Risks for traumatization in physical education lessons for students with flat feet

Introduction. Physical education at school is an important area of health care due to its impact on the state of health, physical development, function capabilities of the body and the formation of vital skills in children. However, physical education lessons come with certain risks, including injuries of varying severity. The aim of the work — to assess the risks of the occurrence of injuries associated with flat feet in physical education for students in the grades 5^th–11^th.

Materials and methods. The study involved sixteen thousand 671 student from the grades 5^th–11^th who noted the presence of flat feet in an online questionnaire according to an orthopedic doctor and 42,663 students who were not diagnosed with such a diagnosis. The children also indicated the number of minor and serious injuries in physical education (PhE) over the past 12 months. The risks of flat feet influencing the occurrence of injuries in PhE were calculated using evidence-based medicine methods.

Results. In children with flat feet, compared with children with a normal arch of the foot, injuries were found to be more common, respectively, 33.1% and 29.4% (p < 0.05). This is true for both minor (29.4% and 27.0%, respectively; p < 0.05) and serious (3.7% and 2.4%, respectively; p < 0.05) injuries. The risk of flat feet influencing on the occurrence of minor injuries is low (EF = 3.6% in boys and EF = 13.9% in girls), and moderate in serious injuries (EF = 35.0% in boys and EF = 43.0% in girls). Serious injuries in boys were more often detected than in girls with both normal arch of the foot (2.8% and 2.1%, respectively; p < 0.05) and flat feet (3.9% and 3.5%, respectively; p < 0.05).

Conclusion. The data obtained can be used to substantiate a differentiated approach to the management of physical education classes for children with flat feet, the implementation of which will contribute to the prevention of injuries in PhE.

Contribution:
Khramtsov P.I. — concept and design of research, writing the text;
Berezina N.O. — processing and analysis of the material;
Razova E.V. — collection and processing of the material;
Komarova O.V. — editing the text.
All co-authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: October 31, 2025
Accepted: November 27, 2025
Published: December 25, 2025

1. Verhagen E., Collard D., Paw M.C., van Mechelen W. A prospective cohort study on physical activity and sports-related injuries in 10-12-year-old children. Br. J. Sports Med. 2009; 43(13): 1031–5. https://doi.org/10.1136/bjsm.2008.055483

2. Kennedy E.A., Filchner D.A., Patterson Z.D., Olsen H.M. Epidemiological characteristics of school playground injuries Clin. Pediatr. (Phila). 2024; 63(1): 135–45. https://doi.org/10.1177/00099228231172482

3. Sukhareva L.M., Rapoport I.K., Polenova M.A. The state of health of Moscow schoolchildren and factors influencing its formation (longitudinal studies). Zdorove naseleniya i sreda obitaniya – ZNiSO. 2019; (3): 28–31. https://elibrary.ru/skhpkj (in Russian)

4. Rapoport I.K., Chubarovsky V.V., Sokolova S.B. The dynamics of morbidity among children and adolescents in Russia and the main directions of the prevention strategy. Orenburgskiy meditsinskiy vestnik. 2024; 12(3): 51–5. https://elibrary.ru/sfpfiy (in Russian)

5. Sankova M.V., Nikolenko V.N. Connective tissue risk management in sports medicine. Sportivnaya meditsina: nauka i praktika. 2023; 13(3): 78–87. https://doi.org/10.47529/2223-2524.2023.3.10 (in Russian)

6. Sankova M.V., Nikolenko V.N., Gridin L.A. Changing the adaptation of the musculoskeletal system to physical exertion in connective tissue dysplasia: an analysis of some triggering factors. Sportivnaya meditsina: nauka i praktika. 2024; 14(3): 55–64. https://doi.org/10.47529/2223-2524.2024.3.6 (in Russian)

7. Nikolenko V.N., Oganesyan M.V., Vovkogon A.D., Sankova M.V., Rizaeva N.A. Morphological markers of structural and functional disorders of the musculoskeletal system that occur after physical exertion. Chelovek. Sport. Meditsina. 2019; 19(3): 103–11. https://elibrary.ru/rzlwve (in Russian)

8. Khramtsova S.N., Razova E.V., Kisieva T.M. Prevention of school injuries by coordination exercises. Fizicheskaya kultura v shkole. 2024; (7): 12–6. https://elibrary.ru/auphvn (in Russian)

