Excessive Weight Bearing Compromises Foot Structure and Function Across the Lifespan - The Mechanobiology of Obesity and Related Diseases - page 167

5 Summary and Conclusions

Based on the cross-sectional studies reviewed in this chapter it is evident that foot
structure and function is compromised in overweight and obese individuals, irre-
spective of age, and changes occur as early as the preschool years. This is reflected
in the development of larger, broader and flatter feet in obese individuals com-
pared to their leaner counterparts, with the flatter foot structure likely to be caused
by a combination of a decreased height of the medial longitudinal arch and a
thicker midfoot plantar fat pad. These changes in foot structure are accompanied
by a higher prevalence of foot pain and increased dynamic plantar peak pressures
in overweight and obese children, which appear to progress from the midfoot area
in preschool children, to include the midfoot and forefoot in primary school
children, and then the midfoot, forefoot and heel regions of the foot in obese
adults, although these plantar pressures are dependent upon the degree of obesity.
However, these changes in foot structure, function and pain, their mechanisms, and
the long-term effects of these changes on the ability of obese individuals to par-
ticipate in activities of daily living, work and recreation, require confirmation by
further investigation, particularly by longitudinal studies.
With the prevalence of obesity rising rapidly in today's society and with the
trend for overweight and obese children to become obese adults, it is critical to
identify musculoskeletal problems, particularly those of the foot, in early child-
hood. If these foot problems are left untreated they may prevent children from
being physically active, increasing the likelihood that their obesity, together with
the associated negative health consequences, will continue as they age.
More importantly, changes to foot pain, structure, and function impair the
ability of older obese adults to perform even the simplest activities of daily living,
and may therefore jeopardise their ability to live independently. As such, we need
to develop intervention strategies that can prevent excessive body mass impacting
on the developing feet of children or on the aging feet of adults. It is recommended
that evidence-based interventions be designed to reduce excess fat mass in over-
weight and obese individuals, focussing on non-weight bearing activities, to
relieve loading of their foot structures and, in turn, improve the quality of life of
these individual across the lifespan.

Acknowledgments The authors wish to thank Sheridan Gho for the artwork in Figs. 2 and 3 .

References

1. Norkin, C.C., Levangie, P.K.: Joint Structure and Function: A Comprehensive Analysis, 2nd
edn. FA Davis Company, Philadelphia (1992)
2. Bertsch, C., et al.: Evaluation of early walking patterns from plantar pressure distribution
measurements. First year results of 42 children. Gait Posture 19(3), 235-242 (2004)