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\def\RunningAuthor{Nupur Shukla and Monika Gupta}
\firstPage{136}
\articleType{Original Article}
\receivedDate{15 Jun 2023}
\acceptedDate{26 Jul 2023}
\revisedDate{25 Jul 2023}
\journalVolume{2023, 14}
\journalIssue{3}
\journalDoi{ijrps.v14i3.4302}
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\title{Gender Determination by Using Left Foot Index in Rajasthan Adults}
\author{Nupur~Shukla\textsuperscript{*}\textsuperscript{1}\textsuperscript{\href{https://orcid.org/0009-0009-2103-7906}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}}, 
            Monika~Gupta\textsuperscript{2}\textsuperscript{\href{https://orcid.org/0009-0005- 4655-6308}{\XeTeXLinkBox{\includegraphics[height=7pt]{orcid-logo-pharmascope.pdf}}}}~\\[5pt]{\textsuperscript{1}Department of Anatomy, NIMS Medical College, Jaipur, Rajasthan, India}~\\{\textsuperscript{2}Department of Anatomy, RUHS College of Medical Sciences, Jaipur, Rajasthan, India}}

\begin{abstract}
In the present era, with the evolution in the medical field, many parameters have gained  importance in researches by the forensic experts, anthropologists in the identification of biological remains. Nowadays, complete human skeletons can be used for the identification of the biological profile of an individual. One of the emerging parameters are the foot dimensions in identification and gender determination. The study was conducted on   207 males \& 200 females from Rajasthan adult population of age group   17 to 25 years. The anthropometric measurements of left foot length and breadth were measured by the digital sliding caliper. Significant Foot index was calculated, it was found that the overall left foot index for males was 37.89 and females was 38.24.  This indicates that the value of left foot index is less than 38 in male but more than 38 in females. This  38 value obtained can be the deviation point in predicting the gender, by calculating the left foot index. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Left Foot breadth,\newline Left Foot Index,\newline Left Foot length,\newline Digital sliding caliper
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Nupur~Shukla~\\ Phone:\ 7878654396~\\  Email:\ nups1202@gmail.com
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\section{Introduction}
In the era of recent researches, no two individuals are comparable in their observable qualities. Even genetically identical twins can have some minor differences. Dayananda R, et al. \unskip~\cite{2021711:28636837} defined anthropometry as a collection of systematic procedures that quantitatively depict the dimensions of the human skeleton. It is considered to be a fundamental instrument of biological anthropology and is finding greater usage in medical science, particularly in the field of forensic medicine. Forensic studies of unidentified human remains have consistently using anthropometry \unskip~\cite{2021711:28636832}.\ensuremath{^{}}

The determination of a person's gender is a crucial and vital factor in determining their identity \unskip~\cite{2021711:28636834}.

Gender refers to the culturally defined characteristics of a human being, by which it gets associated with the society. Gender  determination is a significant and vital factor in determining  the identity of an individual. If the entire skeleton is present, determining the sex of an individual becomes very simple.  Although the pelvis and skull are the most dependable bones for this purpose. It is becoming crucial to determine the sex from other areas of the skeleton as well because in medico-legal cases, one does not always have a fully developed pelvis or skull \unskip~\cite{2021711:28636828}. DNA technology may be the most precise method for identifying body parts in the event of mass disasters where it is possible to examine numerous dismantled body parts. But still, it is not an affordable method as it is expensive, time-consuming and extensive. The identification by anthropometry becomes more significant, affordable and convenient methods in such massive catastrophes. 

Partially damaged bodies and human remains are often encountered in fields, where dismantling, explosion, or other mass disasters took place. The main purpose of investigating the damaged remains is to develop a biological profile that identifies individuals by estimating the age, and gender, which is of prime prerequisite nowadays.  Foot dimensions have not been frequently used in investigating these areas. But generally the human foot is mostly shielded by shoes, so the recovery of undestroyed foot becomes more evident at these explosive and disaster sites, making the investigation possible. Hence feet can  be an excellent clue regarding personal identity. Also, the foot dimensions vary between populations around the globe which is attributed to factors such as genetics, environment and climatic, different habitat and social conditions. Thus, the present study was conducted to find association  of the left foot index in gender determination. 

\textbf{Aim}

The aim of the study was to determine gender from the Left Foot Index in Rajasthan adult population. 
    
