Jun
23
Written by:
Cherri Choate, DPM
6/23/2010
In today's world stories covering pediatric obesity are read, nearly on a weekly basis, in both national and local media. In addition to all the long term health issues related to this epidemic, studies are now being published about the impact on the lower extremity. Until recently, most discussions regarding biomechanical pediatric foot pathology focused on issues such as metatarsus adductus, clubfoot, pediatric and flat foot. The age old question of when to treat the pediatric flat foot, is now being complicated by two issues: obesity and sports. Both of these issues muddy the waters, the already muddy waters of pediatric flat foot. Perhaps many of us have developed a protocol of treatment that follows the guidelines recommended by AM Evans in her article publsihed in JAPMA (2008): "The Flat-Footed Child--To treat or not to treat:". Her recommendations are primarily based on age related abnormal physical findings and patient symptoms.
But now, we have two intervening issues to make our decisions even more difficult. Over the past few years childhood participation in competitive sports has sky rocketed. I attended a lecture earlier this spring that outlined all the common pediatric sports and injuries and the list was long and disturbing. Will increased use and demand for performance, lead to early biomechanical intervention via shoes and orthotics? The most recent studies only are beginning to cover the frequency and extent of these injuries. A story in the Wall Street Journal on June 22, compared injuries in children based on body location and gender.
In addition to this activity shift, we also have the issue of obesity in children of all ages. The CDC statistics, which are a few years old, reveal trends rising in many areas, including BMI values and ages affected. Will the normal development of a child's body, including their feet/ankles, be affected by a constant increased load? Will these loads lead to irreversilble musculoskeletal damage, that will in kind lead to a more sedentary, more overweight, generation who will eventually live in chronic pain?
Although research has yet to provide us complete answers, protection and prevention seem to be paramount tenets in this situation. The recommendations would include: stable closed shoe gear, stable functional orthotics, appropriate activity schedule, bracing and monitored post-injury treatment and rehabilitation.
An article studying the impact of obesity on foot structure has been reviewed for today's Ejournal: (Morrison 2007)
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