Hip dysplasia along with flat feet are pathologies that have been studied gradually in our environment in depth, which is why other studies have been developed that invite these associations and determine other variables that can be correlated with these two diseases.

Ponce de León Samper in his study analysed these variables of Dysplasia of the development of hip and flat feet, and generated a large number of questions in this respect, therefore the Ponce study served as support for the realization of this research, where the idea is search for results and clearer conclusions that may lead to some degree of recommendation and to protocolize processes as risk factors in these pathologies [6].

The general objective of this study is to identify the association between flatfeet in the school population in children aged from 4 to 14 years associated with a history of Hip Development Dysplasia as a predictive factor and prognosis of the symptomatology of this pathology [7] and as a determinant of biomechanical alterations of lower limbs and, consequently, of mid and long-term deforming pathologies [5].

2.      Materials and Methods

It is a descriptive, cross-sectional, retrospective study whose inclusion criteria are children between 4 and 14 years of age, from the city of Bogotá and Soacha of the Cardiovascular Hospitals, Central Hospital of the Police and Clínica Colombia, both female and male, who attend an orthopedics outpatient consult, with a flat feet clinic associated with a history of hip dysplasia. 150 patients were taken from these medical centers, a retrospective history of hip dysplasia was verified by means of the clinical history and a flat feet clinic was confirmed in the orthopedic consultation; Homogeneous samples were taken in number of these 3 institutions, Hospital of the Police (45 patients) Soacha Cardiovascular Hospital (52 patients) and Clínica Colombia (53 patients) with similar socioeconomic, cultural, genotypic and phenotypic characteristics that met inclusion criteria Age, signed consent and authorization to participate in the study [8].

To the studied population, we analysed variables such as degree of symptomatology of flat feet clinic, gender, age, and history of hip dysplasia.

The alternative hypothesis was formulated where there is an association between HD and flat feet and formulating a null hypothesis, where there is no association between these two variables. The statistical program was used with analysis of variables in EXCEL table, with chi square test or distribution of Pearson, using contingency tables and analysing qualitative variables by means of tables of frequencies observed and tables of frequencies expected to determine the continuous probability with the determined variables of flat feet, that represents the degrees of freedom of a random variable, where the variable dysplasia and flatfeet are normal random variables independent of mean zero and variance one.

The ratio of cross products or ORs with exposed and non-exposed groups to the history of dysplasia and a control group with no history of dysplasia and no clinical presence of flat feet were determined, determining the probability of developing flat feet with the presence of HD.

Statistical significance was set at p <0.01. There were mean differences between groups with 99% confidence intervals (IC).

3.      Results

Of the 150 patients, a representative sample of the hospitals linked to the study, 102 patients reported having a flat feet clinic, confirming with physical examination during the consultation of Children's Orthopaedics, observing a decrease in longitudinal plantar arch and presence of a back foot in valgus, of which 78 patients had a history of hip dysplasia, 24 had no history of HD. In the sample of 150 patients; 100 patients had a history of hip development dysplasia, of which 22 patients did not present a flat feet clinic and 26 patients were part of the control group, with no history of HD, nor a flat feet clinic.

We performed a chi square analysis of 13,876, taking into account the degree of freedom of 1, and chi square according to the degree of reliability of the study of 99%, we identified the ratio of tabular chi square is 6.6349, the calculated chi being greater than the tabulated chi square.

We identified a p-value of 0.00800765 with asymptotic significance, less than 0.01, which indicates that it has statistical significance.

Odd Ratio is calculated in 3.8, taking into account the 2 variables, a group with a history of HD, a group with flat feet and the control group and relation with exposed and unexposed groups.

A 79% more chance of developing flat feet associated with a history of hip development dysplasia was determined

It was found that of the 150 patients enrolled in the study, 88 patients were female and 62 male patients, representing 58.7% and 41.3% respectively of the global study sample.

For age groups we found a distribution during the statistical analysis, of the 150 global patients in the study, 82 patients (54%) were in the range of 4 to 10 years and 68 patients (45%) between the ages of 10 and 14 years old.

In the sample of patients between 4 and 10 years old the age distribution was as follows: (4 years: 18 patients (21.9%), 5 years: 12 patients (14%), 6 years: 8 patients (9.7%), 7 years: 10 patients (12.1%), 8 years: 14 patients (17%), 9 years: 11 patients (13%), 10 years: 9 patients (10.9%).

