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From the Society's Annual Conference in UK, as reported by the BBC: Obesity 'damages children's feet'
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Children who are obese are damaging their feet and may have problems walking, a study has suggested.
The research, presented to the Society of Podiatrists and Chiropodists conference, found obese children had wider and longer feet than normal.
Obese children were also found to have problems balancing, and walked at a slower pace.
Experts warned the effects of obesity put children at risk of long-term foot, leg and back problems.
Each foot is made up of 26 bones, around 19 muscles, a large number of ligaments, tendons, blood vessels and nerves and is designed to absorb the shock of walking and running.
But podiatrists say that excess weight and obesity can damage the delicate, immature nature of children's feet, leaving them at particular risk of deformities and abnormalities.
Balance problem
One study by the podiatrists looked at 200 children from Glasgow aged nine to12 years - 54 were obese and 15 were severely obese. Another 30 were overweight.
Obese children had feet that were up to 15 millimetres (mm) longer and seven wider than feet in normal weight children.
In children with severe obesity, their feet were on average 18mm longer and 15mm wider.
A second study of 44 nine to 11 year olds, half of whom were obese, found that the obese children were unstable when they walked.
They spent more time balancing on two feet when walking and less time on one foot than normal weight children. They also walked at a slower pace.
Flat feet can lead to other problems, such as knock-knees which can lead on to other knee problems and - later in life - to back and pelvis problems.
Some children are born with flatter than normal feet, and for them putting on too much weight can exacerbate the problems that can cause.
Others will be born with normal foot structures, but their weight will still cause problems.
Podiatrists suggest it can put extra pressure on the joints in the foot, leading to problems in the way the foot aligns and functions.
'Prevention better than cure'
Dr Stewart Morrison, a lecturer from the University of East London, who carried out the research, said: "Obese children are less stable when walking and cannot walk efficiently.
He added: "The findings are interesting because previous research suggested that foot problems limit obese children's ability to take part in physical activity - so encouraging them to carry out exercise might not be the best thing."
Gordon Watt, a consultant paediatric podiatrist, added: "This research is very important as it flags up to the podiatrist the 'at risk' nature of the foot in the child who is overweight or obese.
"Clinicians have been aware for some time of particular problems associated with these children but this research provides evidence that obesity and being overweight has an effect, not only on the development of the foot, but also on the way the foot and lower limb functions during walking."
Dr Ian Campbell of the charity Weight Concern said: "This typifies the problems of obesity, showing it affects every part of the body.
And he said that foot problems limiting the ability of obese children to exercise put them in a "catch 22 situation" because they need to be more active.
"This reinforces the need for prevention rather than cure, and for early intervention."
OBJECTIVE: The purpose of this study was to determine whether the flat feet displayed by young obese and overweight children are attributable to the presence of a thicker midfoot plantar fat pad or a lowering of the longitudinal arch relative to that in non-overweight children.
RESEARCH METHODS AND PROCEDURES: Foot anthropometry, an arch index derived from plantar footprints, and midfoot plantar fat pad thickness measured by ultrasound were obtained for 19 overweight/obese preschool children (mean age, 4.3 +/- 0.9 years; mean height, 1.07 +/- 0.1 m; mean BMI, 18.6 +/- 1.2 kg/m(2)) and 19 non-overweight children matched for age, height, and sex (mean age, 4.3 +/- 0.7 years; mean height, 1.05 +/- 0.1 m; mean BMI, 15.7 +/- 0.7 kg/m(2)).
RESULTS: Independent t tests revealed no significant between-subject group differences (p = 0.39) in the thickness of the midfoot plantar fat pad. However, the overweight/obese children had a significantly lower plantar arch height (0.9 +/- 0.3 cm) than their non-overweight counterparts (1.1 +/- 0.2 cm; p = 0.04).
DISCUSSION: The lower plantar arch height found in the overweight/obese children suggests that the flatter feet characteristic of overweight/obese preschool children may be caused by structural changes in their foot anatomy. It is postulated that these structural changes, which may adversely affect the functional capacity of the medial longitudinal arch, might be exacerbated if excess weight bearing continues throughout childhood and into adulthood.
Locomotor strategies in obese and non-obese children.
Obesity (Silver Spring). 2006 Oct;14(10):1789-94
Nantel J, Brochu M, Prince F
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OBJECTIVE: The constant strain in obese children may increase the risks of articular problems in adulthood. In the short term, obesity in children could lead to modifications of the gait pattern. The purpose of this study was to compare biomechanical parameters between obese and non-obese children during self-paced walking.
