# Effect of Abdominal Adiposity on the Impact of Plantar Force in the Foot Support of Obese and Overweight Schoolchildren

## TL;DR

Excess belly fat in overweight and obese children is strongly linked to foot posture changes, which could lead to pain and orthopedic issues.

## Contribution

This study is the first to directly examine the relationship between ultrasound-measured abdominal adiposity and pronated foot posture in children.

## Key findings

- Abdominal adiposity was a strong predictor of increased foot pronation in both feet of overweight and obese children.
- A high-to-moderate association was found between abdominal fat thickness and pronated foot support.
- Obese and overweight children showed more pronated foot posture compared to normal-weight children.

## Abstract

What are the main findings?
•Abdominal adiposity, measured via ultrasound, was a strong predictor of increased foot pronation (on both right and left sides);•A high-to-moderate association was observed between abdominal fat thickness and pronated foot support.

Abdominal adiposity, measured via ultrasound, was a strong predictor of increased foot pronation (on both right and left sides);

A high-to-moderate association was observed between abdominal fat thickness and pronated foot support.

What are the implications of the main findings?
•Abdominal adiposity contributes directly to postural and orthopedic changes in children, specifically pronated foot support.•Changes in foot posture observed in overweight and obese children may predispose them to pain and orthopedic complications during growth, highlighting the critical need for early assessment and intervention.

Abdominal adiposity contributes directly to postural and orthopedic changes in children, specifically pronated foot support.

Changes in foot posture observed in overweight and obese children may predispose them to pain and orthopedic complications during growth, highlighting the critical need for early assessment and intervention.

Background: Childhood obesity is a growing global concern associated with early-onset orthopedic complications that may persist into adulthood. Among the anthropometric indicators, abdominal adiposity plays a key role in assessing health risks during pediatric evaluations. However, the relationship between abdominal fat distribution and biomechanical alterations, such as changes in posture and foot support, remains poorly understood. Ultrasonography (US) is a validated, noninvasive imaging method capable of distinguishing preperitoneal and intraperitoneal fat in children. Despite its diagnostic advantages, no study to date has directly examined ultrasound-measured abdominal adiposity-predicted pronated foot posture in children. Objective: We aimed to verify the impact of abdominal adiposity on foot support and its association with obese, overweight, and eutrophic schoolchildren. Methods: This is a cross-sectional study. Sixty-five pupils (aged 6–9 years) from a public school in São Paulo, Brazil, were divided into three groups according to nutritional status: obese (n = 25), overweight (n = 20), and eutrophic (n = 20). Anthropometric measurements and foot posture, assessed using the Foot Posture Index (FPI), were collected during the initial evaluation. Abdominal adiposity was determined by ultrasonography, measuring subcutaneous, preperitoneal, and intraperitoneal fat thickness. Statistical Analysis: Analyses compared group differences and relations between abdominal fat and foot posture, with significance set at p < 0.05. Results: Obese and overweight schoolchildren showed pronated foot posture when compared to eutrophic children, on both sides of the feet. Abdominal adiposity was a good predictor of a more pronated footrest for the right and left feet, showing a high-to-moderate association. Conclusions: Ultrasound-measured abdominal adiposity was identified as a significant predictor of pronated foot posture in schoolchildren. These findings highlight the importance of monitoring abdominal fat accumulation during pediatric evaluations, as excessive adiposity may increase the risk of musculoskeletal dysfunctions and pain in the lower limbs. Early detection of these alterations may help prevent postural and musculoskeletal disorders in overweight and obese children.