基于智能手机照片筛查青少年扁平足

doi:10.3877/cma.j.issn.1674-134X.2025.06.007

目的

探究智能手机拍照筛查能否作为一种更简便、高效、可普及的扁平足快速筛查的方法。

方法

于2024年10月15日在广州市某中学进行筛查，收集性别、年龄等信息。纳入标准为年龄12~14岁，在无外力协助下能单足站立且至少维持5 s；排除标准为足踝先天性异常或畸形无法配合、数据不全等。由骨科医生使用智能手机分别拍摄单足站立的足内侧位照片并通过照片筛查；足底压力筛查使用压力板测量，测量足宽、足长，前足、中足、足跟压地面积，前足、中足、足跟压地压强，前足、中足、足跟负荷和足弓分型。使用McNemar检验比较智能手机拍照和足底压力两种筛查方法的结果差异，使用独立样本t检验比较两种筛查方法数据特征的异同。

结果

总共对596名学生（男332，女264）进行拍照筛查，共有85名学生（男49名、女36名，共170足）同时完成两种筛查，足底压力的阳性检出率（62.9%）高于智能手机拍照（41.8%）（χ²=22.34，P<0.001），但两种筛查方法差异具有统计学意义的数据特征一致。

结论

拍照筛查阳性足的足跟负荷降低和中足负荷增加的特征与足底压力筛查结果一致，但智能手机拍照尚不能直接用于青少年扁平足快速筛查。

关键词: 扁平足, 筛查, 青少年, 智能手机

Objective

To investigate whether smartphone photo screening can be used as a more simple, efficient and widely available method for rapid screening of flatfoot.

Methods

A screening was conducted on October 15, 2024, in a middle school in Guangzhou, and informations such as gender and age of students were collected. Inclusion criteria: age from 12 to 14 years, the students could standing on one foot for at least five seconds without other supporting. Exclusion criteria: abnormality of foot or ankle, student was incompetent to cooperate, incomplete data, etc. Orthopedic surgeons used smartphones to photograph the inside position of feet while standing on one foot and were screened by the pictures. Plantar pressure screening was performed using pressure plate measurements (ZKBF-D1E, JOINCA), measuring foot width and length, plantar contact areas of forefoot, midfoot and heel, pressures on ground of forefoot, midfoot and heel, loads of forefoot, midfoot and heel, and arch types. The screening outcomes of smartphone-based photo and plantar-pressure were compared using the McNemar test, and differences in their data characteristics were evaluated with independent-samples t test.

Results

A total of 596 students (332 males and 264 females) were photo-screened, and 85 students (49 males and 36 females, 170 feet) completed both screenings. The positive detection rate for plantar pressure (62.9%) was higher than that for smartphone photography (41.8%) (χ²=22.34, P<0.001), and the characteristics with statistically significant differences between the two screening methods were in line.

Conclusion

The features of reduced heel load and increased midfoot load in photo-screened positive feet are consistent with the results of plantar pressure screening, but smartphone photography cannot be directly used for rapid screening of adolescent flatfoot yet.

