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Consequences of Pediatric Obesity on the Foot and Ankle Complex

Sarah P. Shultz Biokinetics Research Laboratory, Athletic Training Division, Department of Kinesiology, Temple University, Philadelphia, PA.
School of Sport and Exercise, Massey University, Wellington, New Zealand.

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 PhD, ATC
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Michael R. Sitler Biokinetics Research Laboratory, Athletic Training Division, Department of Kinesiology, Temple University, Philadelphia, PA.

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Ryan T. Tierney Biokinetics Research Laboratory, Athletic Training Division, Department of Kinesiology, Temple University, Philadelphia, PA.

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Howard J. Hillstrom Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York, NY.

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Jinsup Song Gait Study Center, Temple University School of Podiatric Medicine, Philadelphia, PA.

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Background:

Anthropometric status can influence gait biomechanics, but there is relatively little published research regarding foot and ankle characteristics in the obese pediatric population. We sought to compare the structural and functional characteristics of the foot and ankle complex in obese and non-obese children.

Methods:

Twenty healthy children (ten obese and ten normal weight) were recruited for a cross-sectional research study. Anthropometric parameters were measured to evaluate active ankle dorsiflexion, arch height (arch height index, arch rigidity index ratio, and arch drop), foot alignment (resting calcaneal stance position and forefoot-rearfoot alignment in unloaded and loaded positions), and foot type (malleolar valgus index). Independent t tests determined significant differences between groups for all assessed parameters. Statistical significance was set at P < .0125.

Results:

Compared with non-obese participants, obese participants had significantly greater arch drop (mean ± SD: 5.10 ± 2.13 mm versus 2.90 ± 1.20 mm; P =.011) and a trend toward lower arch rigidity index ratios (mean ± SD: 0.92 ± 0.03 versus 0.95 ± 0.02; P = .013). In addition, obese participants had significantly less active ankle dorsiflexion at 90° of knee flexion versus non-obese participants (mean ± SD: 19.57 ± 5.17 versus 29.07 ± 3.06; P < .001). No significant differences existed between groups for any other anthropometric measurements.

Conclusions:

The decreased active ankle dorsiflexion in the obese group can increase foot contact for a longer period of the stance phase of gait. Obese participants also presented with a more flexible foot when bearing weight. (J Am Podiatr Med Assoc 102(1): 5–12, 2012)

Corresponding author: Sarah P. Shultz, PhD, ATC, School of Sport and Exercise, Massey University, 63 Wallace Street, Wellington, New Zealand 6140. (E-mail: S.P.Shultz@massey.ac.nz)