifard A, Jabalameli M, Moghtadaei M, Torkaman A, Yahyazadeh H, Ghaderi MT, Fanaeian MM, Langeroudi MK: Evaluation of early complications, outcome, and mortality in Coronavirus Disease 2019 (COVID-19) infection in patients who underwent orthopedic surgery. BMC Musculoskeletal Disorders 2022, 23(1):64.
  3. Tahami M, Vaziri AS, Tahmasebi MN, Vosoughi F, Khalilizad M, Shakiba S, Pesántez RF: Practical approach to the native distal femur fractures in the elderly: A rapid review over the recent trends. Injury 2022.
  4. Tahmasebi MN, Vaziri AS, Vosoughi F, Tahami M, Khalilizad M, Rabie H: Low post-arthroplasty infection rate is possible in developing countries: long-term experience of local vancomycin use in Iran. Journal of Orthopaedic Surgery and Research 2021, 16(1):1-7.
  5. Sadeghi-Demneh E, Melvin JM, Mickle K: Prevalence of pathological flatfoot in school-age children. The foot 2018, 37:38-44.
  6. Russell B: Orthotics and Prosthetics in Rehabilitation, ed 2. Physical Therapy 2007, 87(4):480-480.
  7. Almansouf AS, Alosaimi MI, Alsinan SH, Almanea RK, Almansoof AS, Jawadi AH: The prevalence of flatfoot among Saudi population: A systematic review. Journal of Musculoskeletal Surgery and Research 2022, 6(4):247-255.
  8. Barry RJ, Scranton Jr PE: Flat feet in children. Clinical Orthopaedics and Related Research (1976-2007) 1983, 181:68-75.
  9. Ueki Y, Sakuma E, Wada I: Pathology and management of flexible flat feet in children. Journal of orthopedic science 2019, 24(1):9-13.
  10. Emami MJ, Emami S, Mohammad HM: Prevalence of flexible flat foot in male children. 2005.
  11. Krul M, van der Wouden JC, Schellevis FG, van Suijlekom-Smit LW, Koes BW: Foot problems in children presented to the family physician: a comparison between 1987 and 2001. Family practice 2009, 26(3):174-179.
  12. Matsumoto T, Chang SH, Takeda R, Tanaka S, Juji T: Bilateral Stress Fractures of the Talus Associated with Adult-Acquired Flatfoot Deformities. Case Reports in Orthopedics 2018, 2018:5376384.
  13. Ryu SM, Lee TK, Lee SH: Prevalence of flatfoot among young Korean males and the correlation among flatfoot angles measured in weight-bearing lateral radiographs. Medicine (Baltimore) 2022, 101(30):e29720.
  14. Evans AM, Rome K, Carroll M, Hawke F: Foot orthoses for treating pediatric flat feet. Cochrane Database of Systematic Reviews 2022(1).
  15. Kothari A, Dixon P, Stebbins J, Zavatsky A, Theologis T: The relationship between quality of life and foot function in children with flexible flatfeet. Gait & posture 2015, 41(3):786-790.
  1. Hassanin M, Felembane F, Nassaane M: Flat foot among Saudi Arabian army recruits: prevalence and risk factors. 2006.
  2. Abolarin T, Aiyegbusi A, Tella B, Akinbo S: Relationship between selected anthropometric variables and prevalence of flatfoot among urban and rural school children in south west Nigeria. Nigerian quarterly journal of hospital medicine 2011, 21(2):135-140.
  3. Echarri JJ, Forriol F: The development in footprint morphology in 1851 Congolese children from urban and rural areas, and the relationship between this and wearing shoes. Journal of pediatric orthopaedics B 2003, 12(2):141-146.
  4. Chen J-P, Chung M-J, Wang M-J: Flatfoot prevalence and foot dimensions of 5–to 13-year-old children in Taiwan. Foot & ankle international 2009, 30(4):326-332.
  5. Pita-Fernandez S, Gonzalez-Martin C, Alonso-Tajes F, Seoane-Pillado T, Pertega-Diaz S, Perez-Garcia S, Seijo-Bestilleiro R, Balboa-Barreiro V: Flat Foot in a Random Population and its Impact on Quality of Life and Functionality. J Clin Diagn Res 2017, 11(4):Lc22-lc27.
  6. Zakeri Y, Baraz S, Gheibizadeh M, Bijan Nejad D, Latifi SM: Prevalence of musculoskeletal disorders in primary school students in Abadan-Iran in 2014. International Journal of Pediatrics 2016, 4(1):1215-1223.
  7. E S: Determining the relative frequency of flat feet in 7-14 year old students in Isfahan city. Journal of medical council of islamic republic of Iran 2011, 29(2):142-149.
  8. Kamali MHA, N Janmohammadi, M Kamali A: Prevalence of Flat Foot in Elementary, Guidance and High School Students (BABOL 2005-2006). Journal of Babol University of Medical Sciences 2008, 9(6):50-54.
