Comparative analysis of morphometric parameters of the foot and general anthropometric characteristics of 6-year-old children with normal and excessive body weight

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INTRODUCTION

In the past decades, healthcare all around the world registers a continued growth of excess body weight (EBW) and obesity among people, and rapid growth of these values among children, especially in the early and pre-school age, is especially alarming [1, 2]. This phenomenon has reached the scale of a global epidemic and is recognized as a serious public health problem, as it is associated with an increased risk of developing cardiovascular diseases, certain cancers, type 2 diabetes mellitus, as well as musculoskeletal disorders and diseases that progress with age [3-7].

One of the key elements of the locomotor system that is exposed to increased loads in the events of EBW is the foot [8]. The increase of body weight leads to changes in the biomechanics of gait, redistribution of load exercised on the foot resulting in the risk of deformation of the arch of the foot [9, 10]. The importance of analyzing the effect of EBW on the condition of the foot in the childhood stems from the continued growth and development of the musculoskeletal system, as well as potential possibility of prevention of development of irreversible deformations. Plantography is one of the affordable and non-invasive methods of studying of the foot that provides objective data on its anatomic and functional condition. The use of plantography allows for the assessment of distribution of load on different sections of the foot, identify status of flat foot, and determine other deformations of the foot [11]. Contemporary scientific publications present the data, according to which children with EBW demonstrate a more manifested flattening of the longitudinal arch of the foot as compared to children with a normal body weight [12, 13]. At the same time, despite the existing data, the question of specific changes of plantographic parameters of the foot in children with EBW aged 6 years still needs more attention. It requires further research to specify mechanisms of effects of EBW on the formation of arches of the foot and to develop effective prevention measures. The analysis of the problem is of special importance for children aged 6, when the processes of the foot arch formation are highly active, and when the child is preparing for their education at school, which entails significant static loads [14].

AIM

To study the effect of body weight on the dynamics of anthropometric indicators, somatotype, and morphofunctional condition of the feet in six-year-old children.

MATERIAL AND METHODS

The study involved examination of 262 children aged 6 years attending preschool educational institutions of Tyumen (123 girls and 139 boys) divided into groups of normal body weight (NBW) (99 boys, 90 girls) and excessive body weight (EBW) (40 boys, 33 girls).

Inclusion criteria: preschool age group of 6 years, I-II health status group, ho history of chronic somatic illnesses as of the moment of study, availability of informed consent for the study obtained from parents or representatives at law. The study is approved by the resolution of the Ethics Committee of Tyumen State Medical University and is performed under the approved protocol No. 127 dated 04.03.2025, voluntary informed consent of parents or guardians is obtained.

Exclusion criteria: other age group, child being registered for regular medical check-up, diagnosis of obesity, lack of informed consent for the study from parents or representatives at law, refusal from participation in the study, III-V health status groups.

A comprehensive assessment of the health status of the examined children, followed by classification into health groups, was conducted in accordance with the criteria set forth in Appendix No. 2 to Order No. 514n of the Ministry of Health of the Russian Federation dated August 10, 2017 “On the Procedure for Conducting Preventive Medical Examinations of Minors”.

The physical development assessment methodology included standard anthropometry: measurement of standing body height, body weight, chest circumference (CC), and calculation of derived indices.

Body mass index (BMI) was calculated as the ratio of body weight (BW, kg) to standing body height (BH) squared: BMI = BW / BH² × 100.

The Verweck index was calculated as BH / (2BW + CC) and was used to determine developmental harmony and somatotyping.

The Pignet index was calculated as BH – (BW + CC), i.e., standing body height minus the sum of body weight and chest circumference.

The Brugsch index (chest proportionality) was calculated as (CC × 100) / BH.

To determine the thickness of the skinfolds, caliperometry was performed at four sites according to the method described by C. Brook. Measurements were taken over the triceps and biceps muscles of the arm, in the subscapular region, and above the iliac crest along the anterior axillary line. The obtained data were analyzed using centile tables appropriate for the age and sex of the study participants [15].

