Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Are the feet of obese children fat or flat? Revisiting the debate

International Journal of Obesity volume 35, pages 115–120 (2011)Cite this article

Subjects

Abstract

Objective:

There is debate as to the effects of obesity on the developing feet of children. We aimed to determine whether the flatter foot structure characteristic of obese primary school-aged children was due to increased medial midfoot plantar fat pad thickness (fat feet) or due to structural lowering of the longitudinal arch (flat feet).

Methods and procedures:

Participants were 75 obese children (8.3±1.1 years, 26 boys, BMI 25.2±3.6 kg m−2) and 75 age- and sex-matched non-obese children (8.3±0.9 years, BMI 15.9±1.4 kg m−2). Height, weight and foot dimensions were measured with standard instrumentation. Medial midfoot plantar fat pad thickness and internal arch height were quantified using ultrasonography.

Results:

Obese children had significantly greater medial midfoot fat pad thickness relative to the leaner children during both non-weight bearing (5.4 and 4.6 mm, respectively; P<0.001) and weight bearing (4.7 and 4.3 mm, respectively; P<0.001). The obese children also displayed a lowered medial longitudinal arch height when compared to their leaner counterparts (23.5 and 24.5 mm, respectively; P=0.006).

Conclusion:

Obese children had significantly fatter and flatter feet compared to normal weight children. The functional and clinical relevance of the increased fatness and flatness values for the obese children remains unknown.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Bordin D, De Giorgi G, Mazzocco G, Rigon F . Flat and cavus foot, indexes of obesity and overweight in apopulation of primary-school children. Minerva Pediatr 2001; 53: 7–13.

    CAS  Google Scholar 

  2. Dowling AM, Steele JR, Baur LA . Does obesity influence foot structure and plantar pressure patterns in prepubescent children? Int J Obes Relat Metab Disord 2001; 25: 845–852.

    Article  CAS  Google Scholar 

  3. Mickle KJ, Steele JR, Munro BJ . The feet of overweight and obese young children: are they flat or fat? Obes Res 2006; 14: 1949–1953.

    Article  Google Scholar 

  4. Riddiford-Harland DL, Steele JR, Storlien LH . Does obesity influence foot structure in prepubescent children? Int J Obes Relat Metab Disord 2000; 24: 541–544.

    Article  CAS  Google Scholar 

  5. Welton EA . The Harris and Beath footprint: interpretations and clinical value. Foot Ankle 1992; 13: 462–468.

    Article  CAS  Google Scholar 

  6. Mauch M, Grau S, Krauss I, Maiwald C, Horstmann T . Foot morphology of normal, underweight and overweight children. Int J Obes 2008; 32: 1068–1075.

    Article  CAS  Google Scholar 

  7. Villarroya MA, Esquivel JM, Tomas C, Moreno LA, Buenafe A, Bueno G . Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study. Eur J Pediatr 2009; 168: 559–567.

    Article  Google Scholar 

  8. Tax HR . Podopediatrics, 4th ed. Williams & Wilkins: Baltimore, MD, 1985.

    Google Scholar 

  9. Volpon JB . Footprint analysis during the growth period. J Pediatr Orthop 1994; 14: 83–85.

    Article  CAS  Google Scholar 

  10. Riddiford-Harland DL, Steele JR, Baur LA . Are the feet of obese children fat or flat? 14th Annual Scientific Meeting of the Australasian Society for the Study of Obesity; 28–30 October 2005; Glenelg, South Australia.

  11. Jones RA, Okely AD, Collins CE, Morgan PJ, Steele JR, Warren JM et al. The HIKCUPS trial: a multi-site randomized controlled trial of a combined physical activity skill-development and dietary modification program in overweight and obese children. BMC Public Health 2007; 7: 15.

    Article  Google Scholar 

  12. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH . Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 2000; 320: 1240–1243.

    Article  CAS  Google Scholar 

  13. Parham K, Gordon C, Bensel C . Anthropometry of the Foot and Lower Leg of U.S. Army Soldiers: Fort Jackson, S.C. Army Natick Research, Development and Engineering Center: Natick, MA, 1992.

    Google Scholar 

  14. Riddiford-Harland DL, Steele JR, Baur LA . The use of ultrasound imaging to measure midfoot plantar fat pad thickness in children. J Orthop Sports Phys Ther 2007; 37: 644–647.

    Article  Google Scholar 

  15. Hashimoto BE, Kramer DJ, Wiitala L . Applications of musculoskeletal sonography. J Clin Ultrasound 1999; 27: 293–318.

    Article  CAS  Google Scholar 

  16. Vincent WJ . Statistics in Kinesiology. Human Kinetics: Champaign, IL, 1995.

    Google Scholar 

  17. Timpson NJ, Sayers A, Davey-Smith G, Tobias JH . How does body fat influence bone mass in childhood? A Mendelian randomization approach. J Bone Min Res 2009; 24: 522–533.

    Article  Google Scholar 

  18. Williams DS, McClay IS . Measurements used to characterize the foot and the medial longitudinal arch: Reliability and validity. Phys Ther 2000; 80: 864–871.

    CAS  PubMed  Google Scholar 

  19. Queen RM, Mall NA, Hardaker WM, Nunley JA . Describing the medial longitudinal arch using footprint indices and a clinical grading system. Foot Ankle Int 2007; 28: 456–462.

    Article  Google Scholar 

  20. Ozdemir H, Yilmaz E, Murat A, Karakurt L, Poyraz AK, Ogur E . Sonographic evaluation of plantar fasciitis and relation to body mass. Eur J Radiol 2005; 54: 443–447.

    Article  Google Scholar 

  21. Saltzman CL, Nawoczenski DA, Talbot KD . Measurement of the medial longitudinal arch. Arch Phys Med Rehabil 1995; 76: 45–49.

    Article  CAS  Google Scholar 

  22. Ferri M, Scharfenberger AV, Goplen G, Daniels TR, Pearce D . Weightbearing CT scan of severe flexible pes planus deformities. Foot Ankle Int 2008; 29: 199–204.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the research teams from the Hunter Illawarra Kids Challenge Using Parent Support (HIKCUPS) project, an Australian National Health & Medical Research Council funded project (354101), for their support during participant recruitment.

Author information

Authors and Affiliations

  1. Biomechanics Research Laboratory, School of Health Sciences, University of Wollongong, Wollongong, NSW, Australia

    D L Riddiford-Harland & J R Steele

  2. The Children's Hospital at Westmead, University of Sydney Discipline of Paediatrics and Child Health, Sydney, NSW, Australia

    L A Baur

Authors
  1. D L Riddiford-Harland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J R Steele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L A Baur
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to D L Riddiford-Harland.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Riddiford-Harland, D., Steele, J. & Baur, L. Are the feet of obese children fat or flat? Revisiting the debate. Int J Obes 35, 115–120 (2011). https://doi.org/10.1038/ijo.2010.119

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2010.119

Keywords

This article is cited by

Search

Advanced search

Quick links