Doctors with the American College of Foot and Ankle Surgeons (ACFAS) recently reported treating more overweight and obese children with foot and ankle pain, mirroring a national epidemic of childhood obesity.
According to the Centers for Disease Control and Prevention, an estimated 16% of U.S. children ages 6 to 19 are overweight. Poor diet, lack of exercise and genetics can play a role.
These factors lead to a “vicious cycle,” whereby children cannot lose the weight until they become more active, but are unable to exercise because of foot pain.
Thanh Dinh, DPM, FACFAS, a foot and ankle surgeon at Children’s Hospital and Beth Israel Deaconness Center in Boston and spokesperson for ACFAS, noted that there have been a number of different studies throughout the years that have looked at changes in foot structure in the pediatric population. Many of these studies have found significant changes, including decreases in the arch and an altered angle at which the foot rests when the patient is standing or walking.
Similarly, in November 2006 the Society of Chiropodists and Podiatrists in Britain reported “alarming new evidence that childhood obesity changes foot structure and results in instability when walking.” Children who are overweight suffer from flattened feet, which strains the plantar fascia — a band of tissue that runs from the heel to the base of the toes — and causes heel pain.
In addition, because the heel bone is not fully developed until age 14 or older, overweight children are more prone to calcaneal apophysitis, the most common cause of heel pain in children. Also known as Sever’s disease, it is an inflammation of the heel’s growth plate due to muscle strain and repetitive stress. This condition causes pain and tenderness, both exacerbated by activities such as walking.
Being overweight may also cause stress fractures, or hairline fractures in a child’s heel bone.
Dinh said that, while data in this area is limited, many podiatrists recount similar patient stories.
“Something like plantar fascitiis, for example, rarely happens in children, but we are seeing it more,” Dinh told O&P Business News.
She added that more podiatrists also report seeing obese children with generalized foot pain.
“My personal opinion is that, overall in the United States, we are more sedentary than we used to be, everybody’s weight is increasing and we are starting to have all these complications,” said Samuel Nava, DPM, FACFAS, Dallas-based foot and ankle surgeon and spokesperson for ACFAS.
“The purpose of [bringing this to light] is to let everybody know that this is something we have noticed and things can be done to help.”
In order to determine the best treatment options for any type of foot pain, a doctor first must identify the source of the pain. Each of these conditions brings its own set of symptoms. Then the patient can be treated with a combination of methods to eliminate the condition, and therefore the symptoms.
Physical therapy is one of the first steps in decreasing foot pain. A physical therapist will begin a stretching program to lessen any swelling and help children gain strength in their legs and feet. Nava and Dinh recommend shoe modifications, such as orthotics, to alleviate heel pain. In addition, medications such as anti-inflammatories can be useful to reduce swelling.
Once the foot pain is reduced, a pediatrician might suggest implementing a more active lifestyle, including an exercise routine, in conjunction with modifying the child’s diet and eating habits.
“What I have found, anecdotally, is that once children, as well as the parents, start to understand the problem, they can take a more proactive role,” Dinh said. “Some of my patients have lost weight, [taken] active measures to decrease the pain in their feet and increased their activity. Once you start them back on that path, they seem to do well.”
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Stephanie Z. Pavlou is a staff writer for O&P Business News