\section{Materials and Methods}
The present study was a cross-sectional, observational and descriptive study. It was conducted in the Department of Anatomy, RUHS College of Medical Sciences (RUHS-CMS), Jaipur. 

The study was carried on 407 (207 Males \& 200 females) healthy, asymptomatic adults, residing in Rajasthan University of Health Sciences of Rajasthan origin in the age group of 17 to 25 years. The study was approved by Ethical Committee of the institute. Written Informed consent was taken from each subjects. 

\textbf{Inclusion Criteria}

Healthy, asymptomatic male and female subjects who were willing to participate  and of the age group between 17 and 25 years were included in the study. 

\textbf{Exclusion Criteria}

Subjects with apparent physical foot anomalies, inflammation, deformities and surgery (if any), the history of accident or fracture, congenital foot deformity like vertical talus, club foot and  systemic chronic illness were excluded for the study.

\textbf{Measurement of foot dimensions}

Digital Sliding caliper was used to measure the foot dimensions.

Foot dimensions included foot length and foot breadth.

\textbf{Foot Length}

It was measured as the distance from the most posterior point of the heel (pterion) to the most anterior point of the longest toe-first or the second toe (accordion) \unskip~\cite{2021711:28636829}.

\textbf{Foot Breadth}

The distance between the most prominent point on the medial aspect of the head of the first metatarsal and the most prominent point on the lateral aspect of head of fifth metatarsal was measured \unskip~\cite{2021711:28637735}. 

Left foot was selected for measurement according to the recommendation of the international agreement for paired measurements \unskip~\cite{2021711:28636830} [Figures~\ref{f-8b7920b1ce7a}, \ref{f-e205c36bdd66}, \ref{f-1e36b3b4a296} and~\ref{f-80b3f4b26c78}].


