Full length articleBiomechanical characteristics of lower limb gait waveforms: Associations with body fat in children
Introduction
Childhood obesity is associated with a greater incidence of musculoskeletal pain and dysfunction. Studies have reported links between orthopaedic conditions (e.g. Slipped Capital Femoral Epiphysis), increased musculoskeletal pain, foot problems, lower limb joint osteoarthritis and aberrant lower limb biomechanics and obesity [[1], [2], [3]]. Excessive and misplaced forces across lower limb joints may predispose to joint dysfunction resulting in increased stress, joint pathology and pain [[4], [5]]. Greater understanding of the biomechanical impact on childhood obesity is important to fully understand the impact of musculoskeletal structure and function, to inform rehabilitation strategies for obesity related joint and soft-tissue dysfunction, and prevent musculoskeletal co-morbidities.
The impact of childhood obesity on clinical gait characteristics has been documented; obese children are reported to walk slower, with a greater base of support and longer stance phase duration [[6], [7]]. To date, five studies have described associations between childhood obesity and three-dimensional (3D) kinematic/kinetic changes in the lower limb [[8], [9], [10], [11], [12]] with conflicting findings. Both significantly greater [9] and lower [11] hip abduction moments have been reported when comparing obese/overweight (OW/OB) children with healthy-weight controls. McMillan et al. [10] reported less hip flexion at initial contact, whereas Cimolin et al. [12] reported greater hip flexion at the same gait event. Three studies have reported reduced knee flexion angle in OW/OB participants [[8], [11], [12]] yet all reported conflicting findings for frontal plane knee moments; Gushue et al. [8] reported greater knee abduction moments, McMillan et al. [11] reported reduced knee abduction moment and Cimolin et al. [12] reported no significant difference. Three studies report reduced ankle plantarflexion moments in OW/OB children [[8], [10], [11]] and one study reported no significant differences [12].
Conflicting findings in previous studies may result from two methodological factors; (1) The definition of obesity used to define groups and, (2) the method of analysing gait data. Earlier studies have used BMI Z-Scores to define OW/OB groups which are based on arbitrary cut-offs (e.g >99%, >97%, >95%) rather than fat measurements as a continuous variable. Furthermore, defining OW/OB by BMI Z-Scores has low sensitivity meaning some OW/OB children are grouped as healthy-weight whereas measures of body fat provide greater confidence in the degree of obesity in children [13]. Previous work by the authors has utilised waveform analysis to determine relationships between foot motion and body fat in the same cohort as that reported in the current article [14]. Analysis of complete waveforms does not rely on the selection of peak or event data to describe gait (commonly reported in previous studies), but instead enables examination over the entirety of the gait cycle.
Looking at the evidence to date, the overall impact of obesity on paediatric gait biomechanics is not understood. However, to the authors’ knowledge, no study has used complete waveform analysis to provide a detailed lower limb kinematic and kinetic analysis in children. The aim of this study was to identify relationships between percentage body fat and lower limb gait waveforms in young boys.
Section snippets
Selection and description of participants
Fifty-five boys, aged 7 to 11 years, participated in the study (Table 1). Ethical approval was obtained (Ref No. ETH/13/11). Participants were recruited from a convenience sample of local schools and clubs. Parental consent and child assent was obtained prior to testing. Participants were excluded from participating if any medical conditions affecting neuromuscular and orthopaedic integrity or any complications contributing to altered foot posture and/or gait disturbance were identified from a
Demographic, anthropometric and spatiotemporal characteristics of the participants
Participant’s demographic, anthropometric and spatiotemporal characteristics are presented (Table 1). Eight participants were classified as obese, 12 participants were classified overweight, 29 as ideal weight and 6 were underweight [16].
Principal component analysis
Mean and standard deviation of joint angular waveforms are presented (Fig. 1). Table 2 presents the results of PCA for the three lower limb joint angles, each joint in three planes of motion. From the hip angular waveform two sagittal, five frontal and three
Discussion
The aim of this study was to analyse complete 3D waveforms of lower limb joint angular motion and joint moments to examine the impact of body fat on gait in young boys. The findings offer novel information about the relationships between angular motion of the lower limb joints and body fat and demonstrates that body fat was associated with altered joint angle and moments of the lower limb during gait.
Our data demonstrated reduced hip extension during the second half of the stance phase with
Summary
The current study presents novel information on the associations between hip, knee and ankle kinematic and kinetic gait waveforms with body fat in 7–11 year-old boys. Utilising the entire kinematics and kinetics waveforms pattern may provide insight into the effects of obesity on gait biomechanics and help to inform further research into preventing musculoskeletal co-morbidities and promoting weight management. The findings of this study have clinical implications for allied health
Conflict of interest
The authors declare that there are no conflict interests.
Acknowledgments
Ryan Mahaffey was funded by the Dr William M. Scholl Podiatric Research and Development Fund
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