Key words: Flatfoot, Mass screening, Adolescent, Smartphone

图1 两种测量方法示意图

Figure 1 Schematic diagram of the two measurement methods

表1 人群基线特征

Table 1 Baseline characteristics of the population

项目Objectives		男性Male	女性Female	t值	P值
例数[n（%）]Number of cases		49（57.6）	36（42.4）
年龄[岁，（±s）]Age (year)		12.80±0.7	12.9±0.9	-0.90	>0.05
足宽[cm，（±s）]Foot width	左	8.0±1.6	7.2±1.7	2.40	0.01
足宽[cm，（±s）]Foot width	右	8.1±1.3	7.4±1.7	1.01	0.05
足长[cm，（±s）]Foot length	左	22.5±1.9	21.8±2.1	1.48	>0.05
足长[cm，（±s）]Foot length	右	22.9±1.7	21.8±2.0	2.72	0.01
前足压地面积[cm²，（±s）]Forefoot contact area	左	223.4±65.4	180.0±50.2	3.32	<0.01
前足压地面积[cm²，（±s）]Forefoot contact area	右	236.9±52.9	200.3±37.7	3.55	<0.01
中足压地面积[cm²，（±s）]Midfoot contact area	左	151.0±41.1	116.7±32.0	4.17	<0.01
中足压地面积[cm²，（±s）]Midfoot contact area	右	159.9±35.5	128.5±28.1	4.39	<0.01
足跟压地面积[cm²，（±s）]Heel contact area	左	150.6±32.5	122.7±24.6	4.32	<0.01
足跟压地面积[cm²，（±s）]Heel contact area	右	161.7±28.6	135.2±23.1	4.56	<0.01
前足压地压强[N/cm²，（±s）]Forefoot plantar pressure	左	495.6±294.0	517.8±234.8	-0.37	>0.05
前足压地压强[N/cm²，（±s）]Forefoot plantar pressure	右	549.8±239.1	572.0±212.5	-0.44	>0.05
中足压地压强[N/cm²，（±s）]Midfoot plantar pressure	左	762.4±302.4	774.2±213.3	-0.20	>0.05
中足压地压强[N/cm²，（±s）]Midfoot plantar pressure	右	778.6±247.9	812.7±215.6	-0.66	>0.05
足跟压地压强[N/cm²，（±s）]Heel plantar pressure	左	1491.6±556.5	1442.9±527.6	0.41	>0.05
足跟压地压强[N/cm²，（±s）]Heel plantar pressure	右	1401.8±494.2	1445.8±519.4	-0.40	>0.05
前足负荷[%，（±s）]Forefoot load	左	19.0±6.0	19.0±8.0	-1.11	>0.05
前足负荷[%，（±s）]Forefoot load	右	19.0±6.0	20.0±7.0	-0.79	>0.05
中足负荷[%，（±s）]Midfoot load	左	54.0±3.0	53.0±3.0	1.53	>0.05
中足负荷[%，（±s）]Midfoot load	右	54.0±3.0	53.0±3.0	1.60	>0.05
足跟负荷[%，（±s）]Heel load	左	28.0±7.0	28.0±9.0	-0.10	>0.05
足跟负荷[%，（±s）]Heel load	右	26.0±7.0	27.0±8.0	-0.53	>0.05

表1 人群基线特征

Table 1 Baseline characteristics of the population

项目Objectives		男性Male	女性Female	t值	P值
例数[n（%）]Number of cases		49（57.6）	36（42.4）
年龄[岁，（±s）]Age (year)		12.80±0.7	12.9±0.9	-0.90	>0.05
足宽[cm，（±s）]Foot width	左	8.0±1.6	7.2±1.7	2.40	0.01
足宽[cm，（±s）]Foot width	右	8.1±1.3	7.4±1.7	1.01	0.05
足长[cm，（±s）]Foot length	左	22.5±1.9	21.8±2.1	1.48	>0.05
足长[cm，（±s）]Foot length	右	22.9±1.7	21.8±2.0	2.72	0.01
前足压地面积[cm²，（±s）]Forefoot contact area	左	223.4±65.4	180.0±50.2	3.32	<0.01
前足压地面积[cm²，（±s）]Forefoot contact area	右	236.9±52.9	200.3±37.7	3.55	<0.01
中足压地面积[cm²，（±s）]Midfoot contact area	左	151.0±41.1	116.7±32.0	4.17	<0.01
中足压地面积[cm²，（±s）]Midfoot contact area	右	159.9±35.5	128.5±28.1	4.39	<0.01
足跟压地面积[cm²，（±s）]Heel contact area	左	150.6±32.5	122.7±24.6	4.32	<0.01
足跟压地面积[cm²，（±s）]Heel contact area	右	161.7±28.6	135.2±23.1	4.56	<0.01
前足压地压强[N/cm²，（±s）]Forefoot plantar pressure	左	495.6±294.0	517.8±234.8	-0.37	>0.05
前足压地压强[N/cm²，（±s）]Forefoot plantar pressure	右	549.8±239.1	572.0±212.5	-0.44	>0.05
中足压地压强[N/cm²，（±s）]Midfoot plantar pressure	左	762.4±302.4	774.2±213.3	-0.20	>0.05
中足压地压强[N/cm²，（±s）]Midfoot plantar pressure	右	778.6±247.9	812.7±215.6	-0.66	>0.05
足跟压地压强[N/cm²，（±s）]Heel plantar pressure	左	1491.6±556.5	1442.9±527.6	0.41	>0.05
足跟压地压强[N/cm²，（±s）]Heel plantar pressure	右	1401.8±494.2	1445.8±519.4	-0.40	>0.05
前足负荷[%，（±s）]Forefoot load	左	19.0±6.0	19.0±8.0	-1.11	>0.05
前足负荷[%，（±s）]Forefoot load	右	19.0±6.0	20.0±7.0	-0.79	>0.05
中足负荷[%，（±s）]Midfoot load	左	54.0±3.0	53.0±3.0	1.53	>0.05
中足负荷[%，（±s）]Midfoot load	右	54.0±3.0	53.0±3.0	1.60	>0.05
足跟负荷[%，（±s）]Heel load	左	28.0±7.0	28.0±9.0	-0.10	>0.05
足跟负荷[%，（±s）]Heel load	右	26.0±7.0	27.0±8.0	-0.53	>0.05

