Today's Podiatrist Can Help Lead the Way in Decreasing Childhood Obesity

Just as our feet can reflect the onset of diabetes, so too obesity in the young can point to foot problems. Podiatric doctors are an important step in keeping children moving and pain-free, and therefore decreasing childhood obesity. We've polled some of our PPMA podiatrists to get their take on the connection between healthy feet and combating obesity in children.

"Obesity can affect a child's foot in several ways—increased strain on the arch due to escalating weight can produce plantar fasciitis and can also lead to a flatfoot deformity.": The most common pediatric foot problems that podiatrists see are plantar warts and ingrown toenails. Plantar warts are caused by a virus that transforms normal skin tissue into wart tissue, and essentially are the same as regular warts but are found on the "plantar" surface or sole of the foot. Since we walk on that surface, this causes warts to grow inward and become more painful.

Ingrown nails occur when the side of the nail penetrates into the nail-fold causing an infection. The ingrown nail can be caused by improper nail-cutting, very tight shoes, an inherited curvature of the nail, or a combination of all three.

Childhood obesity is a growing problem in the United States. As kids become more addicted to video games and fast foods their resulting lack of exercise produces obesity. Obesity can affect a child's foot in several ways—increased strain on the arch due to escalating weight can produce plantar fasciitis and can also lead to a flatfoot deformity. –William Schlorff, DPM, Jersey Shore, PA, Past PPMA President

"It is very important to try to control a child's weight earlier than later.": Children are prone to all sorts of problems as their feet grow. Primarily seen are ingrown toenails caused by their shoes being too tight. I see so many kids coming in with terrible ingrown toenails that they have had for months and didn't tell mom or dad they were having a problem. In many cases, the kids were wearing the same sneakers/shoes that they wore at the beginning of the school year. Being the parent of four, I know this is true. It's also true that kids grow like weeds and should have their sneakers checked to make sure they are not too tight. Do this at Christmas (a new pair of sneakers for the holidays), spring break, and at the beginning of summer break. This will ensure good fitting shoes and no ingrown toenails!

Childhood obesity can have a significant impact on the feet, and the lower extremities as a whole. It is very important to try to control a child's weight earlier than later. Each step a person takes places two to three times the body-weight force across the foot. The heavier a child is, the more force across such young joints, causing the joints to deform over time. Quite often this will lead to flatfoot and knock-knees, two permanent conditions! Later in life, flatfoot can lead to all types of other deformities like bunions, hammertoes, and heel spurs. So—lose the weight and check the feet!! –Pete Smith, DPM, Lancaster, PA, PPMA Board Member

"I recommend taking regular walks with one or both parents in order to reinforce some type of behavior modification." My advice to parents to help their children become more active is for them to encourage any type of sports. If the child is still resistant to sports, I recommend taking regular walks with one or both parents in order to reinforce some type of behavior modification. Also walking events for schools or charities are usually readily available. A shoe brand that I feel gives the best support in regards to width size is New Balance, which is also reasonably priced. –Marc Karpo, DPM, PPMA President-Elect

"Many have never been taught proper foot hygiene.": Whenever I see a new pediatric patient, I like to do a complete lower extremity exam, regardless of the chief complaint. Many times as children get older, they fail to show parents their feet, therefore numerous underlying problems go undiagnosed. For example, when a parent brings in their child with warts, I may find structural issues with the feet and lower extremities that could have been treated at a younger age. Parents may not even be aware of these issues. Sometimes I am able to initiate treatment to pediatric patients in order to prevent problems in the future. It is also at that time that I educate parents to check their other children's feet. I find that many times parents are told that their child will "outgrow" their deformity when this is not the case.

Also, when I see children as new patients, I like to personally educate them. Many have never been taught proper foot hygiene. Proper nail-care is imperative as children age and care for their feet themselves. I find that some children trim their own nails only to perform it improperly and risk the onset of infected ingrown toenails. Also, thoroughly washing and drying the feet is reinforced to prevent athlete's foot infections. I do find that obesity is starting to become a problem with children who are predisposed to having certain foot problems: Bunions, Flatfoot, Growth Plate Injuries. Extra weight on growing bones can only exacerbate these problems. When a child presents with heel pain, for example, that may be caused by flatfoot and inflammation of the heel's growth plate (apophysitis), not only do I address any structural issues, but I also access the patient's weight.

I have no qualms addressing this issue with parents. It may not be the primary cause of the child's complaint, but it does contribute. I do make recommendations to the child's parent and also the pediatrician on initiating a weight-loss program if it is indicated. Not only can it help the current condition, but it also will help the child through adulthood. –Joe Gershey, DPM, PPMA Board Member "Plantar fasciitis is normally seen in adults but obese children are getting this with increased frequency.": I find that overweight kids tend to be more subject to foot issues such as plantar fasciitis (where feet are overstrained) and calcaneal apophysitis. Plantar fasciitis is normally seen in adults but obese children are getting this with increased frequency. Those are the two biggest. –Gerald Gronborg, DPM, PPMA Board Member

"As they become more sedentary this leads to further obesity and less activity.": Children that have foot deformities, not easily recognizable by family members or family physicians, may cause them to become sedentary due to foot, ankle, knee, leg, hip, or back pain. As they become more sedentary this leads to further obesity and less activity. Those children who tend to lag behind the group during ambulatory activities and frequently look for places to sit down may have underlying foot conditions, which make it difficult for them to comfortably participate in activities. This then becomes a vicious cycle with a more sedentary lifestyle leading to increased weight gain and further stress and strain on the feet and lower extremities. If your children exhibit any of these signs an examination by a podiatric physician is recommended. –Mark Pinker, DPM, PPMA Past President & Treasurer