The study also comprised plantographic measurements performed with a computer plantograph “PCS-01” (Russia). In the course of measurements, the following indices were calculated: Chizhin Index = (b)/(a), where b is the width of the print in the medial section (mm), a is the width of the arch notch (mm); interpretation: 0–1.0 in the norm; 1.1–2.0 is the flattened foot; Shtriter Index = (b)/(W) × 100%, where b is the width of the stained midfoot region (mm), W is the total width of the foot in the same area (mm); interpretation: 43 … 50 for normal foot, 50 … 60 for flattened foot. Additionally, plantometric parameters of the foot were determined, including foot length, foot width at mid-length, and foot width at the heel region, all measured in millimeters.

Statistic processing of the obtained materials was performed in the statistics software suite SPSS 26.0. Data are presented as medians and interquartile ranges (25th–75th percentiles), as preliminary analysis (Shapiro–Wilk test, histograms, Q–Q plots) revealed asymmetric distribution, multimodality, and the presence of outliers. Comparisons between the normal foot (NF) and flattened foot (FF) groups were performed using nonparametric methods due to deviation of the data from a normal distribution. The critical level of assessment of statistical significance of results was set at p < 0.05.

RESULTS

At the first stage of the study, a comprehensive health assessment was conducted in 262 six-year-old children. A significant percentage of children with excessive body weight was identified: 33 girls (12.8%) and 40 boys (15.5%). These findings are consistent with current statistics showing a steady increase in the number of children with overweight and obesity [1, 2]. The study also included a separate analysis of key anthropometric parameters of children with excessive body weight and their comparison with similar metrics of the normal body weight group. Statistically significant differences were established in the majority of parameters (Table 1). Thus, while the body weight of girls from the NBW group was 21.2 (19.3; 23.3) kg, which meets the average age values (50–75th centile corridor), the median body weight of girls from the EBW group was 25.3 (24.4; 26.3) kg (p < 0.001), which aligns with the region of the 90–97th centile. A similar trend was seen in boys (p < 0.001). The values of body height also demonstrated significant differences. Children from the EBW group were taller than their peers with normal weight (p < 0.001). The CC was expectedly higher in the EBW group both among boys and girls (p < 0.001). The median value of BMI among boys in the NBW group was 15.8 (14.3; 16.8) kg/m², while in the EBW group this value was statistically significantly higher: 18.0 (17.4; 18.4) kg/m² (p < 0.001). The similar statistically significant difference was registered among girls. Special interest lies in the analysis of calculated indices characterizing the somatotype. The Verweck index, which reflects the ratio of longitudinal to transverse body dimensions, was significantly lower in the EBW group, with a median of 1.08 (1.06–1.10) for both sexes (p < 0.001), whereas in the NBW group it ranged from 1.17 to 1.18. A decrease in this index indicates a predominance of mesomorphic and brachymorphic features in children with excess body weight. This is further supported by the Pignet index, which characterizes body build robustness. Among boys with EBW, the median Pignet index was 32.4 compared with 38.1 in the NBW group (p < 0.001). The differences were also highly pronounced in girls (p < 0.001). Lower Pignet index values in the EBW group indicate a more robust and solid physique. The Brugsch index, which assesses chest proportionality relative to height, showed a significant increase in boys from the EBW group (52.0 vs. 49.6 units; p < 0.001), indicating chest widening. A similar trend toward an increase in this index was observed in girls with EBW (p < 0.001). Thus, six-year-old children with EBW not only have greater body weight but also differ from their peers by being taller and having a specific somatotype with a predominance of transverse trunk dimensions, which creates additional mechanical load on the musculoskeletal system.

