Orthopaedic Complications

The objective of this paper is the presentation of obesity-related musculoskeletal problems in childhood while a) focusing on the prevention of anticipated discomforts in adulthood and b) providing information on how best to address such complications in children who are obese.

One of the most common problems found in young people is, in particular, the strain on the lower extremities. The results of which can range from pes valgus and pes planus to genu valgum or knock-knee deformity caused by excessive anatomical and mechanical strain. Limited activities are often the first signs of dynamic impairment and usually manifest as shortening of the hip flexor and knee extensor muscles (e.g. psoas and quadriceps). Such shortening often causes retropatellar symptoms (pain at the anterior surface of the knee joint) or induces a hyperlordosis (exaggerated lumbar curve in the spine or “swayback”).

However, some well-known childhood orthopaedic conditions tend to present more commonly in patients afflicted with obesity. These conditions include Perthes’ disease, Osgood Schlatter’s disease, calcaneal apophysitis and slipped capital femoral epiphysis. Again, the lower extremities are mainly affected.

Early symptoms in the axial skeleton begin with signs of overstraining of the lumbar vertebrae; these range from hyperlordosis to Scheuermann’s disease with the exaggerated hunchback.

If size-weight ratios are not improved by the end of growth, early onset of arthrosis, particularly of the knee joints, spine and feet, is likely. In addition to the mechanical factors, also hormonal changes can contribute to an acceleration of arthrosis. Degenerative changes of the locomotor system and Charcot foot become central topics particularly in patients with diabetes. From an orthopaedic perspective, this negatively formulated outlook should be countered with early identification and a positive recommendation on how to manage such complaints.

Weight-loss and increased physical fitness of children and adolescents who are morbidly obese – although difficult – can successfully reduce the risk of the above-referenced orthopaedic problems.