1118 - Rethinking the impact of obesity on gait: A case report of a morbidly obese pediatric female patient Diagnosis

Case Diagnosis:
A 9-year-old female with morbid obesity (BMI 42.23 kg/m²), attention deficit and hyperactivity disorder, speech delay presented due to increasing falls with a history of right leg pain and weakness. Three-dimensional gait analysis was performed demonstrating gait abnormalities were primarily due to morbid obesity, prompting targeted multidisciplinary interventions.

Case Description: This patient was referred to evaluate right leg weakness, foot dragging, and out-toeing with falls since age 4. Suspected etiologies included neuromuscular and musculoskeletal pathologies. Gait analysis revealed she walked at 55% of normal velocity for her age. Kinematics showed anterior pelvic tilt with asymmetric prolonged right stance followed by a short swing phase. She had 20 degrees of right external foot progression, with rotational breakdown demonstrating external rotation originating from the hip and compensatory left hip internal rotation. Kinetics showed abnormal knee flexion-extension and varus-valgus moments.Foot pressure analysis showed increased right midfoot pressure and a collapsed arch. All her abnormal gait analysis findings could be attributed to her morbid obesity that altered her joint loading of her right lower extremity. Bilateral University of California-Berkley Lab orthotics were recommended to prevent midfoot breakdown. She was referred to weight management clinic, physical therapy, and a psychologist specializing in weight management.

Discussions: Childhood obesity is a disease that is treatable with appropriate medical and psychosocial interventions. Obesity can lead to insufficient postural control, increased forces that contribute to joint malalignment, reduced bone mineral density, and musculoskeletal overuse injuries and fractures. This case study highlights the importance of assessing gait deviations in obese children and identifying areas for intervention such as therapy focusing on quad strengthening, bracing to support midfoot breakdown, and weight management to decrease present and future musculoskeletal and psychological complications.

Conclusions: Gait deviations in obese children can be further evaluated with formal gait analysis. It is important to individualize care based on the findings