 

Parameter groups	Values	Sex	NBW group (n=189)	EBW group (n=73)	p-value
Anthropometric values	Body height (cm)	B G	117.8 (113.2; 120.3) 115.3 (114.1; 117.2)	118.7 (116.3; 122.1) 118.2 (116.1; 119.3)	< 0.001
	Body weight (kg)	B G	21.3 (19.2; 24.3) 21.2 (19.3; 23.3)	25.2 (24.3; 27.30) 25.3 (24.4; 26.3)	< 0.001
	CC (cm)	B G	58.5 (56.5; 61.5) 57.3 (56.3; 59.3)	61.3 (58.3; 63.3) 59.0 (58.0; 61.0)	< 0.001
Calculated indices	Verweck (rel. units)	B G	1.17 (1.15;1.19) 1.18 (1.16;1.19)	1.08 (1.06;1.10) 1.08 (1.06;1.10)	< 0.001
	Pignet	B G	38.1 (32.6; 43.5) 37.6 (35.2; 41.6)	32.4 (29.2; 36.3) 33.2 (31.3; 35.30	< 0.001
	Brugsch (rel. units)	B G	49.6 (47.0;53.3) 50.0 (48.1;52.1)	52.0 (48.8; 54.80) 51.0 (49.0; 53.0)	< 0.001
	BMI, kg/m2	B G	15.8 (14.3; 16.8) 15.7 (14.1; 16.7)	18.0 (17.4; 18.4) 18.1 (17.9; 18.6)	< 0.001

Notes: BMI – body mass index, NBW – normal body weight, EBW – excessive body weight, CC – chest circumference. The differences are significant (p < 0.05) when comparing between groups (NBW and EBW).

Примечания: ИМТ – индекс массы тела, НМТ – нормальная масса тела, ИзМТ – избыточная масса тела, ОГК – окружность грудной клетки. Различия значимы (p < 0,05) при сравнении между группами (НМТ и ИзМТ).

Table 1. Comparative anthropometric parameters and indices of physical development in 6-year-old children across different body weights, Me (Q1; Q3)

Таблица 1. Сравнительная характеристика антропометрических показателей и индексов физического развития детей 6 лет с различной массой тела, Ме (Q1; Q3)

 

On the second stage of the study, detailed analysis of fat deposition was performed using caliperometry. The analysis of skinfold thickness confirmed the statistically significant prevalence of subcutaneous fat deposition in the EBW group across all the studied anatomical sites. Especially manifested differences were registered in the total skinfold thickness value (Table 2). Among the girls from the EBW group, the total skinfold thickness was 46.3 (45.6; 47.1) mm, which is 1.7 higher than the values from the NBW group: 26.6 (26.4; 26.7) mm (p < 0.001). Among the boys, a significant increase of fatty component in the EBW group is seen, although the increase was somewhat lower than among the girls.

 

Sex	NBW group (n=189)	EBW group (n=73)	p-value
Boys	23.0 (22.5; 23.5)	37.3 (35.7; 37.9)	< 0.001
Girls	26.6 (26.4; 26.7)	46.3 (45.6; 47.1)	< 0.001

Notes: NBW – normal body weight, EBW – excessive body weight. The differences are significant (p < 0.05) when comparing between groups (NBW and EBW).

Примечания: НМТ – нормальная масса тела, ИзМТ – избыточная масса тела. Различия значимы (p < 0,05) при сравнении между группами (НМТ и ИзМТ).

Table 2. Total skinfold thickness (mm) in 6-year-old children based on caliperometry data, Ме (Q1; Q3)

Таблица 2. Суммарные показатели толщины кожно-жировых складок (мм) у детей 6 лет по данным калиперометрии, Ме (Q1; Q3)

 

