May 2016

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Editor Message

emily-delzell-196x198The weight problem

Many, many stories in both LER: Pediatrics and its parent publication, Lower Extremity Review, highlight the biomechanical and physiological effects of being over­weight or obese.

It’s cliché, but the problem is truly a vicious cycle. Physical inactivity, often a byproduct of an existing lower extremity condition, adds to the problem of excess weight, and excess weight promotes increasingly seden­­tary behavior. Patients gain more weight, lose mobility and function, and their risk for myriad comorbidities grows.

Research continues to show these effects can begin at very young ages.

A recent study on foot function in more than 7000 children found obesity starts increasing foot loading in children as young as 2 years (see “Excess weight affects foot loading, peak pressure even in young kids,” page 6).

Previous research reported in LER: Pediatrics has also found evidence suggestive of conditions once considered purely adult diseases in kids who carry excess weight. Viennese researchers, for example, reported magnetic resonance imaging showed knee cartilage lesions in morbidly obese children as young as 9 years (see “Childhood obesity and OA: Can early care reduce risk?” August 2015, page 15).

Lower extremity practitioners are in a unique position to help these children and their parents by reducing pain and improving function and mobility. In-shoe orthoses, braces, physical therapy, conditioning programs, and other care all can help children lead more active lives.

Physical activity, however, can also lead to injury (see “Look out below: Injury risk on the trampoline,” page 15). But, as sources for that article note, all activity that goes beyond sitting on the couch can potentially cause injury, and, sometimes, even exercise deemed “risky” may be preferable to the dangers of inactivity.

Here again, lower extremity practitioners can help by educating parents about injury prevention—and by talking early about the immediate and long-term effects of obesity on children’s development and health.

By Emily Delzell, Senior Editor


  • Lower body conditioning may cut upper body injury risk in softball

    Safety of underhand pitch is over-rated – Better pre- and off-season lower-body conditioning may help prevent some serious overuse injuries to the upper extremities of young female fast-pitch softball players, according to the lead author of a recent prospective study of player-reported injuries.

    By Hank Black

  • Excess weight affects foot loading, peak pressure even in young kids    

    Weight loss may improve function – Overweight and obese children present with higher overall foot loading and a disproportional impact on the midfoot and longitudinal arch, with those as young as 1 or 2 years of age affected, according to research from Germany that may have implications for abnormal foot loading prevention in children.

    By Katie Bell

  • Walking study in CP highlights need for tailored orthotic prescription

    Effects of AFOs on distance, speed vary – A recent study demonstrates the importance of personalizing prescriptions for ankle foot orthoses (AFOs) in children with cerebral palsy, rather than applying group data to individuals.

    By Larry Hand


  • When the shoe doesn’t fit: footwear in Down syndrome

    These children often have wider, more flexible, and more pronated feet than typically developing kids that don’t fit well into conven­tionally sized and shaped footwear. Ill-fitting shoes are linked to foot-specific disability and many other issues. Here, clinicians share strategies for finding the right fit.

    By Lori Roniger

  • Look out below: injury risk on the trampoline

    Trampoline use, both in backyards and in large recreational parks, is up. So are injuries incurred on the equipment, including fractures with potentially serious long-term sequelae. Some groups advise  a ban on home use, but other experts disagree, citing the equipment’s benefits for motor learning and active play.

    By P.K. Daniel