表2 拍照筛查与足底压力数据的相关性分析（

±s）

Table 2 Correlation analysis between photo-based screening and plantar pressure data

分类Classification	例数Number of cases	前足压地面积（cm²）Forefoot contact area	中足压地面积（cm²）Midfoot contact area	足跟压地面积（cm²）Heel contact area
拍照筛查阴性Photo screening negative	99	199.6±52.3	129.8±35.1	136.6±29.0
拍照筛查阳性Photo screening positive	71	232.2±59.0	157.9±37.9	155.9±31.2
t值		-3.80	-4.98	-4.15
P值		<0.01	<0.01	<0.01
分类Classification	例数Number of cases	前足压地压强（N/cm²）Forefoot plantar pressure	中足压地压强（N/cm²）Midfoot plantar pressure	足跟压地压强（N/cm²）Heel plantar pressure
拍照筛查阴性Photo screening negative	99	534.1±213.0	790.6±239.8	1 483.4±514.4
拍照筛查阳性Photo screening positive	71	529.3±295.3	765.8±266.0	1 393.1±530.5
t值		0.12	0.64	1.12
P值		>0.05	>0.05	>0.05
分类Classification	例数Number of cases	前足负荷（%）Forefoot load	中足负荷（%）Midfoot load	足跟负荷（%）Heel load
拍照筛查阴性Photo screening negative	99	19.0±6.0	53.0±2.0	28.0±7.0
拍照筛查阳性Photo screening positive	71	19.0±8.0	56.0±3.0	26.0±8.0
t值		0.40	-6.42	2.06
P值		>0.05	<0.01	0.04

表2 拍照筛查与足底压力数据的相关性分析（

±s）

Table 2 Correlation analysis between photo-based screening and plantar pressure data

分类Classification	例数Number of cases	前足压地面积（cm²）Forefoot contact area	中足压地面积（cm²）Midfoot contact area	足跟压地面积（cm²）Heel contact area
拍照筛查阴性Photo screening negative	99	199.6±52.3	129.8±35.1	136.6±29.0
拍照筛查阳性Photo screening positive	71	232.2±59.0	157.9±37.9	155.9±31.2
t值		-3.80	-4.98	-4.15
P值		<0.01	<0.01	<0.01
分类Classification	例数Number of cases	前足压地压强（N/cm²）Forefoot plantar pressure	中足压地压强（N/cm²）Midfoot plantar pressure	足跟压地压强（N/cm²）Heel plantar pressure
拍照筛查阴性Photo screening negative	99	534.1±213.0	790.6±239.8	1 483.4±514.4
拍照筛查阳性Photo screening positive	71	529.3±295.3	765.8±266.0	1 393.1±530.5
t值		0.12	0.64	1.12
P值		>0.05	>0.05	>0.05
分类Classification	例数Number of cases	前足负荷（%）Forefoot load	中足负荷（%）Midfoot load	足跟负荷（%）Heel load
拍照筛查阴性Photo screening negative	99	19.0±6.0	53.0±2.0	28.0±7.0
拍照筛查阳性Photo screening positive	71	19.0±8.0	56.0±3.0	26.0±8.0
t值		0.40	-6.42	2.06
P值		>0.05	<0.01	0.04