A comparative analysis of plantographic metrics in the NBW group showed a statistically significant change in the morphometric parameters of the foot at the flattening of the longitudinal arch (LA) (Table 3). It was found that the foot arch deformation in the flatfoot (FF) group was accompanied with a significant ‘flattening’ of the foot. Among boys, a statistically significant increase of the foot length was registered (p < 0.001). Among girls, a trend for the foot length increase was also seen: 197.0 (194.8; 199.2) mm for the normal foot (NF), whereas with the flattening of the arch, the value increased to 198.9 (193.8; 203.9) mm; however, the differences were at the borderline of statistical significance (p = 0.060). A statistically significant increase of the foot width was registered in the midfoot region. The width of the foot in the mid region in the FF group increased by more than 22% as compared to the NG group among boys (p = 0.003), and girls (p < 0.001). An increase of width in the heel region was also registered in both sex groups, (p < 0.001) among boys and (p = 0.025) among girls. The application of standard indices to assess the condition of the arches demonstrated a significant increase of their deformation in the FF group. The Chizhin index, whose median in the NF group was 0.84, increased with the flattening of the arch, reaching 1.53 among boys and 1.54 among girls (p < 0.001), which aligns with a marked flattening. The Shtriter index demonstrated a similar trend: in the FF group, the value of this parameter statistically significantly exceeded the values in the NF group, reaching 54.8% among boys and 53.8% among girls (p < 0.001). Thus, among six-year-old children with normal body weight the plantographic method allowed for a statistically significant identification of the flattening of the arch. The deformation is characterized not only with the change in the calculated indices, but also with the statistically significant increase of all linear parameters of the foot, which shows a decrease of its shock-absorbing function and an increase of the contact of the sole with the supporting surface.

 

Parameter groups	Values	Sex	NF group (n=78)	FF group (n=59)	p-value
Anthropometric values (mm)	Foot length	B G	197.4 (195.8; 199.2) 197.0 (194.8; 199.2)	199.7 (197.7; 201.8) 198.9 (193.8; 203.9)	< 0.0010.060
	Foot width (midfoot)	B G	52.7 (52.2; 53.2) 52.3 (49.2; 55.2)	64.5 (63.3; 66.1) 64.3 (60.6; 66.8)	0.003< 0.001
	Foot width (heel)	B G	47.2 (45.8; 49.1) 46.2 (45.8; 48.2)	48.2 (46.2; 50.2) 47.1 (45.1; 49.8)	< 0.0010.025
Calculated indices	Chizhin	B G	0.84 (0.77; 0.91) 0.84 (0.72; 0.99)	1.53 (1.47; 1.61) 1.54 (1.22; 1.82)	< 0.001
	Shtriter, %	B G	45.4 (44.7; 46.1) 45.8 (43.2; 48.2)	54.0 (51.6; 59.2) 53.8 (53.2; 54.3)	< 0.001

Notes: NF – normal foot, FF – flattened foot. The differences are significant (p < 0.05) when comparing between groups (NF and FF).

Примечания: НС – нормальная стопа, УС – уплощенная стопа. Различия значимы (p < 0,05) при сравнении между группами (НС и УС).

Table 3. Morphometric parameters of the foot in 6-year-old children with normal body weight, depending on the condition of the longitudinal arc, Ме (Q1; Q3)

Таблица 3. Морфометрические параметры стопы у детей 6 лет с нормальной массой тела в зависимости от состояния продольного свода, Ме (Q1; Q3)

 

The analysis of plantograms of six-year-old children with excessive body weight allowed for determination of characteristic changes in the morphology of the foot that stem from the flattening of its arches (Table 4). Among boys with EBW and flattened foot, statistically significant increase of foot length was registered in comparison to the EBW group with normal foot (p < 0.001). Among girls, a statistically significant elongation of the foot was also registered, however, the difference of medians was less manifested (p = 0.028). The most significant changes were registered in the analysis of the foot width in the midfoot region. In children of either sex with excessive body weight and flattened foot, this value increased (p < 0.001). Notably, even in the normal foot group the foot width of children with excessive body weight was high on the baseline level at 59.7 (58.3; 62.6) mm, which was higher than the mean values in children with normal body weight, which is explained by the presence of excessive fatty tissue. Unlike that of the midfoot region, the width of the heel region did not undergo statistically significant changes in the flattening of the arch neither in boys (p = 0.208), nor in girls (p = 0.368). It is to be remembered, however, that the value is significantly higher than in the similar groups of children with normal body weight. This indicates that in children with EBW the foot adaptation to loads occurs mainly at the cost of the midfoot region. In the transition from the NF to FF, the Chizhin index increased: in boys, to 1.88 (1.82; 1.92), in girls, to 1.85 (1.72; 1.92) (p < 0.001). A similar statistically significant trend was registered for the Shtriter index. Its median values in the FF group increased to 58.2–58.0% in boys and girls, respectively, vs. 48.8–46.2% in the NF group (p < 0.001). The high values of the calculated indices in the NF group point at morphological remodeling of the foot that occurs on the background of initially increased transversal dimensions (due to the fatty component).

