Normative reference data for paediatric foot posture


Normative reference data is helpful for clinicians, as it allows comparison of an individual with a relevant group or population.

Paediatric reference values are perhaps more challenging for clinicians, as these change with growth, such that a normal finding at one age, may be abnormal at a different age.

A good example of this is encountered with coronal plane knee alignment in children, eg

Genu varum at age 18 months                       –           normal

Genu varum at age 4 years                             –           abnormal

Genu valgum at age 18 months                     –           abnormal

Genu valgum at age 4 years                           –           normal.

Paediatric foot posture has been a confused clinical encounter for too long. The recent publication of International normative data for paediatric foot posture assessment, has collated the foot posture (Foot Posture Index: FPI-6) from over 3000 healthy children (

This large study found the average FPI score across childhood to be +4, with standard deviation of +3. This means that approximately 2/3 children can be expected to have an FPI within a normal range of +1 to +7.

Further, this study refuted the relationship between heavier children and ‘flatter’ feet.

Below is a paediatric foot posture ‘Ready Reckoner’, developed from this study in effort to aid clinicians in discussions with parents, children and other medical and health professionals.

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As you can see, the ‘bottom line’ from the ‘Ready Reckoner’ suggests clinicians appreciate that:

* Normal FPI across childhood = 4  (Range 1 – 7)

* Triage using ‘Three Quick Questions’ – 3QQ – pain/asymmetry/age (

* Consider wider diagnoses for ALERT values


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Kind regards,

Angela Evans

Dr Angela Evans AM       PhD, FFPM RCPS(Glasg)