RESEARCH METHODS AND PROCEDURES: Gait analysis was performed on 10 non-obese and 10 obese (body weight > 95th percentile) children between 8 and 13 years of age. Subjects were asked to walk at their own pace on a 10-m walkway with two embedded AMTI force plates (Advanced Mechanical Technology, Watertown, MA) sampling at 960 Hz. Kinematics were captured with eight VICON optoelectronic cameras (Oxford Metrics Limited, Oxford, United Kingdom) recording at 60 Hz.
RESULTS: Obese children modified their hip motor pattern by shifting from extensor to flexor moment earlier in the gait cycle. This led obese children to significantly decrease the mechanical work done by the hip extensors during weight acceptance and significantly increase the mechanical work done by the hip flexors compared with non-obese children. The ratio of power-absorption-by-hip-flexors to power-generation-by-hip-flexors was also significantly increased in the obese group compared with non-obese children. Finally, there was a significant decrease in the single support duration in the obese group compared with non-obese.
DISCUSSION: The kinetics analyzed showed that obese children could take advantage of a passive hip strategy to achieve forward progression during walking. However, considering that they are mechanically less efficient to transfer energy, walking at a natural cadence should be an appropriate exercise to reduce weight in obese children.
Objective. To analyse the association between overweight and obesity and foot structure in children older than 9 years of age, whose longitudinal medial arch (MLA) should be practically established.
Design, setting and subject. A cross-sectional study of 245 children (age: 13.22+/-1.8 years) from four randomly selected schools (Zaragoza, Spain). Body mass index (BMI) was calculated and normal-weight, overweight and obese groups were defined. Footprints for both feet were collected. Measurements. Foot angle (FA) and Chippaux-Smirak index (CSI) were calculated from the footprints. Height and body mass were measured to calculate the BMI.
Results. Mean values of FA and CSI in the normal-weight group indicated the presence of a normal MLA; however, in the overweight they indicated an intermediary MLA and in the obese group, a low MLA. Comparison among the groups showed a decrease of FA (p<0.01) and an increase of CSI (p<0.01) with increasing weight associated with a lower MLA. A low but significant correlation (p<0.0001) was found between the z-score BMI and footprint parameters.
Conclusions. In children aged 9 to 16.5 years, the increase of body mass is related to a lower MLA. The MLA is lower in these obese children than in the younger ones studied in previous works probably due to the continuous bearing of excessive mass from childhood. A lower MLA could cause health problems. An assessment of foot structure in these children is recommended as the classification of the foot arch type can help decide if treatment to avoid these problems is necessary.
OBJECTIVE: To determine the effects of overweight and obesity on plantar pressures generated by pre-school children during gait.
METHODS: Dynamic plantar pressure variables were measured for 17 overweight/obese children (age = 4.4 +/- 10.8 years; height = 1.08 +/- 0.1 m; body mass index (BMI) = 18.5 +/- 1.3 kg x m(-2)) and 17 age, gender and height matched non-overweight peers (age = 4.4 +/- 0.7 years, height = 1.06 +/- 0.1 m, BMI = 15.7 +/- 0.7 kg x m(-2)).
RESULTS: When walking, the overweight/obese children displayed significantly larger contact areas and generated significantly larger forces on the plantar surface of their total foot, heel, midfoot and forefoot compared to the non-overweight children. Despite generating these higher forces over larger contact areas, the overweight/obese children displayed significantly higher peak pressures, force-time integrals and pressure-time integrals in the midfoot compared to their leaner counterparts.
CONCLUSIONS: Although the overweight/obese children displayed greater midfoot contact, this increased contact area was not sufficient to compensate for the high forces generated during walking, resulting in them experiencing higher midfoot plantar pressures relative to the non-overweight children. The overweight/obese children also experienced significantly higher force-time and pressure-time integrals than their leaner counterparts, suggesting that their midfoot may be exposed to increased stress and, in turn, vulnerable to bony fatigue and soft tissue damage. The impact of these greater plantar pressure variables on foot discomfort and physical activity levels of these young overweight/obese children as they develop into adults requires further investigation.
Anthropometric Foot Structure of Peripubescent Children with Excessive versus Normal Body Mass. A Cross-sectional Study
Stewart C. Morrison, PhD, Brian R. Durward, PhD , Gordon F. Watt, DPM and Malcolm D. C. Donaldson, MD J Am Podiatr Med Assoc 97(5): 366–370, 2007
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Background: A variety of musculoskeletal problems have been associated with excessive body mass in children, including structural foot problems.
