Association and Influencing Factors of Body Image Anxiety and Social Avoidance Behaviour in Children With Flat Feet

Abstract

Background: This study aimed to explore the relationship between body image anxiety and social avoidance behaviour in children with flat feet, and to analyse the influencing factors associated with social avoidance behaviour.

Methods: A retrospective analysis was conducted on the clinical data of 98 children with flat feet and 104 children with normal arches who visited a tertiary hospital between January 2022 and June 2025. Measurement results of the Body Image Scale (BIS), Social Anxiety Scale for Children (SASC), Children’s Depression Inventory (CDI), and Self-Perception Profile for Children (SPPC) were extracted. Differences between the two groups were compared, and Spearman correlation analysis was used to analyse the relationships between variables. Binary logistic regression (with independent models constructed after collinearity diagnosis) was used to analyse the influencing factors of social avoidance behaviour.

Results: The flat-foot group scored significantly higher than the normal-arch group in body image anxiety (16.36 ± 5.21 vs. 11.75 ± 4.38, p < 0.001) and social avoidance behaviour (10.86 ± 3.37 vs. 7.23 ± 2.96, p < 0.001), whereas their self-worth level was significantly lower (14.69 ± 3.33 vs. 19.21 ± 2.69, p < 0.001). No statistically significant difference was observed in depression levels between the two groups (p > 0.05). The severity of flat feet was positively correlated with body image anxiety (r = 0.886, p < 0.001) and social avoidance behaviour (r = 0.882, p < 0.001), and negatively correlated with self-worth level (r = –0.893, p < 0.001). Logistic regression analysis showed that the severity of flat feet (moderate: odds ratio [OR] = 2.399, severe: OR = 3.928), negative comments related to foot appearance or gait abnormalities (OR = 2.683), and body image anxiety (OR = 1.172) were risk factors for significant social avoidance behaviour in children with flat feet, whereas self-worth (OR = 0.845) was a protective factor. 

Conclusions: Children with flat feet exhibit significant body image anxiety and social avoidance behaviours, with body image anxiety and social avoidance behaviours being closely related. Clinical intervention should focus on the children’s psychosocial adaptation alongside foot function rehabilitation, providing targeted psychological support and self-worth enhancement interventions.