\begin{table*}[!htbp]
\caption{\boldmath {Age-wise overall parameters of Male subjects and their p- value} }
\label{tw-5b71c4d57d90}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.13779999999999998\linewidth-2\tabcolsep}p{\dimexpr.12670000000000002\linewidth-2\tabcolsep}p{\dimexpr.15549999999999999\linewidth-2\tabcolsep}p{\dimexpr.1555\linewidth-2\tabcolsep}p{\dimexpr.1245\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\multicolumn{5}{p{\dimexpr(.70\linewidth-2\tabcolsep)}}{\cAlignHack MALE} & \\
\rowcolor{kwdboxcolor}AGE \mbox{}\protect\newline In  Years & TOTAL  NO. OF  SUBJECT \mbox{}\protect\newline S & Foot  Length  (Mean\ensuremath{\pm}SD) & Foot Breadth  (Mean\ensuremath{\pm}SD) & Foot Index  (Mean\ensuremath{\pm}SD) & P-Value\\
\tblmidrule 
18 &
  5 &
  25.96\ensuremath{\pm}1.13 &
  9.71\ensuremath{\pm}0.53 &
  37.42\ensuremath{\pm}1.45 &
  0.000\\
19 &
  30 &
  25.78\ensuremath{\pm}1.23 &
  9.62\ensuremath{\pm}0.53 &
  38.24\ensuremath{\pm}1.44 &
  0.000\\
20 &
  56 &
  25.36\ensuremath{\pm}1.17 &
  9.57\ensuremath{\pm}0.48 &
  37.75\ensuremath{\pm}1.13 &
  0.000\\
21 &
  62 &
  24.99\ensuremath{\pm}1.09 &
  9.43\ensuremath{\pm}0.41 &
  37.76\ensuremath{\pm}1.32 &
  0.000\\
22 &
  23 &
  25.28\ensuremath{\pm}0.97 &
  9.66\ensuremath{\pm}0.37 &
  38.27\ensuremath{\pm}1.77 &
  0.000\\
23 &
  23 &
  25.21\ensuremath{\pm}1.05 &
  9.58\ensuremath{\pm}0.47 &
  38.0\ensuremath{\pm}1.40 &
  0.000\\
24 &
  8 &
  25.24\ensuremath{\pm}0.77 &
  9.42\ensuremath{\pm}0.5 &
  37.34\ensuremath{\pm}1.47 &
  0.000\\
\multicolumn{2}{p{\dimexpr(.2645\linewidth-2\tabcolsep)}}{OVER  ALL} &
  25.21\ensuremath{\pm}1.1 &
  9.55\ensuremath{\pm}0.46 &
  37.89\ensuremath{\pm}1.37 &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Age-wise overall parameters of Female subjects and their p- value} }
\label{tw-a757e815feb2}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.1534\linewidth-2\tabcolsep}p{\dimexpr.16439999999999998\linewidth-2\tabcolsep}p{\dimexpr.1622\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\multicolumn{5}{p{\dimexpr(.80\linewidth-2\tabcolsep)}}{\cAlignHack FEMALE} & \\
\rowcolor{kwdboxcolor}AGE \mbox{}\protect\newline In  Years & TOTAL  NO.OF \mbox{}\protect\newline SUBJECTS & Foot  Length  (Mean\ensuremath{\pm}SD) & Foot Breadth  (Mean\ensuremath{\pm}SD) & Foot Index  (Mean\ensuremath{\pm}SD) & P-Value\\
\tblmidrule 
18 &
  11 &
  22.56\ensuremath{\pm}1.0 &
  8.59\ensuremath{\pm}0.29 &
  38.12\ensuremath{\pm}1.88 &
  0.000\\
19 &
  39 &
  22.68\ensuremath{\pm}1.18 &
  8.62\ensuremath{\pm}0.42 &
  38.05\ensuremath{\pm}1.64 &
  0.000\\
20 &
  64 &
  23.08\ensuremath{\pm}1.04 &
  8.85\ensuremath{\pm}0.45 &
  38.36\ensuremath{\pm}1.56 &
  0.000\\
21 &
  61 &
  22.86\ensuremath{\pm}1.02 &
  8.72\ensuremath{\pm}0.42 &
  38.17\ensuremath{\pm}1.43 &
  0.000\\
22 &
  20 &
  22.56\ensuremath{\pm}1.14 &
  8.61\ensuremath{\pm}0.41 &
  38.21\ensuremath{\pm}1.32 &
  0.000\\
23 &
  5 &
  22.18\ensuremath{\pm}1.32 &
  8.72\ensuremath{\pm}0.25 &
  39.41\ensuremath{\pm}2.05 &
  0.001\\
\multicolumn{2}{p{\dimexpr(.31779999999999998\linewidth-2\tabcolsep)}}{OVER  ALL} &
  22.83\ensuremath{\pm}1.08 &
  8.72\ensuremath{\pm}0.43 &
  38.24\ensuremath{\pm}1.54 &
  \\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Comparison of Foot Index of left foot in Males and Females} }
\label{tw-336d65427490}
\def\arraystretch{1.1}
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\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2333\linewidth-2\tabcolsep}p{\dimexpr.2168\linewidth-2\tabcolsep}p{\dimexpr.27330000000000005\linewidth-2\tabcolsep}p{\dimexpr.2766\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Side of  foot & Foot  Index & Male \mbox{}\protect\newline (Mean  \ensuremath{\pm}  SD) & Female  (Mean  \ensuremath{\pm}  SD)\\
\tblmidrule 
LEFT &
  F  I~&
  37.89\ensuremath{\pm}1.37 &
  38.24\ensuremath{\pm}1.54\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Comparison of Foot Indices of Left foot of males and females} With previous studies}
\label{tw-a599d364225b}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2318\linewidth-2\tabcolsep}p{\dimexpr.2159\linewidth-2\tabcolsep}p{\dimexpr.14170000000000002\linewidth-2\tabcolsep}p{\dimexpr.2106\linewidth-2\tabcolsep}p{\dimexpr.20\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Authors & Study  Population & Sex & No.of  Subjects & Foot  Index(Mean  \ensuremath{\pm}  SD)  Left  Foot\\
\tblmidrule 
Present  study &
  Rajasthan &
  M  F &
  207 \mbox{}\protect\newline 200 &
  37.89\ensuremath{\pm}1.37 \mbox{}\protect\newline 38.24\ensuremath{\pm}1.54\\
Agnihotri et  al &
  Mauritius &
  M  F &
  125 \mbox{}\protect\newline 125 &
  36.91\ensuremath{\pm}0.54 \mbox{}\protect\newline 37.62\ensuremath{\pm}0.52\\
Jaydip Sen  et \mbox{}\protect\newline al &
  Bengal &
  M  F &
  175 \mbox{}\protect\newline 175 &
  41.30\ensuremath{\pm}1.8 \mbox{}\protect\newline 40.50\ensuremath{\pm}2.1\\
Kewal  Krishan  et  al &
  Himachal Pradesh &
  M  F &
  123 \mbox{}\protect\newline 123 &
  38.65\ensuremath{\pm}2.1 \mbox{}\protect\newline 37.93\ensuremath{\pm}1.9\\
Barnabas et al &
  Nigerians &
  M  F &
  250 \mbox{}\protect\newline 150 &
  34.28\ensuremath{\pm}2.19 \mbox{}\protect\newline 32.60\ensuremath{\pm}2.35\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\bgroup
\fixFloatSize{images/014f6b96-8bfa-427d-90a5-20078611c1c9-upicture1.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/014f6b96-8bfa-427d-90a5-20078611c1c9-upicture1.png}{\includegraphics{images/014f6b96-8bfa-427d-90a5-20078611c1c9-upicture1.png}}{\includegraphics{014f6b96-8bfa-427d-90a5-20078611c1c9-upicture1.png}}
\makeatother 
\caption{\boldmath {Digital Sliding Caliper}}
\label{f-8b7920b1ce7a}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/c6cfcd8d-838f-4487-92a1-5fba0c380ce8-upicture2.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/c6cfcd8d-838f-4487-92a1-5fba0c380ce8-upicture2.png}{\includegraphics{images/c6cfcd8d-838f-4487-92a1-5fba0c380ce8-upicture2.png}}{\includegraphics{c6cfcd8d-838f-4487-92a1-5fba0c380ce8-upicture2.png}}
\makeatother 
\caption{\boldmath {Anatomical landmarks taken in Measurements of the foot}}
\label{f-e205c36bdd66}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/eb54300f-4980-4306-9279-666b8a07ca64-upicture3.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/eb54300f-4980-4306-9279-666b8a07ca64-upicture3.png}{\includegraphics{images/eb54300f-4980-4306-9279-666b8a07ca64-upicture3.png}}{\includegraphics{eb54300f-4980-4306-9279-666b8a07ca64-upicture3.png}}
\makeatother 
\caption{\boldmath {Measurements of Left Foot Breadth}}
\label{f-1e36b3b4a296}
\end{figure}
\egroup