9. Khramtsov P.I., Sedova A.S., Berezina N.O., Shestakova V.N., Marchenkova Yu.V. Injury prevention in educational institutions. Voprosy shkolnoy i universitetskoy meditsiny i zdorovya. 2017; (2): 46–59. https://elibrary.ru/ztcblb (in Russian)

10. Kadilyarova R.R., Nechaeva G.I., Chernyshova T.E., Martynov A.I. Connective Tissue Dysplasia [Displaziya soedinitel’noi tkani]. Moscow: GEOTAR-Media; 2025. (in Russian)

11. Szczepanowska-Wolowiec B., Sztandera P., Kotela I., Zak M. Feet deformities and their close association with postural stability deficits in children aged 10–15 years. BMC Musculoskelet. Disord. 2019; 20(1): 537. https://doi.org/10.1186/s12891-019-2923-3

12. Levy J.C. Incidence of foot and ankle injuries in West Point cadets with pes planus compared to the general cadet population. Foot Ankle Int. 2006; 27(12): 1060-4. https://doi.org/10.1177/107110070602701211

13. Xu L., Gu H., Zhang Y., Sun T., Yu J. Risk factors of flatfoot in children: a systematic review and meta-analysis. Int. J. Environ. Res. Public Health. 2022; 19(14): 8247. https://doi.org/10.3390/ijerph19148247

14. Sukharev A.G. Educational Environment and Students’ Health [Obrazovatel’naya sreda i zdorov’e uchashchikhsya]. Moscow; 2006. (in Russian)

15. Grinhalkh T. Fundamentals of Evidence-Based Medicine [Osnovy dokazatel’noy meditsiny]. Moscow: GEOTAR-Media; 2024. (in Russian)

16. Verbitskaya E.V., Belousov D.Yu., Kolbin A.S. Evidence-based medicine: new in the search for evidence. Kachestvennaya klinicheskaya praktika. 2023; (3): 15–28. https://doi.org/10.37489/2588-0519-2023-3-15-28 https://elibrary.ru/ccxfjw (in Russian)

17. Solodovnik E.M. Traumatism in physical education lessons: features, causes, prevention. Mezhdunarodnyy zhurnal gumanitarnykh i estestvennykh nauk. 2019; (2-1): 165–8. https://doi.org/10.24411/2500-1000-2019-10559 https://elibrary.ru/yzedbz (in Russian)

18. Khramtsov P.I., Razova E.V., Khramtsova S.N., Kulishenko I.V. Assessment of the body’s capabilities for passing the TRP standards in schoolchildren of the Russian Federation (according to a survey of physical education teachers). Uchenye zapiski universiteta imeni P.F. Lesgafta. 2022; (8): 377–84. (in Russian)

19. Khramtsov P.I., Berezina N.O., Razova E.V., Antonova E.V., Vinyarskaya I.V., Khramtsova S.N. The prevalence of flat feet among students in grades 5-9, depending on gender, class of study and place of residence. Rossiyskiy pediatricheskiy zhurnal. 2025; 28(3): 217–22. https://doi.org/10.46563/1560-9561-2025-28-3-217-222 https://elibrary.ru/wgaygi (in Russian)

20. Averyanova N.I., Pripudova V.V., Semerikova A.I., Starkova I.L. The prevalence and structure of foot deformities in younger schoolchildren. Permskiy meditsinskiy zhurnal. 2019; 36(6): 33–40. https://doi.org/10.17816/pmj36633-40 https://elibrary.ru/gucgbz (in Russian)

21. Khramtsov P.I., Sedova A.S., Berezina N.O. The condition of the feet of younger schoolchildren in an innovative form of education. Gigiena i Sanitaria (Hygiene and Sanitation, Russian journal). 2022; 101(2): 225–30. https://doi.org/10.47470/0016-9900-2022-101-2-225-230 https://elibrary.ru/zmclsv (in Russian)

22. Khramtsov P.I., Kurgansky A.M. The area of the plantar surface as an indicator of the functional state of the foot in children. Fiziologiya cheloveka. 2024; 50(6): 44–51. https://doi.org/10.31857/S0131164624060051 https://elibrary.ru/aggllv (in Russian)

23. Chemodanov V.V., Krasnova E.E. Principles of medical support for children with connective tissue dysplasia. Lechaschiy vrach. 2018; (11): 66–70. https://elibrary.ru/vndbce (in Russian)