Methods: Two hundred children aged 9 to 12 years were recruited to evaluate the effect of body mass on foot structure. Three reliable anthropometric measures were recorded: foot length, forefoot width, and navicular height.
Results: Following independent sample t test analysis of the data, significant differences were found for the three anthropometric variables when children with normal body mass were compared with those with excessive body mass. The research indicates that foot length and width increase with body mass, whereas navicular height drops.
Conclusions: Excessive body mass affects the discrete anthropometric structure of the peripubescent foot. With the growing concern about childhood obesity, further research is essential to develop a comprehensive understanding of the issues identified and to quantify the findings presented here.
Musculoskeletal pain in obese children and adolescents.
Stovitz SD, Pardee PE, Vazquez G, Duval S, Schwimmer JB. Acta Paediatr. 2008 Apr;97(4):489-93.
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Aim: To determine whether bodyweight is associated with musculoskeletal pain within a population of obese children and adolescents.
Methods: A descriptive, cross-sectional study of subjects evaluated at a tertiary care medical centre for the management of obesity. Analyses were conducted using both a person-specific model, and then again, using a joint site model in order to account for correlations between joints within children.
Results: We evaluated 135 children and adolescents (68 girls, 67 boys) with a mean age of 12.3 years (range: 3-18). The study population was racially and ethnically diverse - Hispanic (51%), non-Hispanic white (26%), non-Hispanic black (13%), other (10%). The majority of subjects (61%) complained of at least one joint hurting more than once per month. Back pain was the most common complaint (39%), followed by foot (26%) and knee (24%) pain. After adjustment for age, pain in the knees and hips were associated with increased weight and/or body mass index (BMI).
Conclusions: In this cross-sectional analysis of obese children and adolescents, musculoskeletal pain was common and, in the knee and hip joints, was positively associated with extra bodyweight. Clinicians may want to ask about musculoskeletal pain when recommending physical activity for weight management counselling.
Objective: Due to the fact that there is a global increase in obesity, knowledge about the impact of obesity on the development of a child's foot is of great importance for orthopaedic and paediatric physicians with regard to prevention, clinical treatment and management. Therefore, the purpose of this study was to investigate the influence of body mass on the development of a child's foot based on a foot type classification.
Methods:The feet of 1450 boys and 1437 girls aged 2-14 years were measured using a three-dimensional (3D) foot scanner (Pedus, Human Solutions Inc., Germany) in a bipedal upright position. Twelve relevant 3D foot measures were recorded, as well as the children's age, gender, height and mass. Factor analysis of principal components was used to obtain a smaller number of independent and standardized variables. The variables were used for cluster analysis to classify the children's feet.
Results:Five foot types were identified: flat, robust, slender, short and long feet. There were significant differences among foot types with respect to the children's body mass index. Normal weight children displayed an almost equal distribution of all foot types throughout childhood. Flat and robust feet were more common in overweight children, whereas underweight children showed more slender and long feet.
Conclusion:The influence of excess, as well as deficient mass could be verified for the comprehensive foot morphology based on a foot type classification. Subsequently, foot discomfort as a result of various musculoskeletal disorders may develop. In turn, this might keep the children from being active and therefore reinforce the risk of developing obesity. However, there is still a lack of information regarding these relationships, which needs to be determined. This knowledge may help prevent orthopaedic foot problems and injuries
Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study.
Villarroya MA, Esquivel JM, Tomás C, Moreno LA, Buenafé A, Bueno G. Eur J Pediatr. 2008 Aug 27. [Epub ahead of print]
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The purpose of this study was to evaluate foot arch types of obese children and adolescents aged 9-16.5 years using both indirect and direct measures. Fifty-eight obese children/adolescents attending the paediatric endocrinology unit of the University Hospital "Lozano Blesa" in Zaragoza were selected as experimental subjects. Fifty-eight gender and age matched, normal-weight children/adolescents were selected as control subjects. To assess the medial longitudinal arch (MLA) height, which is used as a main reference for the diagnosis of flatfoot, footprints from both feet were collected (in both groups) and lateral weight-bearing radiographs of both feet were taken (of 49 of the 58 obese children). Footprint angle (FA) and the Chippaux-Smirak index (CSI) were calculated from the footprints. Talus-first metatarsal (TFMA) and calcaneal inclination angles (CIA) were obtained from lateral feet radiographs. In the normal-weight group, mean values of FA and CSI indicated a normal MLA. In the obese group, morphological flatfoot was identified. Comparison between both groups, by side and gender, showed a decrease of FA (p < 0.001) and an increase of CSI (p <0.001) in obese subjects. Mean values of TFMA and CIA in the obese group indicated a lowering of the MLA. Obese children/adolescents between 9 and 16.5 years of age had significantly lower values of FA and higher CSI, related to a lower MLA. Radiographic parameters supported these findings and mean values were associated with a fall of this arch.
