Look down to find one possible culprit in America’s childhood obesity epidemic: feet.

Physician members of the American College of Foot and Ankle Surgeons have noticed a link between foot pain and childhood obesity.

A vicious cycle occurs with overweight children. They should exercise and lose weight, but because of their weight, their feet hurt and they cannot exercise.

An estimated 16 percent of U.S. children ages six to 19 are overweight, and doctors are starting to see more overweight and obese children with foot and ankle pain.

Being overweight can cause many problems in the feet. For example, the pressure of extra weight causes a flattening of the foot, resulting in strain on the plantar fascia (the band of tissue which runs from the heel to the base of the toes), a primary cause of heel pain.

Because the heel bone is not fully developed until age 14 or older, overweight children are also more prone to Sever’s disease. Although not an actual disease, it involves inflammation of the heel’s growth plate due to muscle strain and repetitive stress. Walking makes the pain worse. Being overweight may also cause stress fractures, or hairline breaks in a child’s heel bone.

Children may also complain of calf or arch pain. This can be caused by a flatfoot that is flexible. The collapsing of the arch can require more energy, making it difficult for a child to walk and run.

Some overweight children may suffer foot pain from congenital or inherited foot conditions, such as bunions, hammertoes, pediatric flatfoot  and tarsal coalition, an abnormal connection between two or more bones in the back of the foot.

Foot and ankle surgeons may treat overweight children with custom orthotic devices (shoe inserts), physical therapy and other conservative measures to reduce and eliminate pain. Parents should also watch their child’s lifestyle and diet.