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Ghasemi S, Adibnejad N. Does Body Mass Index Affect the Symmetry Index Between Preferred and Nonpreferred Foot. J Sport Biomech. 2020; 6 (3) :204-213
URL: http://biomechanics.iauh.ac.ir/article-1-240-en.html
1- Department of Sports Management, Faculty of Sports Sciences, Arak University, Arak, Iran.
2- Department of Sports Pathology, Faculty of Sports Sciences, Arak University, Arak, Iran.
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1. Introduction
n the world of biomechanics, an increase in Body Mass Index (BMI) is associated with aberrations in gait and an increase in the forces of the whole body, especially the lower limbs that bear weight [1]. On the other hand, obesity and overweight lead to decreased range of motion of the knee increased osteoarthritis, reduced stride length, increased joint wear, and changes in gait [2]. Nevertheless, it is unclear what effect BMI has on maintaining balance and symmetry in the feet’ soles. While maintaining balance and symmetry of the sole is a critical factor in performing daily activities and weight-bearing activities [6, 5, 43]. 
The symmetry between the lower limbs is fundamental in performing sports movements [7, 8]. Besides, it has been reported that balance between the preferred and non-preferred foot may prevent muscle imbalance and prevent sports injuries [9, 10]. Because the right and left sides of the body are different, it may be thought that the parameters of the sole of the preferred foot may differ from those of the non-preferred foot. The feet soles provide comprehensive information about the symmetry between the feet [11, 12]. This may offer appropriate rehabilitation programs to prevent lower limb imbalance and maintain proper posture [5, 1314]. Therefore, this study aimed to investigate the symmetry of preferred and non-preferred foot of young girls with different BMI when standing on two legs.
2. Materials and Methods
The present research method was quasi-experimental, and the research design was comparative with the control group and the type of applied research. The statistical sample consisted of 42 people for both groups using Power ×G software [15], but 44 people were selected to enter the study to prevent a drop in the number of people. Of these, 22 were selected as an overweight group with 25≥ BMI (kg/m2) <30 and 22 with 18.5≥ BMI (kg/m2) <25 for the normal weight group. The research ethics committee approved the research protocol, and informed consent was obtained from the individuals. First, the height and weight of the subjects were taken, and the BMI was calculated. Then, the subjects’ preferred foot was determined using the ball impact test [16]. 
Subjects were placed on a pedoscope [17] and asked to look at a fixed point on the wall at a distance of 3 m and stand with bare feet so that the distance between the legs is 8 cm when standing, and three 20-second testing sessions with 15 seconds rest between each test were performed. The symmetry index was obtained from the ratio of the variables of the sole of the right foot divided by the left foot [18, 19]. The mean of the received data was recorded as an individual’s record for further calculations. The Kolmogorov-Smirnov test was used to check the normality of data distribution. The Levene test was used to prevent group matching. An Independent inferential t-test was used to compare inter-group results, and paired t-test was used to compare intra-group results. Tests were analyzed at a significance level of 0.05 using SPSS software v. 24.
3. Results
The subjects’ demographic characteristics showed that the participating groups were homogeneous in terms of age and height but differed in weight and BMI, divided into two groups. The overweight group had the Mean±SD age of 22.41±3.42, the Mean±SD BMI was 26.78±1.67, and the average weight group had the Mean±SD age of 21.41±1.37, and the Mean±SD BMI was 21.35±1.38. The Kolmogorov-Smirnov test was not significant for checking the normality of variables (P≥0.05). The independent t-test, symmetry index in overweight, and control groups (Table 1) did not show a significant difference in symmetry indices (P≥0.05). 


4. Discussion and Conclusion
The present study aimed to investigate the symmetry of preferred and non-preferred foot of young girls with different BMI. The symmetry index of the preferred and non-preferred foot of the overweight group ranged from 0.72 to 1.41, and in the normal group was 0.76 to 1.43, but the results did not differ significantly (P>0.05). Some researchers examined the symmetry of the preferred and non-preferred foot when walking [31, 32], and in line with our results, it was found that there is no significant difference between the preferred and non-preferred foot. In contrast, in another study [33], the asymmetry between the preferred and non-preferred foot in different gait parameters was found to be inconsistent with our investigation. Among the reasons for inconsistency with this research, we can mention the selected variables to study symmetry, including spatial-temporal and kinetic variables. 
Dağ et al. examined the symmetry of preferred and non-preferred foot of taekwondo athletes, and their results did not show a significant difference in line with the results of the present study [35]. Sforza et al. examined the analysis of coordination symmetry of the feet of healthy young people. They were consistent with the current study results and observed high symmetry between both legs in individuals, and the symmetry index of women was higher than men [36]. The mechanisms of amplification or reduction that affect the foot’s symmetry are unknown. The use of more motor neurons in the dominant limb may be related to the greater need for energy production of the limb’s plantar flexor and greater motive force [37]. To this end, research should assess how an organ’s dominance affects the risk of injury and foot disorders, leading to preventive measures to eliminate subsequent complications and injuries of the foot.