\bgroup
\fixFloatSize{images/563d6d9f-1d7d-4d44-9f8a-f3bfab5798da-upicture4.png}
\begin{figure}[!htbp]
\centering \makeatletter\IfFileExists{images/563d6d9f-1d7d-4d44-9f8a-f3bfab5798da-upicture4.png}{\includegraphics{images/563d6d9f-1d7d-4d44-9f8a-f3bfab5798da-upicture4.png}}{\includegraphics{563d6d9f-1d7d-4d44-9f8a-f3bfab5798da-upicture4.png}}
\makeatother 
\caption{\boldmath {Measurements of Left Foot Length}}
\label{f-80b3f4b26c78}
\end{figure}
\egroup
Foot dimensions were measured in centimeters  up to two decimal places. All the measurements were recorded thrice and then their mean was calculated for accuracy.

To eliminate the discrepancies due to diurnal variation, the measurements were taken between 2 to 5 p.m. To minimize instrument and inter-observer errors, the same observer carried out all the measurements with the same instrument. 

\textbf{Foot Index (FI) }

It  was calculated by using the measured foot parameter foot length and foot breadth.
\begin{eqnarray*}FI=\frac{foot\;breadth}{foot\;length}\times100 \end{eqnarray*}
\textbf{Statistical Analysis}

Data collected was entered in Microsoft excel 2010 worksheet in the form of a master chart. The data were subjected to statistical analysis using a statistical package for social sciences (SPSS) version 20. Standard deviation, p-values were obtained. Comparison of mean in two groups was done with an independent t-test. 
    
\section{RESULTS}
There were a total of 407 participants in this study (207 males and 200 females). Mean foot length in males was 25.21 (SD\ensuremath{\pm}1.1) and in females was 22.83 (SD\ensuremath{\pm}1.08). Similarly, mean foot breadth in males was 9.55cm (SD = 0.46) and that in females was 8.72 cm (SD = 0.43). This gender-wise difference in mean foot length and mean foot breadth was statistically significant(p{\textless}0.001).

Foot Index was calculated.

