Biomedical Engineering Reference
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display lower cadence, lower velocity, a longer stance period and a longer duration of
the gait cycle compared to non-obese children (n = 10, BMI = 16.0 ± 0.8 kg/m 2 )
[ 72 ]. Young obese children (aged 8-10 years, BMI C 95 percentile [ 73 ]; and
6-11 years, BMI = 20.4 ± 1.8-22.8 ± 2.0 kg/m 2 [ 74 ] ), were also found to spend
more time in dual stance and have increased levels of postural sway during the gait
cycle when compared to their leaner counterparts [ 73 ]. In another study of prepu-
bertal children, spatiotemporal differences were evident between obese
(age = 9.7 ± 2.0 years; BMI = 26.7 ± 7.1 kg/m 2 ) and non-obese (age = 9.4 ±
1.4 years; BMI = 18.1 ± 2.8 kg/m 2 ) participants, during the single support phase
of walking but not during double support [ 75 ]. The authors suggested that flatter foot
parameters recorded in the previous study by Hills and Parker [ 72 ] may have
accounted for the contrast between studies or that their participants were more
physically active than those in the previous study. Similar to the findings by Hills and
Parker, Dufek et al. [ 76 ] found differences in the walking patterns displayed by
overweight and obese teenagers (age = 14.2 ± 1.4 years; BMI C 95 percentile).
Walking velocity, time spent in both double support and swing phases and the width
of the stance phase all differed between the overweight/obese group and the normal
weight group (BMI B 85 percentile). Differences between studies suggest that the
effects of obesity on gait require further investigation with larger participant numbers
to determine how bearing excess body mass affects the temporal parameters of
walking during both childhood and adolescence.
Functional foot assessment of overweight and obese children during walking
has identified that these children display higher pressure distributions beneath their
feet compared to their leaner counterparts [ 77 ]. Hennig et al. [ 42 ] identified body
mass as a major influence on the magnitude of the pressures under the feet of 125
children aged 6-10 years. Significantly higher peak plantar pressures were also
reported by David et al. [ 78 ] in an obese group of children aged 5-11 years when
compared to normal-weight children. Obese children also generated significantly
greater peak dynamic forefoot pressures when the results of 13 obese and 13 non-
obese prepubertal children (8 years of age) were compared [ 62 ]. Further studies
have also consistently shown higher pressure distribution beneath the midfoot and
forefoot regions in obese children compared to non-obese children [ 79 , 80 ]
(Table 1 ). Combined, these studies confirm the notion that the increase in plantar
contact area displayed by obese school-aged children (see Sect. 4.2.1 ) is not
sufficient to compensate for the higher forces in the forefoot and midfoot regions
(Fig. 5 ). Furthermore, the additional medial midfoot fat padding observed in obese
school-aged children appeared to reflect their excess adiposity rather than any
adaptation to cushion pressures associated with increased body mass [ 68 ].
4.2.3 Effects of Obesity in Children on Foot Pain and Plantar
Pressures
The need for overweight and obese individuals to bear excess body mass can cause
musculoskeletal pain and discomfort, perpetuating the cycle of obesity due to
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