[1]	Kanatli U, Yetkin H, Cila E. Footprint and radiographic analysis of the feet[J]. J Pediatr Orthop, 2001, 21（2）: 225-228.
[2]	Žukauskas S, Barauskas V, Degliūtė-Muller R, et al. Really asymptomatic? health-related quality of life and objective clinical foot characteristics among 5-10-year-old children with a flexible FlatFoot[J/OL]. J Clin Med, 2023, 12（9）: 3331. DOI: 10.3390/jcm12093331.
[3]	Rabadi D, Seo S, Wong B, et al. Immunopathogenesis, early Detection, current therapies and prevention of plantar Fasciitis: a concise review[J/OL]. Int Immunopharmacol, 2022, 110: 109023. DOI: 10.1016/j.intimp.2022.109023.
[4]	梁晓军, 赵宏谋, 张言, 等. 学龄期儿童柔韧性平足的横断面流行病学研究[J]. 中国骨与关节损伤杂志, 2017, 32（8）: 812-815.
[5]	Sadeghi-Demneh E, Jafarian F, Melvin JMA, et al. Flatfoot in school-age children: prevalence and associated factors[J]. Foot Ankle Spec, 2015, 8（3）: 186-193.
[6]	Chang J-H, Wang SH, Kuo CL, et al. Prevalence of flexible flatfoot in Taiwanese school-aged children in relation to obesity, gender, and age[J]. Eur J Pediatr, 2010, 169（4）: 447-452.
[7]	戴小宇, 冯科曙, 许晨阳, 等. 常州市7~8岁儿童柔韧性扁平足筛查结果及相关因素分析[J]. 中国学校卫生, 2024, 45（10）: 1471-1475.
[8]	程翔宇, 刘建全, 赵喆, 等. 深圳市中小学生平足症的发生率及危险因素分析[J]. 中国儿童保健杂志, 2021（1）: 88-91.
[9]	李海, 张海瑞, 张瀚元, 等. 扁平足检测方法研究及进展[J]. 中国卫生标准管理, 2018, 9（9）: 34-37.
[10]	Chang C-H, Yang W-T, Wu CP, et al. Would foot arch development in children characterize a body maturation process? A prospective longitudinal study[J]. Biomed J, 2022, 45（5）: 828-837.
[11]	Banwell HA, Paris ME, MacKintosh S, et al. Paediatric flexible flat foot: how are we measuring it and are we getting it right? A systematic review[J/OL]. J Foot Ankle Res, 2018, 11: 21. DOI: 10.1186/s13047-018-0264-3.
[12]	Younger AS, Sawatzky B, Dryden P. Radiographic assessment of adult flatfoot[J]. Foot Ankle Int, 2005, 26（10）: 820-825.
[13]	Yamashita T, Sato M, Ata S, et al. Predictors of flatfoot in 11-12-year olds: a longitudinal cohort study[J/OL]. Biomed Eng Online, 2024, 23（1）: 83. DOI: 10.1186/s12938-024-01282-4.
[14]	He Z, Lu N, Chen Y, et al. Conditional generative adversarial network-assisted system for radiation-free evaluation of scoliosis using a single smartphone photograph: a model development and validation study[J/OL]. EClinicalMedicine, 2024, 75: 102779. DOI: 10.1016/j.eclinm.2024.102779.
[15]	Kasović M, Štefan L, Zvonár M. Foot characteristics during walking in 6-14- year-old children[J/OL]. Sci Rep, 2020, 10（1）: 9501. DOI: 10.1038/s41598-020-66498-5.
[16]	Jaszczur-Nowicki J, Bukowska JM, Kruczkowski D, et al. Distribution of feet pressure on ground and maintaining body balance among 8-10-year-old children with and without external load application[J]. Acta Bioeng Biomech, 2020, 22（4）: 93-99.
[17]	张文举, 张宇, 李彦, 等. 青少年扁平足的足底压力特征及对早期干预的指导价值[J]. 足踝外科电子杂志, 2022, 9（4）: 7-12.
[18]	Wang C, Evans K, Hartley D, et al. A systematic review of artificial neural network techniques for analysis of foot plantar pressure[J]. Biocybern Biomed Eng, 2024, 44（1）: 197-208.
[19]	Yamashita T, Yamashita K, Sato M, et al. Foot-surface-structure analysis using a smartphone-based 3D foot scanner[J]. Med Eng Phys, 2021, 95: 90-96.
[20]	Feng ZY, She JY, Hu XY, et al. Exploring flatfeet morphology in children aged 6-12 years: relationships with body mass and body height through footprints and three-dimensional measurements[J]. Eur J Pediatr, 2024, 183（4）: 1901-1910.
[21]	Shen J, Liu J, Liang F, et al. Correlation analysis between body mass index and foot length in Chinese adolescents: a regional study[J]. Ergonomics, 2023, 66（12）: 1845-1853.
[22]	Salinas-Torres VM, Salinas-Torres RA, Carranza-García LE, et al. Prevalence and clinical factors associated with pes planus among children and adults: a population-based synthesis and systematic review[J]. J Foot Ankle Surg, 2023, 62（5）: 899-903.
[23]	Kirmizi M, Sengul YS, Akcali O, et al. Effects of foot exercises and customized arch support insoles on foot posture, plantar force distribution, and balance in people with flexible flatfoot: a randomized controlled trial[J]. Gait Posture, 2024, 113: 106-114.
[24]	Carr JB 2nd, Yang S, Lather LA. Pediatric pes planus: a state-of-the-art review[J/OL]. Pediatrics, 2016, 137（3）: e20151230. DOI: 10.1542/peds.2015-1230.
[25]	Coheña-Jiménez M, Pabón-Carrasco M, Pérez Belloso AJ. Comparison between customised foot orthoses and insole combined with the use of extracorporeal shock wave therapy in plantar fasciitis, medium-term follow-up results: a randomised controlled trial[J]. Clin Rehabil, 2021, 35（5）: 740-749.

