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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The finding that recruits with flat feet had, on average, a poorer perception of physical health at the end of basic training than did recruits with normal feet is of interest. However, this was a self-report measure, and the only objective measure of physical health we had available, namely, maximal oxygen uptake from the 2.4-km run in week 3, showed no statistically significant differences by foot shape. Based on these findings, the current regulations, i.e., accepting potential recruits with flexible (nonrigid) flat feet who are asymptomatic, appear reasonable.

Cavus feet, like flat feet, have been shown in the literature to be associated with fatigue, foot pain, and foot discomfort. They are also associated with difficulty in obtaining shoes and a greater chance of falling.18 In this study, after adjustment for confounding variables, we found that cavus feet had little association with any of the outcome measures. Whereas current ADF regulations with regard to flat feet reject recruits only if their feet are immobile (i.e., rigid flat feet), painful, or so severely affected that the recruits cannot wear standard service footwear, cavus feet are an unconditional rejection factor.6 The results of our study suggest that having flexible cavus feet is no better or worse than having flexible flat feet, and neither condition appears sufficiently related to adverse outcomes to warrant restrictions. We therefore suggest that conditional acceptance of flexible cavus feet, similar to that applying to recruits with flat feet, is more appropriate than the current ADF regulations.

Finally, in our study we found that female recruits had 4.6 times the injury rate of male recruits. Factors that may contribute to the increased risk of injury among female recruits include lack of fitness among female recruits, compared with male recruits,14 differences in previous sports undertaken, and anatomic differences. Gender differences include levels of conditioning, lower extremity alignment, ligamentous laxity, pelvic width, tibial rotation, and foot alignment.19 At the time of writing, the ADF uses the same physical training regimen for male and female recruits. Given the high injury rates for female recruits and the gender differences outlined, it is time to rethink the policy of mixed-gender physical training. Rudzki20 has already suggested that mixed-gender physical training should be reviewed.

With the increasing professionalism of defense forces and the difficulty of recruiting sufficient numbers of high-quality personnel, defense forces cannot afford to disqualify potential recruits for medical reasons based on little or no evidence. This study provides some of the first evidence that foot shape has little impact on pain, injury, or functioning among military recruits.

Acknowledgments

We thank the staff of IRTU, RAAF Edinburgh, particularly the physical training instructors, for their help during the study.

References

1. Giladi M, Milgrom C, Stein M, et al: The low arch, a protective factor in stress fractures. Orthop Rev 1985; 14: 81-4.