Foot structure in overweight and obese children

Abstract

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.

Body weight and the medial longitudinal foot arch: high-arched foot, a hidden problem?

“…Clarke’s angle (footprint angle α ) is a widely used method of assessing the longitudinal foot arch [22, 25, 26]. It is constructed by drawing a tangent to the medial edge of the foot (the prints) and a line connecting the deeper part of the footprint with the most medial point of the forefoot (Fig.…”

“…El et al [11] described the decrease in flat foot incidence up to the age of 9. Villeroya et al [25] established the age of 9 years to be the moment of full development of the MLA.…”

Mitigating clinician and community concerns about children's flatfeet, intoeing gait, knock knees or bow legs

“…A flatfoot appearance is normal in the first decade of life, reducing by age 10. Flatfoot is more common in boys, overweight/obesity and younger children, and it varies with ethnicity …”

Pes planus and paediatric obesity: a systematic review of the literature

“…Other studies report prevalences of 4–28% and support a positive association between prevalence of pes planus and child weight. Although pes planus is not considered a comorbidity of paediatric obesity, it is a common diagnosis among children who are overweight . It is not known, however, if carrying excess weight may be a cause of pes planus in children; studies have questioned whether pes planus may occur as a result of a lowered medial longitudinal arch after full development or a thicker midfoot plantar fat pad .…”

“…Although pes planus is not considered a comorbidity of paediatric obesity, it is a common diagnosis among children who are overweight . It is not known, however, if carrying excess weight may be a cause of pes planus in children; studies have questioned whether pes planus may occur as a result of a lowered medial longitudinal arch after full development or a thicker midfoot plantar fat pad . Foot pain severity and thickness of plantar fascia are related to the midfoot loading and foot arch angle .…”