Screen Exposure, BMI, and Foot Arch Structure in Preschool Children

Figure. Stepwise footprint-based foot arch classification procedure using the Staheli arch index (SAI). (A) Illustrates the calculation of the SAI as the ratio of the narrowest width of the midfoot to the widest width of the heel. (B) Presents representative podoscope images and corresponding medial longitudinal arch profiles used for classification into high arch (SAI < 0.29), normal arch (SAI = 0.30–0.70), and flatfoot morphology (SAI ≥ 0.71). Participants classified as having flatfoot morphology were subsequently evaluated using the Jack test to distinguish flexible flatfoot from rigid flatfoot.

Early childhood is a critical developmental period during which behavioral and anthropometric characteristics associated with child health begin to emerge. Screen exposure and sedentary behaviors have been linked to physical activity, growth, and musculoskeletal health, but their relationships with foot arch categories remain unclear. This analytical cross-sectional study examined associations between screen exposure, body mass index (BMI) percentile, and foot arch categories in 509 children aged 5–6 years attending four public preschools in Çanakkale, Türkiye. Foot arch profile was assessed using a podoscope and classified according to the Staheli Arch Index and Jack test. Screen exposure was determined from parent-reported daily duration, and BMI percentiles were calculated using World Health Organization reference standards. Multinomial logistic regression was used to examine associations after adjusting for age and sex. Higher screen exposure and BMI percentile were significantly associated with specific foot arch categories, with the strongest associations observed for rigid flatfoot. Although causal inferences cannot be drawn because of the cross-sectional design, these findings suggest that screen exposure and BMI percentile may be associated with foot arch characteristics in preschool children.

Source: Duran M. Sedentary behavior and early childhood health: associations between screen exposure, body mass index, and foot arch structure in preschool children. Front Public Health. 2026 Jul 6;14:1858773. doi: 10.3389/fpubh.2026.1858773.