A cross-sectional study of age-related changes in plantar pressure distribution between 4 and 7 years: A comparison of regional and pixel-level analyses

•We examined age-related plantar pressure changes in young children.•Regional pressures increased with age at the central metatarsals and medial midfoot.•Pixel data disagreed with regional midfoot and heel data and were also more detailed.•Pixel data showed that children's feet tend to become longer and narrower with age.•Pixel-level analysis overcomes regional analysis' inadequate spatial resolution.

Quantifying morphological and functional development in children's feet, and thereby establishing development norms is difficult. In addition to practical challenges of experimentation on children, measurement equipment like plantar pressure (PP) platforms are almost exclusively geared towards adult-sized feet. These PP quantification problems may be exacerbated by typical regional data analysis techniques, which further reduce spatial resolution. The goal of this study was to quantify PP distributions in developing children, and also to compare the results obtained from typical (regional) techniques with those obtained from a higher-resolution (pixel-level) technique. Ninety-eight children between four and seven years of age were assessed in a cross-sectional design. Maximum PP distributions were collected for each child, and these pressures were linearly regressed against age. Present results agree with previous investigations in that maximum pressures and maximum pressure changes occurred in the forefoot. However, results from the present pixel-level technique suggest that these changes are limited to the central metatarsals, and that regional methods can suggest significance where none exists in the actual raw (pixel-level) data, due to signal aliasing and, in particular, to conflation of regional boundaries. We postulate that increased central metatarsal pressures are reflective of the coupling between generalised joint laxity decreases and relatively increasingly inclined central metatarsal bones with age.