Comparison of Static Footprints and Pedobarography in Obese and Non-obese Children.
Taisa Filippin N, de Almeida Bacarin T, Lobo da Costa PH. Foot Ankle Int. 2008 Nov;29(11):1141-4.
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BACKGROUND: Static footprints have been widely used clinically. However, since this measure provides only indirect information about the medial longitudinal arch height, it is not clear if it can be indicative of dynamic foot function especially in obese children. This study aimed to verify whether static footprints can predict dynamic plantar pressures in obese children.
MATERIALS AND METHODS: Twenty children aged 9 to 11 years, divided into obese and non obese, voluntarily participated in this study. Static footprints and dynamic plantar pressures were analyzed by using a pedograph and the Pedar system (Novel GMbH, Munich, GER), respectively.
RESULTS: In general, correlations between static and dynamic measures were observed to be significant for the non obese children, while no significant correlations were found for the obese ones.
CONCLUSION: Since obesity may affect the relationship between static and dynamic measures, footprints should be used with caution when inferring the characteristics of obese children's feet under dynamic conditions.
CLINICAL RELEVANCE: Footprints and pedobarography should not be used at this time for clinical decision making regarding the feet of obese children
Frontal plane lower extremity biomechanics during walking in boys who are overweight versus healthy weight.
McMillan AG, Auman NL, Collier DN, Blaise Williams DS. Pediatr Phys Ther. 2009 Summer;21(2):187-93.
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PURPOSE: To compare frontal plane lower extremity biomechanics during walking in adolescent boys who were overweight (OW) versus healthy weight (HW).
METHODS: Fourteen boys (7 considered HW, body mass index for age <85th percentile; age 10.8 +/- 0.7 years; 7 considered OW, body mass index for age >95th percentile; age 12.0 +/- 0.7 years) participated. Three-dimensional kinematic data were collected during walking at self-selected speeds. Group means were compared using Student's t tests (alpha = 0.05).
RESULTS: Significant differences were found in timing of rearfoot motions and moments, amplitude of knee motion peaks, timing of knee moment peaks, and timing and amplitudes of peak hip motion and moments.
CONCLUSION: Boys who were OW collapsed into hip adduction and knee valgus during stance and attempted to compensate with rearfoot inversion. Observed differences in frontal plane kinematics during walking suggest that boys who are OW have increased risk of lower extremity musculoskeletal injuries and dysfunction.
PURPOSE: The obesity epidemic in children is spreading at alarming rates. Because musculoskeletal problems can influence physical activity, we compared the frequency of musculoskeletal problems in overweight and obese children with that in normal-weight children.
METHODS: We performed a cross-sectional database and face-to-face interview study that included 2,459 children aged 2 to 17 years from Dutch family practices. We collected data on self-reported height and weight (body mass index), self-reported musculoskeletal problems in the 2 weeks before the interview, number of family physician consultations for musculoskeletal problems in 1 year, and age (2 age-groups were analyzed: 2 to 11 years and 12 to 17 years, because of the proxy interview in the youngest age-group). We calculated the odds ratio (OR) and 95% confidence interval (CI) for musculoskeletal problems in overweight and obese children, compared with normal-weight children.
RESULTS: Overweight and obese children in both age-groups (2 to 11 years and 12 to 17 years) reported significantly more musculoskeletal problems (OR = 1.86; 95% CI, 1.18-2.93; and OR = 1.69; 95% CI, 1.08-2.65, respectively) than normal-weight children. The total group of children who were overweight or obese reported more lower extremity problems than did the normal-weight children (OR = 1.62; 95% CI, 1.09-2.41); furthermore, they reported more ankle and foot problems than children who were of normal weight (OR = 1.92; 95% CI, 1.15-3.20). Overweight and obese children aged 12 to 17 years consulted their family physicians more often with lower extremity problems than did the normal-weight children (OR = 1.92; 95% CI, 1.05-3.51).
CONCLUSION: This study shows that overweight and obese children more frequently experience musculoskeletal problems than do normal-weight children.
Obesity 'damages children's feet'
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