 

Parameter groups	Values	Sex	NF group (n=25)	FF group (n=31)	p-value
Anthropometric values (mm)	Foot length	B G	199.3 (197.3; 200.3) 198.8 (195.7; 199.8)	202.5 (200.5; 204.5) 200.5 (197.4; 206.1)	< 0.0010.028
	Foot width (midfoot)	B G	59.7 (58.3; 62.6) 59.4 (57.4; 62.2)	68.4 (67.3; 70.1) 68.7 (65.5; 70.6)	< 0.001
	Foot width (heel)	B G	49.2 (47.2; 51.2) 48.8 (46.6; 50.3)	50.5 (47.0; 52.1) 49.2 (47.2; 51.6)	0.2080.368
Calculated indices	Chizhin	B G	0.96 (0.91; 0.99) 0.94 (0.88; 0.98)	1.88 (1.82; 1.92) 1.85 (1.72; 1.92)	< 0.001
	Shtriter, %	B G	48.8 (45.9; 50.0) 46.2 (45.2; 49.9)	58.2 (57.2; 60.0) 58.0 (55.6; 59.9)	< 0.001

Notes: NF – normal foot, FF – flattened foot. The differences are significant (p < 0.05) when comparing between groups (NF and FF).

Примечания: НС – нормальная стопа, УС – уплощенная стопа. Различия значимы (p < 0,05) при сравнении между группами (НС и УС).

Table 4. Morphometric parameters of the foot in overweight children aged 6 years, depending on the condition of the longitudinal arch, Ме (Q1; Q3)

Таблица 4. Морфометрические параметры стопы у детей 6 лет с избыточной массой тела в зависимости от состояния продольного свода, Ме (Q1; Q3)

 

DISCUSSION

The results of the study identified a systemic impact of excessive body weight on the morpho-functional characteristics of children’s organisms in the first growth spurt period. The comprehensive analysis showed that six-year-old children with excessive body weight not only have quantitative differences in the body weight but also the qualitative specifics of the somatotype. The statistically significant decrease of the Verweck and Pignet indices in the EBW group confirms formation of meso- and brachymorphic physique types. Higher values of body height and chest circumference in EBW children may be interpreted as manifestations of acceleration. At the same time, such ‘accelerated’ development creates a serious disbalance: the child’s muscular-ligamentous apparatus is not ready to increased static and dynamic loads, which is first reflected in the condition of the feet. This observation fully aligns with the findings of S. Jandova (2024), who studies children of early school age and emphasized a direct associative correlation between elevated values of BMI and incidence rate of flatfoot thus showing inevitable deformation of the longitudinal arch of the foot if the force and resilience of the ligaments is not sufficient [10]. The caliperometry data highlights the scope of the problem: the total skinfold thickness in EBW girls is almost double that of their peers with NBW. Deposition of subcutaneous fat occurs not only in the typical sites but, judging by plantographic data, affects the soft tissue of the foot, which is confirmed by the data of C. Escalona-Marfil et al. (2023). The work studied morphology of feet in children aged 5–10 years and identified statistically significant differences in the indices of the position and height of the arch of the foot in all weight categories, from weight deficit to obesity. The width of the midfoot was most closely related to the body weight, and the waist circumference to the morphological changes of the feet, which, in its turn, emphasizes the importance of central fat deposition and body composition for the weight-bearing function of the foot [8]. Our findings fully confirm these data: in children with normal body weight, the flattening of the arch is accompanied by the classic flattening of the foot. The most sensitive parameter was the foot width in the mid-region that increased by more than 11–12 mm in both boys and girls (p < 0.001). It is interesting to note that in boys with normal body weight the deformation of the arch leads to a significant increase of the foot length (p < 0.001), while in girls this trend is only borderline (p = 0.060). This might indicate greater rigidity of the foot of the girls in longitudinal direction at this age. The excessive body weight group demonstrates a radically different morphometric pattern. First, the ‘baseline’ width of the foot is noteworthy: in EBW children, even with normal foot it is an average 59.7 mm, which is 7 mm wider than in their peers with normal body weight. This fact is explained by the presence of a pronounced plantar fat pad, which increases the footprint area, thereby masking the true configuration of the underlying bony structures. This ‘masking’ effect was mentioned by A.V. Sapogovsky et al. (2023), who reported in their studies of children aged from 7 to 15 (St.-Petersburg), that the plantographic criteria often have but a minor correlative linkage with clinical parameters (e.g., valgus of the hindfoot or Dowle’s angle) specifically due to a mismatch in the form of the foot print and the internal osseous structures of the arch [11]. Second, in the flattening of the arch in the EBW group, the foot width reaches greater values (68.4–68.7 mm). Notably, in this group the foot width in the heel region does not undergo significant changes in deformation (p > 0.05), while in the NBW group, this value is higher. The presence of a marked fat pad in the medial section of the foot results in the fact that even with the anatomically preserved arch, the print of the foot of EBW children seems wider, imitating the flattening. This is further confirmed by the fact that the statistical significance of differences of the foot width in the heel region between the normal and flattened foot in the EBW group is not observed.