[1]	王琪, 杨春凤, 宋宏萍, 许磊. 2021 至2023 年陕西省渭北农村地区基于超声的乳腺癌筛查结果及影响因素分析[J/OL]. 中华医学超声杂志（电子版）, 2025, 22(02): 106-113.
[2]	胡娜娜, 刘雪情, 尹诗九. 跗骨窦螺钉术后矫正器对青少年平足症的影响[J/OL]. 中华关节外科杂志(电子版), 2025, 19(05): 543-548.
[3]	谭建新, 王玉国, 邵彬彬, 蒋祝, 罗春玉, 许争峰. 携带者筛查发现孕妇携带DMD基因非致病性重复的家系分析及遗传咨询[J/OL]. 中华妇幼临床医学杂志(电子版), 2025, 21(04): 429-434.
[4]	安霞, 石玉生, 宋智心. 结直肠癌早期筛查的实验室检测策略及临床价值分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 446-448.
[5]	胡博文, 胡亚兰, 梁辉. 前列腺癌早期筛查的常见方法及最新研究进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(06): 800-808.
[6]	高鉴兴, 马晶晶, 夏洁, 柯晓燕, 方慧. 儿童青少年首次抑郁发作的临床特征及非自杀性自伤的影响因素[J/OL]. 中华临床医师杂志(电子版), 2025, 19(09): 633-641.
[7]	张建锋, 马洪庆, 武雪亮, 郭甘霖, 孟泽松, 冯鋆, 赵泽铭, 王贵英. 恶性肿瘤相关皮肌炎的病理机制与临床管理研究进展[J/OL]. 中华临床医师杂志(电子版), 2025, 19(08): 601-605.
[8]	康清源, 张克石, 肖文韬, 谢培森, 东黎光, 袁平, 关振鹏. 在职钢铁工人群体膝关节骨关节炎流行情况及其可能的危险因素调查[J/OL]. 中华临床医师杂志(电子版), 2025, 19(04): 248-255.
[9]	林再菊, 胡凌云, 王雪丽, 杨爱珍, 张燕, 董金凤, 周媛媛, 刘军权, 闫恒. 浙江省玉环地区育龄女性地中海贫血基因分布和血液学指标特征分析[J/OL]. 中华临床实验室管理电子杂志, 2025, 13(04): 213-219.
[10]	黄文波, 范舒舒, 徐静, 刘玉兰, 陈惠英, 马占忠. 广东韶关地区2646例孕妇脊髓性肌萎缩症携带者筛查及产前诊断[J/OL]. 中华临床实验室管理电子杂志, 2025, 13(04): 220-224.
[11]	王彦云, 洪冬洋, 管贤伟, 王欣, 孙云. 串联质谱法检测精氨酰琥珀酸和瓜氨酸水平在新生儿精氨酰琥珀酸尿症筛查中的价值[J/OL]. 中华诊断学电子杂志, 2025, 13(04): 225-229.
[12]	朱名超, 章尹岗, 朱娅, 郭飞波, 徐会荣, 朱卫芳, 陈艳丽, 白玉娇, 余海燕, 刘濯. 基于形态学AI的粪便分析仪在肠道寄生虫筛查中的应用[J/OL]. 中华诊断学电子杂志, 2025, 13(04): 230-235.
[13]	王洪岩, 高立. 中国青少年网络成瘾诊断从行为描述到临床操作的"三阶进化"[J/OL]. 中华诊断学电子杂志, 2025, 13(03): 208-212.
[14]	曹婧然, 王勇, 张宝帅, 周怡, 徐勇. 老年前列腺疾病患者肌少症、营养状况和衰弱状况调查分析[J/OL]. 中华老年病研究电子杂志, 2025, 12(02): 14-18.
[15]	王思雨, 高丽莲, 于影, 杨华, 张雯, 林清然. 肥胖青少年接受减重代谢手术后骨骼健康的研究进展[J/OL]. 中华肥胖与代谢病电子杂志, 2025, 11(03): 222-226.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Smartphone-based photo screening for adolescent flatfoot

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Smartphone-based photo screening for adolescent flatfoot