  9. Shapouri J, Aghaali M, Aghaei M, Iranikhah A, Ahmadi R, Hovsepian S: Prevalence of lower extremities’ postural deformities in overweight and normal weight school children. Iranian Journal of Pediatrics 2019, 29(5).
  10. Askary Kachoosangy R, Aliabadi F, Ghorbani M: Prevalence of flat foot: comparison between male and female primary school students. Iranian Rehabilitation Journal 2013, 11(3):22-24.
  11. Karimi S, Kashi O, Admadimanesh V, Moradi A: The relationship between anthropometric factors and flat feet. The Scientific Journal of Rehabilitation Medicine 2016, 5(1):126-134.
  12. al Ahe: An epidemiologic study of flat feet in Iran. Tehran University Medical Journal 1997, 55(3):78-83.
  13. Milan N, Dehghani M, Nematian H, Nabian MH, Baghdadi T: Prevalence of Flexible Flat Foot in Iranian Male School Children. Journal of Orthopedic and Spine Trauma 2021:17-19.
  14. Pourghasem M, Kamali N, Farsi M, Soltanpour N: Prevalence of flatfoot among school students and its relationship with BMI. Acta orthopaedica et traumatologica turcica 2016, 50(5):554-557.
  15. Homayouni K, Karimian H, Naseri M, Mohasel N: Prevalence of flexible flatfoot among school-age girls. Shiraz E-Medical Journal 2015, 16(2).
  16. Pashmdarfard M, Amini M, Sanei SH, Shirdareh ML, Marzbali KH, Namazi NG, Ostadzadeh A: Prevalence of Flat Foot in Primary School Students Aged 7-12 Years, in Zanjan City, Iran. Journal of Modern Rehabilitation 2019, 13(4):207-214.
  17. Mirbagheri SS, Kashani RV, Mehraban F, Gharebaghy S: Prevalence of flat foot and hallux valgus deformity among primary school female students in Kiar city of Chaharmahal and Bakhtiari. Pajouhan Scientific Journal 2013, 11(4):36-41.
  18. Sadeghi-Demneh E, Jafarian F, Melvin JM, Azadinia F, Shamsi F, Jafarpishe M: Flatfoot in school-age children: prevalence and associated factors. Foot & ankle specialist 2015, 8(3):186-193.
  19. Abtahian A, Farzan S: A study of the prevalence of flatfoot in high school children. Biomed Res-India 2016, 27(4):1295-1301.
  20. Salavatian A: Principles of Care for Patients Involved in Fracture and Multiple Trauma Patients in Operating Room and Hospital: The Original Article. Journal of Pharmaceutical Negative Results 2022:3340-3353.
  21. Shokri M, Nayyeri S, Salimi N, Nourmohammadi A, Tarjoman A, Borji M, Kalvandi G, Mahdikhani S: Prevalence of Neonatal birth trauma in Iran: a systematic review and meta-analysis. International Journal of Pediatrics 2021, 9(10):14520-14531.
  22. Maleki MM, Afsharloo S, Tarjoman A, Borji M, Mahdikhani S, Shokri M: Prevalence of trauma and related factors in Iranian children and adolescents: systematic review. International Journal of Pediatrics 2021, 9(9):14293-14306.
  23. Hatefi M, Abdi A, Tarjoman A, Borji M: Investigating the prevalence of Musculoskeletal Pain among Iranian Children and Adolescents: a systematic review and meta-analysis. Journal of Pediatrics Review 2019, 7(4):191-198.
  24. Bhoir T, Anap DB, Diwate A: Prevalence of flat foot among 18-25 years old physiotherapy students: cross sectional study. Indian J Basic Appl Med Res 2014, 3(4):272-278.
  25. Ganapathy A, Sadeesh T, Rao S: Morphometric analysis of foot in young adult individuals. World J Pharm Pharm Sci 2015, 4:980-993.
  26. Tashiro Y, Fukumoto T, Uritani D, Matsumoto D, Nishiguchi S, Fukutani N, Adachi D, Hotta T, Morino S, Shirooka H, Nozaki Y, Hirata H, Yamaguchi M, Aoyama T. Children with flat feet have weaker toe grip strength than those having a normal arch. J Phys Ther Sci 2015, 27(11):3533-3536.
  27. Ukoha U, Egwu O, Okafor I, Ogugua P, Igwenagu V: Pes planus: incidence among an adult population in Anambra State, Southeast Nigeria. Int J Biomed Adv Res 2012, 3(3):166-168.
  28. Abich Y, Mihiret T, Yihunie Akalu T, Gashaw M, Janakiraman B: Flatfoot and associated factors among Ethiopian school children aged 11 to 15 years: A school-based study. PLoS One 2020, 15(8):e0238001.
  29. Aenumulapalli A, Kulkarni MM, Gandotra AR: Prevalence of Flexible Flat Foot in Adults: A Cross-sectional Study. J Clin Diagn Res 2017, 11(6):Ac17-ac20.