Within long-term observations of children aged 7-8 years, S. Yan et al. (2023) registered a transition period (BMI in the range of 18.6–19.9 kg/m²), when negative changes of gait appear, related to changes in the structure of the arch of the foot. Above the threshold of 20.8 kg/m2, the height of the arch starts rapidly decreasing under the excessive load [13]. The calculated podometric indices (Chizhin and Shtriter) in our study demonstrated a high statistical significance in all groups (p < 0.001). However, the values of the Chizhin index in children with EBW and FF were significantly higher than in the NBW group. This indicated that the excessive weight not only triggers actual lowering of the arch, but artificially elevates the values on the plantogram due to the presence of the soft tissue component. With that in mind, the findings of D.R. Dzhuraev et al. (2024), obtained in the Tyumen Region, become especially important. The authors mentioned that in the general population of six-year-old children (where the flatfoot rate reaches 30%, and flattening rate, 32%) there is observed only a weak correlation between the BMI and Chizhin and Shtriter indices [16]. In the context of our study, this is explained by the presence of the fat pad resulting in the elevation of values even with a relatively preserved bony arch. Thus, the morphometry of the foot in children with excessive body weight necessitates a differentiated approach, since the standard plantographic norms may result in hyper-diagnostics of pathological conditions due to the effect of the body composition on the foot print parameters.

CONCLUSION

The results of the study demonstrate the six-year-old children with EBW significantly differ from their peers with NBW in anthropometric parameters, total skinfold thickness, and somato-typological indices. In children with NBW, the flattening of the foot is accompanied with a distinct transformation of its linear parameters, and elevation of Chizhin and Shtriter indices. This confirms the high diagnostic efficacy of plantography for detecting impairments of the shock-absorbing function of the foot in the absence of excess body weight. Excessive body weight in six-year-old children acts as a modifying factor of the morphology of the foot, increasing the baseline width of the print in the mid-region by 13–14% even with the anatomically preserved arch, which is accounted for by the development of the subcutaneous adipose layer in the foot region. Excess adipose tissue in the medial part of the foot, combined with increased body weight pressure, masks the true condition of the arches, thereby complicating classical plantographic diagnostics and potentially leading to false-positive results when assessing the degree of flatfoot. These findings highlight the need for a differentiated approach to evaluating the foot arch status in children of this age. During preventive examinations, it should be taken into account that excessive body weight is not only a risk factor for foot deformity but also a serious obstacle to its objective visual diagnostics. This justifies the need to develop additional arch assessment criteria for children with excess weight. Traditional screening should be supplemented with methods that allow differentiation between true arch deformity and morphological changes caused by excess soft tissue. The age of six years represents a ‘window of opportunity’ for correcting these disorders, as arch formation is not yet complete, and timely normalization of body weight may prevent irreversible musculoskeletal changes.

