Mar
3
Written by:
Cherri Choate, DPM
3/3/2010
Childhood obesity is receiving attention from all corners of the globe. In 2002 a European Task Force on Obesity called it a "pan-European epidemic." As always it is important to look beyond the present moment, in order to see the possible long term effects of this signiciant problem. Two groups, (Morrison 2007 and Mauch 2008) published studies regarding foot morphology of normal, overweight and obese children. Between these two studies more than 3000 childen's feet were evaluated to determine if there was a link between BMI (body mass index) and foot structure. Interestingly, both studies found that length and width increased in overweight and obese children. Since we spend so much energy discussing arch height and plantar pressure, do these results have as much impact? I believe they do.
Let's consider the impact, no pun intended, of extra body mass on the feet. A text book by Hall published in 1989 "Handbook of Normal Physical Measurements" hypothesized that an increased forefoot width in overweight adults was due to loss of ligament strength. This loss of ligamentous strength may be due to a phenomenon called ligamentous creep. As a liagment is under stress it stretches and the strength of the ligament decreases, leading to instability during weightbearing. If this can and does happen in adult feet, then the consequences of an entire lifetime of stress and ligamentous creep may be severe. Instablity an an early age would certainly increase the propensity for pain, modified energy demands and early development of pathology.
As more evidence is presented, I am certainly leaning toward early intervention with PCP evaluation, exercise encouragement, diet changes, pediatric orthotics and shoe gear changes. I would also tend to see these patients annually, to reassess and reinforce the possible long-term risks of minimizing the risks of childhood obesity.
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