Body weight-dependent foot loads, assessed in terms of BMI and adiposity, in school-aged children: a cross sectional study

Abstract

Whereas inherently vulnerable structure of both a child's and an adolescent's foot, characteristic for its dynamic, developmental stage, is particularly exposed to numerous environmental factors, excessive body weight gain may potentially become a crucial causal factor, bringing on a cascade of adverse effects throughout the body, e.g. disorders of the skeletal-articular system, gait alterations, abnormally excessive loading of the plantar zones of the foot, and consequently serious postural defects, especially in later life. Since obesity, aptly dubbed the scourge of the 21st c., directly impacts the way the foot biomechanics are developed, whereupon the actual paradigm of foot loading becomes subject to numerous, adverse modifications, the present study focused on gaining an in-depth insight into prevalent association of BMi, adipose tissue content in body composition, and the actual distribution of foot loads in the school-aged children. Since body weight, the simplest anthropometric indicator, is actually non-indicative of the proportion of adipose tissue within body composition, a number of modern, non-invasive diagnostic methods were applied by the investigators to have this deficit effectively addressed, inclusive of comprehensively mapping out the actual load distribution in the plantar zones of the foot. The World Health Organization (WHO) acknowledges obesity to be the most common metabolic disease, aptly dubbing it a global scourge of the 21st c. This metabolic phenomenon has also affected children and teenagers. The number of overweight and obese cases in the youngsters aged 5-19 years increased from 4% in 1975 to over 18% in 2016. Obesity is a natural consequence of an imbalance between energy supply and its expenditure. Excessive dietary intake, usually combined with low physical activity, appreciably contribute to an increased weight gain through boosting the proportion of adipose tissue within the body composition 1-3. Excessive body weight appreciably contributes to abnormal motor development, agility, and overall coordination of movements, as well as adversely affects the development of the skeletal-articular system, which may consequently result in postural defects. Last but not least, excessive body weight may also be a crucial causal factor in various abnormalities encountered in the feet, i.e. abnormal foot loads 4-6. There are many studies corroborating detrimental effect of increased body weight on foot loads and attendant deformities 4-6. Numerous reports imply that overweight and obesity may well be instrumental in developing flat-footedness 7,8 , even though there are also studies which call this particular assertion into question 9. Cousins et al. 10 , while examining overweight and obese children observed that these children put more load on the metatarsal, in particular onto 2-5 metatarsal bones, than their peers with normal body weight. On the other hand, Buldt et al. 11 having conducted studies of adults with normal, flat, and cavus foot (i.e. a foot of high medial longitudinal arc...

Children with Obesity Experience Different Age-Related Changes in Plantar Pressure Distributions: A Follow-Up Study in China

“…As a result, the lateral forefoot turned out to be the main loading areas during this growing process, as opposed to the most heel loading in the normal-weighted population. This finding was partly in accordance with the previous studies that have confirmed elevated plantar loadings in obese children at the lateral forefoot in comparison with the normal-weighted ones [7,26,27]. Apart from this, a greater increase of peak pressure and pressure-time integral with the increasing age was found at the lateral forefoot in obese children in our study.…”

Vulnerability of the foot's morphological structure to deformities caused by foot loading paradigm in school-aged children: a cross-sectional study

“…The device is fitted with 8 sensors, placed underneath the platform on which a person stands barefooted, as well as in the handles to be held by the subject during the testing procedure. The measurement of electrical bio-impedance, dependent upon respective electrical conductivity of specific body tissues, facilitates the actual assessment of whether a person happens to be undernourished, obese, or just overweight 35 .…”

“…length, width, angles, and axes of the feet were determined. The subjects stood on the Podoscan barefooted, lower limbs straight, feet parallel to each other, upper limbs positioned along the torso 21 , 35 .…”

“…The following indicators were assessed: foot length—the line connecting the furthest points of the forefoot and hindfoot—in mm forefoot width—the line joining the most extreme points on the head of the first (mtt) and the fifth metatarsal bone (mtf)—in mm Clarke’s angle—the angle between the tangent of the medial edge of the foot and the line joining the point of the largest indentation and contact of the medial tangent with the foot edge—in ° the Wejsflog (W) index—length-to-width ratio the hallux valgus angle (α)—the angle between the tangent to the medial edge of the foot and the tangent of the edge of the hallux, derived from the mtt point—in ° The angle of the varus deformity of the fifth toe (β)—the angle between the tangent of the lateral edge of the foot and the tangent of the edge of the fifth toe derived from the point mtf—in ° (Fig. 5 ) 21 , 35 .

Figure 5 The method of determining the foot variables under study.

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“…The angle of the varus deformity of the fifth toe (β)—the angle between the tangent of the lateral edge of the foot and the tangent of the edge of the fifth toe derived from the point mtf—in ° (Fig. 5 ) 21 , 35 .…”