Mean foot index in males was 37.89(SD\ensuremath{\pm}1.37) and that in females was 38.24 (SD\ensuremath{\pm}1.54) This gender-wise difference in Foot Index was found statistically significant(p \textless\ 0.001).  A significant positive correlation was found in both genders. (Tables~\ref{tw-5b71c4d57d90} and~\ref{tw-a757e815feb2}).
    
\section{DISCUSSION}
Gender is the key in defining the human being. It is when this is known one gets acceptance, recognition, differentiation in the society. Gender determination thus, became a very important role in knowing the unknown.

With the increase in calamities, and massive disasters where our forensic experts deal with unidentified and dismantled human remains. It becomes essential to analyze the human remains and to whom it belongs. 

In the present study, attempts have been made to establish the association of Foot  dimensions in predicting gender of a person. For this purpose, Mean foot length, Mean foot breadth and Foot Index of left foot in males and females were calculated. 

It was observed  that Mean left foot length in males was 25.21 (SD\ensuremath{\pm}1.1) and in females was 22.83 (SD\ensuremath{\pm}1.08). Similarly, mean left foot breadth in males was 9.55cm (SD = 0.46) and that in females was 8.72cm (SD = 0.43). A  positive correlation was found between foot dimensions and gender. Males had an average foot length of 2.38 cm greater than females. Foot breadth in males was also about 1 cm greater as compared to females. This gender wise difference in mean foot length and mean foot breadth was statistically significant (p{\textless}0.001). 

The Overall Left foot  index was more  in  females greater than 38 (LFI{\textgreater}38) than in  males (LFI {\textless}38). (Table~\ref{tw-336d65427490}). Thus, this value 38 can be used  as a deviation point for gender determination in the adult population. In our study though LFL and LFB was more in males than females in all the age groups. But the difference in Foot Index was observed in both males and females at different age groups. This states that although foot parameters are interdependent on each other still they differ in gender at different age groups, this can be related to the growth pattern of the individual. 

Our study was in accordance with Agnihotri et al., \unskip~\cite{2021711:28636827} study on Mauritius population where LFI was greater than 37 in females and less in males, and Singla R et al., \unskip~\cite{2021711:28636836} study on Haryanvi and North Indian populations where LFI  was greater than 37  in females and less in males.

While in other studies, conducted by Jaydip Sen et al \unskip~\cite{2021711:28636826} on Bengal population LFI was greater than 41 in males and less in females, Kewal Krishan et al \unskip~\cite{2021711:28636833} on Himachal population LFI was greater than 38 in males and less in females, and Barnabas et al \unskip~\cite{2021711:28636831} on Nigerian population, LFI was greater than 34 males and less in females. Shaifaly Madan Rustagi et al \unskip~\cite{2021711:28636835}  on medical students, LFI was almost equal in males and females. (Table~\ref{tw-a599d364225b})

It can be attributed to genetic, and environmental factors as one moves to different geographical regions. Also, in areas where survival is dependent on adaptation under climatic and biological changes, the morphological variations are more diverse. Thus these parameters can be utilized for identifying an individual in that particular geographical population. Foot dimensions have a wide range of variations around the globe thus, they can be used as good predictors of gender of an individual in cases of massive disaster, where dismantled foot remains are recovered. By determining a gender one can ease the identification procedure by the experts in less time.

By devising the references point i.e. Mean left foot index, one can easily predict the gender of the unknown person. So, this study will be useful to forensic experts and anthropologists in analyzing foot remains and also by surgeons in reconstructive surgeries.

\textbf{Limitations of study}

The study was conducted on young adults between age group of 17 to 25 years, we hope that this age range covers the age at which fusion of foot bones occurs in population.\ensuremath{^{16 }}  A wider age group of participants might have produced a different and more accurate prediction of gender from foot index. Similarly, we measured only the left foot as per the recommendation for paired measurements. The results would have been more refined if both feet were considered for measurements.
    
\section{CONCLUSION}
The present study established a definite relationship in determining gender from the Left Foot Index.
    
\section{Acknowledgement}
The author is grateful to Dr. Gireesh Gupta for his constant support \& guidance throughout the study.

\textbf{Financial Support and Sponsorship}

The authors declare that they have no funding support for this study.

\textbf{Conflicts of Interest }

The authors declare that there are no conflicts of interest.
    

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