In the sample of patients between 11 and 14 years old the age distribution was as follows: (11 years: 15 patients (22%), 12 years: 21 patients: (30%), 13 years: 17 patients (25%), 14 years: 15 patients (22%).

4.      Discussion

In the present investigation, as well as in that carried out by Ponce de León (), a significant association between flat feet and hip dysplasia was found. This finding is particularly important in the sense of alerting the careful search for the first pathology when the latter is diagnosed, or vice versa, in order to provide the patient with a more comprehensive and better-quality care.

Whether the association mentioned above is real or whether it is determined by the relation of the two pathologies to an unidentified factor and which precedes them (spurious association) persists. From a theoretical point of view, it could be thought that there are many factors that could be associated with the two pathologies and that precede them, motivating their association. These factors include: genetic, fetal presentation, uterine height, anatomical conformation of the uterus, pelvic circumference, height of the mother, endocrine, etc.

From a preventive point of view, it would be of the utmost importance to establish, through analytical studies, whether one or more of the factors mentioned correspond to risk factors of the two pathologies studied. Thus, the approach of the same would begin with the identification of risk factors, whose management could prevent its occurrence. Undoubtedly, this would be an outstanding contribution to scientific knowledge and prevention of these pathologies, of high frequency in the population.

5.      Conclusion

We can conclude from this study that the alternative hypothesis that affirms that there is a relationship between flat feet and hip development dysplasia in patients between 4 and 14 years of age in the studied population is true, confirming this hypothesis.

With this study, we were able to determine the probability of 79% more times of developing flat feet with the history of hip development dysplasia by previously analyzing the odds ratios and the cross-product ratio of these two variables, calculating the OR of this study.

From this study, we highlight that there is a high number of cases in the female gender in relation to the male with a presence of flat feet related to dysplasia of the hip development in the global population of the sample.

It was evidenced in the study that the distribution of number of cases between flat feet and hip development dysplasia was greater in the age group between 11 and 14 years, being at the age of 12 years old the point of greatest prevalence of cases.

It was identified that within the general sample of the study there is a greater number of patients with hip development dysplasia that present flat feet associated to symptoms.

6.      Recommendations

Based on the results of the research, it is recommended that the national and international scientific community carry out analytical studies (Cohorts and Cases and Controls) to identify risk factors for the pathologies studied, with hypotheses based on the factors indicated in the Discussion of this document.

Likewise, it is recommended to incorporate in the protocols of clinical and therapeutic management the systematic search for the two pathologies, when the presence of one of the two is identified.

Figure 1: Clinical evidence of flatfeet in a 5-year-old preschooler with a history of HD.

1. C.I. Ezema, Abaraogu UO, Okafor GO (2014) Flat foot and associated factors among primary school children: A cross-sectional study, Physiotherapy Journal 32: 13e20.
2. Vergara Amador E, Sánchez RFS, Posada JRC, Molano AC, GuevaraOA (2012) Prevalence of flatfoot in school between 3 and 10 years. Study of two different populations geographically and socially. Colomb Med 43: 141-146.
3. Rivera Saldívar G (2012) Risk factors associated to the conformation of the medial longitudinal arch and symptomatic flat feet in a metropolitan school population in Mexico, Mexican Orthopedic Act 26: 85-90
4. CBourdet, Seringe R, Adamsbaum C, Wicart P (2013) Flatfoot in children and adolescents. Analysis of imaging findings and therapeutic implications, Orthopaedics& Traumatology: Surgery & Research 99: 80-87.
5. Kothari A, Dixon PC, Stebbins J, Zavatsky AB, Theologis T (2016) Are flexible flat feet associated with proximal joint problems in children?.Gait & Posture 45: 204-210.
6. Ponce de León Samper MC, Herrera Ortiz G, Castellanos Mendoza C (2015) Relationship between flexible flat foot and developmental hip displasia, Rev Esp Cir OrtopTraumatol59:295-298.
7. Zafiropoulos G, Prasad KS, Kouboura T, Danis G (2009) Flat foot and femoral ante version in children—A prospective study. The Foot 19: 50-54.
8. Abolarin T, Aiyegbusi A, Tella A, Akinbo S (2011) Predictive factors for flatfoot: The role of age and footwear in children in urban and rural communities. The Foot 21: 188-192.