Ethical Considerations
Compliance with ethical guidelines

This study was approved by the Ethics Committee of the University of Arak University of Medical Sciences (Code: IR.UMSHA.REC.1394.42). 

Funding
This research was supported by the research project (No. 467), Funded by the University of Arak University Research Council.

Authors' contributions
All authors contributed in preparing this article.

Conflicts of interest
The authors declared no conflict of interest.


References
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  41. Beck B, Weeks B. Which limb to scan? Revisiting the relationship between functional and skeletal limb dominance. J Bone Miner Res. 2010; 25:306.
Type of Study: Research | Subject: Special
Received: 2020/09/24 | Accepted: 2020/11/24 | Published: 2020/11/23

References
1. Messier SP, Ettinger WH, Doyle TE, Morgan T, James MK, O'Toole ML, et al. Obesity: effects on gait in an osteoarthritic population. Journal of applied Biomechanics. 1996;12(2):161-72. [DOI:10.1123/jab.12.2.161]
2. Messier SP. Osteoarthritis of the knee and associated factors of age and obesity: effects on gait. Medicine and science in sports and exercise. 1994;26(12):1446-52. [DOI:10.1249/00005768-199412000-00006] [PMID]
3. DeOreo K, Keogh J. Performance of fundamental motor tasks. A textbook of motor development. 1980:76-91.
4. Deforche B, Lefevre J, De Bourdeaudhuij I, Hills AP, Duquet W, Bouckaert J. Physical fitness and physical activity in obese and nonobese Flemish youth. Obesity research. 2003;11(3):434-41. [DOI:10.1038/oby.2003.59] [PMID]
5. Zvonar M, Lutonska K, Reguli Z. Influence of combative sports on state of plantar pressure. J Martial Arts Anthropol. 2012;12(1):30-5.
6. Barbieri FA, Gobbi LTB, Santiago PRP, Cunha SA. Dominant-non-dominant asymmetry of kicking a stationary and rolling ball in a futsal context. Journal of sports sciences. 2015;33(13):1411-9. [DOI:10.1080/02640414.2014.990490] [PMID]
7. Čular D, Miletić Đ, Miletić A. Influence of dominant and non-dominant body side on specific performance in taekwondo. Kinesiology: International journal of fundamental and applied kinesiology. 2010;42(2.):184-93.
8. Tang W, Chang J, Nien Y. The kinematics characteristics of preferred and non-preferred roundhouse kick in elite Taekwondo athletes. Journal of Biomechanics. 2007;40(2):S780. [DOI:10.1016/S0021-9290(07)70768-6]
9. Niemuth PE, Johnson RJ, Myers MJ, Thieman TJ. Hip muscle weakness and overuse injuries in recreational runners. Clinical Journal of Sport Medicine. 2005;15(1):14-21. [DOI:10.1097/00042752-200501000-00004] [PMID]
10. Söderman K, Alfredson H, Pietilä T, Werner S. Risk factors for leg injuries in female soccer players: a prospective investigation during one out-door season. Knee Surgery, Sports Traumatology, Arthroscopy. 2001;9(5):313-21. [DOI:10.1007/s001670100228] [PMID]
11. De Cock A, De Clercq D, Willems T, Witvrouw E. Temporal characteristics of foot roll-over during barefoot jogging: reference data for young adults. Gait & posture. 2005;21(4):432-9. [DOI:10.1016/j.gaitpost.2004.05.004] [PMID]
12. Orlin MN, McPoil TG. Plantar pressure assessment. Physical therapy. 2000;80(4):399-409. [DOI:10.1093/ptj/80.4.399] [PMID]
13. Wong P-l, Chamari K, Chaouachi A, Wisløff U, Hong Y. Difference in plantar pressure between the preferred and non-preferred feet in four soccer-related movements. British journal of sports medicine. 2007;41(2):84-92. [DOI:10.1136/bjsm.2006.030908] [PMID] [PMCID]
14. Li JX, Hong Y. Plantar pressure distribution during Tai Chi exercise. Archives of physical medicine and rehabilitation. 2006;87(6):814-20. [DOI:10.1016/j.apmr.2006.02.035] [PMID]
15. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior research methods. 2007;39(2):175-91. [DOI:10.3758/BF03193146] [PMID]
16. Hoffman M, Schrader J, Applegate T, Koceja D. Unilateral postural control of the functionally dominant and nondominant extremities of healthy subjects. Journal of athletic training. 1998;33(4):319.
17. Hakimipoor M RR, Minoonejad H. Design, Construction and Validation of Foot Photo Box in Measuring a Selection of Footprint Indexes Journal of Applied Exercise Physiology (JAEP). 2017;13(25):137-46.
18. Sforza C, Fragnito N, Serrao G, Ferrario VF. Harmonic analysis of footprint symmetry in healthy adolescents. Annals of Anatomy-Anatomischer Anzeiger. 2000;182(3):285-91. [DOI:10.1016/S0940-9602(00)80038-2]
19. Sforza C, Michielon G, Fragnito N, Ferrario VF. Foot asymmetry in healthy adults: elliptic fourier analysis of standardized footprints. Journal of orthopaedic research. 1998;16(6):758-65. [DOI:10.1002/jor.1100160619] [PMID]
20. Dağ F, Erdoğan At, Yildirim Dd, Dal U. Foot Symmetry and Plantar Pressure Characteristics in Elite Taekwondo Athletes; Preferred and Non-Preferred Foot Comparison. Türkiye Klinikleri Spor Bilimleri Dergisi. 2017;9(1):12-20. [DOI:10.5336/sportsci.2016-52764]
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22. Jolliffe D. Extent of overweight among US children and adolescents from 1971 to 2000. International journal of obesity. 2004;28(1):4-9. [DOI:10.1038/sj.ijo.0802421] [PMID]
23. Ulrich B, Ulrich D. The role of balancing ability in performance of fundamental motor skills in 3-, 4-, and 5-year-old children. Motor development: Current selected research. 1985.
24. Fulton JE, McGuire MT, Caspersen CJ, Dietz WH. Interventions for weight loss and weight gain prevention among youth. Sports Medicine. 2001;31(3):153-65. [DOI:10.2165/00007256-200131030-00002] [PMID]
25. Jaszczak M. The dynamical asymmetry of the upper extremities during symmetrical exercises. Human movement. 2008;9(2):116-20. [DOI:10.2478/v10038-008-0014-7]
26. Fousekis K, Tsepis E, Poulmedis P, Athanasopoulos S, Vagenas G. Intrinsic risk factors of non-contact quadriceps and hamstring strains in soccer: a prospective study of 100 professional players. British journal of sports medicine. 2011;45(9):709-14. [DOI:10.1136/bjsm.2010.077560] [PMID]
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28. Goulding A, Jones I, Taylor R, Piggot J, Taylor D. Dynamic and static tests of balance and postural sway in boys: effects of previous wrist bone fractures and high adiposity. Gait & posture. 2003;17(2):136-41. [DOI:10.1016/S0966-6362(02)00161-3]
29. Brophy R, Silvers HJ, Gonzales T, Mandelbaum BR. Gender influences: the role of leg dominance in ACL injury among soccer players. British journal of sports medicine. 2010;44(10):694-7. [DOI:10.1136/bjsm.2008.051243] [PMID]
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38. Entezari S, Memar R, Kakavand M. Effect of taekwondo on plantar pressure distribution symmetry in dominant and none-dominant limb. Scientific Journals Management System. 2017;15(13):17-24.
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40. Õunpuu S, Winter DA. Bilateral electromyographical analysis of the lower limbs during walking in normal adults. Electroencephalography and clinical neurophysiology. 1989;72(5):429-38. [DOI:10.1016/0013-4694(89)90048-5]
41. Beck B, Weeks B. Which limb to scan? Revisiting the relationship between functional and skeletal limb dominance. J Bone Miner Res. 2010;25:306.

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