Table 5.

A summary of the studies examined relating to footwear habits and medial longitudinal arch development.

Author	Study Type	Ethnicity	Participants & Age Range	Mean Age (±SD)	Method of Analysis	Main Findings
Mauch et al. [49]	Cross-sectional	N/A	448 male 562 female 3–12 years	Australian- 4.3 ± 0.6 & 9.6 ± 1.4 years German- 4.2 ± 0.7 & 9.6 ± 1.4 years	Footprint angle Chippaux–Smirak Index	There was a significant difference in arch height in preschool-aged children. The Australian preschool children displayed higher arches than those from Germany (39.4° compared to 24°). No significant differences in arch height in primary school-aged children.
Hollander et al. [50]	Cross-sectional	Included ethnicity as a confounding variable, however, did not specify what the ethnicities were.	810 male and female 6–180 years	11.99 ± 3.33 years	Static arch height index Dynamic arch index	An increased static arch height was seen in children and adolescents who grow up barefoot. The findings suggested that habitual footwear use influences the development of the medial longitudinal arch. The arch index only differed in the 10–14 age group (flatter arch in the shod participants).
Rao et al. [42]	Cross-sectional	Rural Indian	1237 male 1063 female 4–13 years	NR	Footprint angle	At age ten, the flat foot prevalence was very low in the barefoot participants and high in the shod participants. Closed-toe shoes seemed to inhibit the development of the arch more than slippers or sandals.
Aibast et al. [86]	Cross-sectional	Kenyan	39 male 39 female 12–18 years	Study 1; 15.1 ± 1.4 years Study 2; 15.5 ± 1.2 & 15.4 ± 1.2 years	Arch height ratio	The habitually barefoot participants had higher medial longitudinal arches. Using the criteria for arch height ratio, habitually barefoot participants would be classified as having high arches.
Sachithanandam et al. [88]	Cross-sectional	South Indian	1846 male and female 16–65 years	NR	Footprint angle	The findings of this study suggested that there is an association between wearing shoes in early life and flat foot.
Echarri et al. [57]	Cross-sectional	Congolese	945 male 906 female 3–12 years	NR	Clarke’s angle Chippaux–Smirak Index Staheli Arch Index	There was a greater proportion of flat feet in the urban environment. This study showed that the development of the medial longitudinal arch is influenced by age, sex and footwear.
Tong et al. [85]	Longitudinal	Not clear	52 male 59 female 7–9 years	6.9 ± 0.3 years 8.7 ± 0.3 years	Dynamic arch index	Participants who wore closed-toe shoes displayed the flattest arch.

Abbreviations: NR—Not Recorded.