Foot Shape and Its Effect on Functioning in Royal Australian Air Force Recruits. Part 1: Prospective Cohort Study

Military Medicine,  Jul 2005  by Esterman, Adrian,  Pilotto, Louis

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Current ADF regulations for the medical examination of new recruits make flat feet acceptable as long as they are not of the immobile (rigid) type and they are asymptomatic.6 In contrast, cavus feet are an unqualified exclusion factor. With the current difficulties encountered by the ADF in obtaining sufficient recruits, clearly it would not be sensible to reject potential recruits because of their foot shape if in fact foot shape had little bearing on the recruits' ability to function or on their probability of incurring a training injury. However, if either flat feet or cavus feet was a risk factor for poor functioning or training injury, then the regulations should be maintained or even possibly strengthened. Because there has been no published evidence on foot shape and functioning, with contradictory evidence on foot shape and training injury, we undertook a prospective cohort study to investigate the impact of foot shape on pain, training injury, foot health, and quality of life among military recruits.

Methods

Location

The study took place at No. 1 Recruit Training Unit (IRTU), located in the Royal Australian Air Force (RAAF) base at Edinburgh, South Australia, -25 km north of Adelaide. All RAAF recruits undergo a 10-week basic training course at IRTU. Each fortnight between 36 and 118 new recruits start basic training at IRTU. Recruits are divided into training courses, each with 36 recruits, so that there are one, two, or three courses starting each fortnight, depending on recruitment numbers.

Study Design

The study was principally a prospective cohort study. However, because little is known about the outcome of providing adults with flat feet with orthotics, we decided to take the opportunity to perform a small, randomized, controlled trial of the provision of orthotics to recruits with flexible flat feet. Therefore, the full design was a hybrid one, because one of the exposure arms (flat feet) was used as the basis for a nested, randomized, controlled trial. In this study, we report on only the prospective study, which consisted of recruits not assigned to receive orthotics. The prospective cohort study followed six intakes of recruits over their 10 weeks of basic training over the period from September 2000 to March 2001. Exposure of interest was foot shape, namely, flat feet, normal feet, or cavus feet.

Study Hypotheses

We hypothesized that recruits with flat feet, as determined by their AI, would have higher rates of pain and injury, poorer foot health, and poorer quality of life at the end of basic training than recruits with normal feet and that recruits with cavus feet, as determined by their AI, would have higher rates of pain and injury, poorer foot health, and poorer quality of life at the end of basic training than recruits with normal feet.

Inclusion and Exclusion Criteria

All recruits attending IRTU for basic training during the study period were eligible for the study. The only exclusion criterion was already wearing orthotics on arrival at IRTU.