title: Influence of Obesity on Foot Loading Characteristics in Gait for Children Aged 1 to 12 Years.
abstract: BACKGROUND
  Overweight and obesity are increasing health problems that are not restricted to adults only. Childhood obesity is associated with metabolic, psychological and musculoskeletal comorbidities. However, knowledge about the effect of obesity on the foot function across maturation is lacking. Decreased foot function with disproportional loading characteristics is expected for obese children. The aim of this study was to examine foot loading characteristics during gait of normal-weight, overweight and obese children aged 1-12 years.
  
  
  METHODS
  A total of 10382 children aged one to twelve years were enrolled in the study. Finally, 7575 children (m/f: n = 3630/3945; 7.0±2.9 yr; 1.23±0.19 m; 26.6±10.6 kg; BMI: 17.1±2.4 kg/m2) were included for (complete case) data analysis. Children were categorized to normal-weight (≥3rd and <90th percentile; n = 6458), overweight (≥90rd and <97th percentile; n = 746) or obese (>97th percentile; n = 371) according to the German reference system that is based on age and gender-specific body mass indices (BMI). Plantar pressure measurements were assessed during gait on an instrumented walkway. Contact area, arch index (AI), peak pressure (PP) and force time integral (FTI) were calculated for the total, fore-, mid- and hindfoot. Data was analyzed descriptively (mean ± SD) followed by ANOVA/Welch-test (according to homogeneity of variances: yes/no) for group differences according to BMI categorization (normal-weight, overweight, obesity) and for each age group 1 to 12 yrs (post-hoc Tukey Kramer/Dunnett's C; α = 0.05).
  
  
  RESULTS
  Mean walking velocity was 0.95 ± 0.25 m/s with no differences between normal-weight, overweight or obese children (p = 0.0841). Results show higher foot contact area, arch index, peak pressure and force time integral in overweight and obese children (p<0.001). Obese children showed the 1.48-fold (1 year-old) to 3.49-fold (10 year-old) midfoot loading (FTI) compared to normal-weight.
  
  
  CONCLUSIONS
  Additional body mass leads to higher overall load, with disproportional impact on the midfoot area and longitudinal foot arch showing characteristic foot loading patterns. Already the feet of one and two year old children are significantly affected. Childhood overweight and obesity is not compensated by the musculoskeletal system. To avoid excessive foot loading with potential risk of discomfort or pain in childhood, prevention strategies should be developed and validated for children with a high body mass index and functional changes in the midfoot area. The presented plantar pressure values could additionally serve as reference data to identify suspicious foot loading patterns in children.
authors.affiliation: University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Mueller
authors.affiliation: University of Education Schwäbisch Gmünd, Institute of Health Sciences, Schwäbisch Gmünd, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Carlsohn
authors.affiliation: University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Mueller
authors.affiliation: Bern University of Applied Sciences, Health, Physiotherapy, Bern, Switzerland.
authors.forename: Heiner
authors.initials: H
authors.lastname: Baur
authors.affiliation: University Outpatient Clinic, Sports Medicine & Sports Orthopaedics, University of Potsdam, Potsdam, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Mayer
mesh_terms: D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D005260:Female; D005528:Foot / Q000503:physiopathology*; D005684:Gait / Q000502:physiology*; D006801:Humans; D007223:Infant; D008297:Male; D063766:Pediatric Obesity / Q000503:physiopathology*; D016138:Walking / Q000502:physiology*