Hypermobile Flatfoot And Pediatric Obesity: What You Should Know

Ron Raducanu, DPM, FACFAS

Given the increasing prevalence of childhood obesity, this author examines the emerging connection with pediatric flatfoot via a thorough review of the current research and discusses the need for further research to support treatment of flatfoot in this population.

Almost daily, you can turn on your TV or open your favorite newspaper and learn about the “national health crisis” that is obesity. There is also a tremendous amount of literature concerning the long-term health pitfalls of morbid obesity and how it can affect the heart, liver, kidney and lymphatic system. Obviously, obesity can also lead to diabetes and a whole host of other health-related issues.

   We are also starting to realize that these poor habits begin in our youth and translate to our overall health as adults. This is very apparent if you’ve ever watched The Jamie Oliver Experiment. In this show, the titular young chef travels the United States and tries to revamp cafeterias in public schools to have a menu that is generally healthier, and convince our nation’s youth to modify their lifestyles and help them attain health into adulthood.

   As a parent, I am very concerned about my children’s health but does their health translate to their feet as well? Are obese children more prone to a certain foot type? If that is the case, how does that relate to their general health?

A Closer Look At How Researchers Are Identifying Flatfoot In Study Populations

Before starting the discussion of flatfoot studies and their outcomes, I would like to discuss the methodologies of many of these authors with respect to how they determined a flatfoot condition. Many of the studies that I will discuss employed modern methods of determining foot type. We use many of these methods (such as weightbearing radiographic measurements and evaluation of patients in stance and ambulation) in the day-to-day practice of podiatry.

   Study authors used these and other more sophisticated methods of determining flatfoot. The other methods included: electronic footprint capture during gait; ultrasonography to measure fat pad thickness; dynamic plantar pressure analysis; and three dimensional laser surface measures. It is important to point out the use of these additional measurement techniques as they lend credence to the outcomes and conclusions of the studies. Without these modalities, one might be tempted to pass off many of the conclusions derived from these studies as “user bias.” However, most of these studies also combined sophisticated measurement techniques with hard data and statistical analysis. This was one the reasons I selected these studies for this review.

   Other studies throughout the world’s medical communities have found similar results when studying the relationship with childhood obesity and flatfoot. In doing the research for this article, it became evident that every corner of the world is struggling with this problem of obesity and flatfoot, given the type of research that is occurring with the pediatric population.

What The Research Says About The Effect Of Weight On Pediatric Feet

As we know, infants do not have much of an arch. Even new walkers do not display much of an arch height. Up until approximately the age of 2, when the arch becomes recognizable, it is virtually impossible to assess foot type unless significant pathology is present.

   One study attempted to correlate obesity and low arch height in adults.1 The authors found, using footprint-based estimates, that study patients who were obese displayed lower arch heights than their non-obese adult counterparts. Although this study did not focus on the pediatric population, it served as a springboard for others to investigate this topic in obese children as well.

   Another study in Australia measured the same basic premise of arch height in obese children.2 The authors found that “obese children had fatter and flatter feet compared to normal weight children.” They did caution, however, that more studies needed to be completed to assess “… the functional and clinical relevance of the increase [sic] … .”2

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