 

ADDITIONAL INFORMATION	ДОПОЛНИТЕЛЬНАЯ ИНФОРМАЦИЯ
Ethical review. The study was approved by the Ethics Committee of Tyumen State Medical University and conducted under approved protocol No. 127 dated March 4, 2025.	Этическая экспертиза. Исследование подтверждено решением комитета по этике при Тюменском государственном медицинском университете, выполнено в рамках утвержденного протокола №127 от 04.03.2025 г.
Informed consent. All legal guardians (parents) signed voluntary informed consent for the children’s participation in the study.	Информированное согласие. Все законные представители (родители) подписали добровольное информированное согласие на участие детей в исследовании.
Study funding. The study was the authors’ initiative without external funding.	Источник финансирования. Работа выполнена по инициативе авторов без привлечения финансирования.
Conflict of interest. The authors declare that there are no obvious or potential conflicts of interest associated with the content of this article.	Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с содержанием настоящей статьи.
Contribution of individual authors. Petukhova L.N.: study concept, writing of the text. Margaryan A.V., Tomilova E.A.: study concept and design, editing of the article. Tkachuk A.A.: collection, processing and analysis of material. The authors gave their final approval of the manuscript for submission, and agreed to be accountable for all aspects of the work, implying proper study and resolution of issues related to the accuracy or integrity of any part of the work.	Участие авторов. Петухова Л.Н.: концепция исследования, написание текста. Маргарян А.В., Томилова Е.А.: концепция и дизайн исследования, редактирование статьи. Ткачук А.А.: сбор, обработка и анализ материала. Все авторы одобрили финальную версию статьи перед публикацией, выразили согласие нести ответственность за все аспекты работы, подразумевающую надлежащее изучение и решение вопросов, связанных с точностью или добросовестностью любой части работы.
Statement of originality. No previously published material (text, images, or data) was used in this work.	Оригинальность. При создании настоящей работы авторы не использовали ранее опубликованные сведения (текст, иллюстрации, данные).
Data availability statement. The editorial policy regarding data sharing does not apply to this work.	Доступ к данным. Редакционная политика в отношении совместного использования данных к настоящей работе не применима.
Generative AI. No generative artificial intelligence technologies were used to prepare this article.	Генеративный искусственный интеллект. При создании настоящей статьи технологии генеративного искусственного интеллекта не использовали.
Provenance and peer review. This paper was submitted unsolicited and reviewed following the standard procedure. The peer review process involved 2 external reviewers.	Рассмотрение и рецензирование. Настоящая работа подана в журнал в инициативном порядке и рассмотрена по обычной процедуре. В рецензировании участвовали 2 внешних рецензента.

 

About the authors

Lyudmila N. Petukhova

Tyumen State Medical University

Author for correspondence.
Email: lydmila.petuhova2312@yandex.ru
ORCID iD: 0009-0000-2525-0098

Senior Lecturer of the Department of Theory and Practice of Nursing.

Russian Federation, Tyumen

Artur V. Margaryan

Tyumen State Medical University

Email: vanic13@mail.ru
ORCID iD: 0000-0003-3497-8157

MD, Dr. Sci. (Medicine), Professor of the Department of Topographic Anatomy and Operative Surgery.

Russian Federation, Tyumen

Evgeniya A. Tomilovа

Tyumen State Medical University

Email: tomilovaea@mail.ru
ORCID iD: 0000-0003-1101-7628

MD, Dr. Sci. (Medicine), Professor of the Department of Normal Physiology.

Russian Federation, Tyumen

Anna A. Tkachuk

Tyumen State Medical University

Email: ponchik117@mail.ru
ORCID iD: 0000-0003-1612-2048

MD, Cand. Sci. (Medicine), Associate professor of the Department of Normal Physiology.

Russian Federation, Tyumen

References

Supplementary files