Association between pediatric obesity and foot morphology: insights from a large-scale cross-sectional study using photogrammetry

Abstract

Background: Childhood obesity is a critical public health concern with implications for musculoskeletal development. Foot posture abnormalities—particularly pes planus—may be associated with obesity and could serve as early diagnostic indicators. Aim: This study investigated the relationship between foot posture and obesity in children aged 4–14 years using non-invasive assessment methods. Materials and methods: A total of 7,908 children (mean age: 8.7 ± 2.9 years; 51.2% male) were assessed using photogrammetry and the Staheli Arch Index, along with the Jack Test to classify foot posture. BMI categories and foot posture types were statistically compared. Results: Rigid pes planus was found in 9.6% of children, flexible pes planus in 7.8%, and high arch in 3.8%. Among overweight and obese children, the prevalence of rigid pes planus was significantly higher (p < 0.001). Logistic regression revealed that rigid pes planus increased the risk of obesity by 7.2 times (OR = 7.156; 95% CI: 5.179–9.887). Conclusion: Rigid pes planus is strongly associated with obesity in children. Foot posture screening, especially in early childhood, may serve as a valuable tool for identifying children at risk for obesity-related complications and guiding early preventive interventions.