Biomedical Engineering Reference
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higher peak pressures, force-time integrals and pressure-time integrals in the
midfoot region of the foot, compared to the non-overweight children [
53
]. These
results imply that the additional contact area displayed by the overweight/obese
children in the midfoot area of the foot was not able to compensate for the high
forces generated in that area of the foot during walking, resulting in higher pressures
under the midfoot. Force-time and pressure-time integrals provide an indication of
the load on particular bony and soft tissue structures in the foot. Therefore, these
results suggest that the midfoot area of the overweight/obese young children may be
exposed to increased stress and may be vulnerable to bony fatigue and soft tissue
damage. Emerging research has also revealed that these higher plantar pressures
generated by preschool-aged children are significantly associated with reduced
physical activity and more time spent in sedentary behaviour, possibly due to foot
pain and discomfort during weight bearing activities [
54
]. How these changes in
foot structure and function due to bearing excess body mass progress as children
enter the school-aged years are described below.
4.2 School-Aged Children (6-18 years)
Once children reach school age (between 5 and 6 years old) their foot structure
resembles that of adult feet. Children's feet, however, continue to develop,
reaching skeletal maturity by the age of approximately 18 years. It is during this
period, often termed childhood and adolescence, where any effects on normal foot
growth and development usually remain into adulthood. Unfortunately, paediatric
obesity often leads to adolescent and adult obesity with the probability that
complications evident during childhood will be exacerbated in later life. There-
fore, as the feet are the base of support for the body and the mechanism for
propulsion during physical activity, and physical activity is crucial to a healthy
lifestyle, complications as a result of excess adiposity on the developing feet of
children need to be understood.
4.2.1 Effects of Obesity in Children on Foot Structure
One of the first research papers to speculate on the detrimental effects of obesity on
foot structure in children was our study of 426 pre-pubertal children [
55
]. Prior to
this investigation, studies had examined medial longitudinal arch type, foot shape,
footprints and foot growth in infants through to older children and adolescents, but
without reference to how these structures were affected by the need to bear excess
body mass, particularly during the early developmental period. We therefore
derived and examined footprint indices for 62 obese children (age = 8.5 ± 0.5 -
years; BMI = 23.3 ± 2.4 kg/m
2
) and 62 age- and sex-matched non-obese chil-
dren (BMI = 16.1 ± 0.9 kg/m
2
), concluding that excess body mass had a
significant impact on the footprints of obese children. That is, the obese children
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