Could Your Pain Have Started With What You Ate as a Child?

Childhood nutrition, metabolic health, and the feet we end up with.

I've worked with horses for 36 years. Over and over, I see the same health patterns show up in horses and in people.

One of the clearest is in the hoof. In horses, metabolic syndrome and laminitis are closely linked. A problem in the metabolism shows up as a problem in the foot.

That got me wondering about our feet.

Over the years I've met a lot of adults with foot (knee, hip and back) problems. Some have high, rigid arches. Some have arches that have collapsed. Some just hurt, and nobody can point to anything structurally wrong.

Almost all of them get the same kind of explanation. Mechanical. Footwear, tendons, ligaments, weak muscles, gait.

That's not wrong. But I keep circling back to a different question.

What if some of this started much earlier? Not just with how our feet grew, but with what we were fed while they were growing.

Specifically: what does a childhood built on refined carbohydrates, added sugar, and processed food do to a developing metabolism? And to the muscles, tendons, nerves, and connective tissue that metabolism is feeding?

I'm not saying this explains every sore foot etc . It doesn't. It's a hypothesis, and I want to be clear about where the research ends and my thinking begins.

One more thing up front. When I say carbohydrates, I don't mean an apple or a bowl of lentils. I mean refined starches and added sugars. They aren't the same thing, and the research doesn't treat them as the same thing.

## What the research shows

Childhood diet shapes body composition. Body composition is linked to foot structure.

In a randomized trial published in the New England Journal of Medicine, children who drank one sugar-sweetened beverage a day gained more weight and body fat over 18 months than children given a sugar-free version.

Separately, a meta-analysis of 73 studies covering more than 1.7 million children and adolescents found that kids with overweight or obesity had a 49% higher relative risk of flat feet.

Put those side by side and you don't get "sugar causes flat feet." You get two links in a chain. Diet affects body composition. Body composition is associated with how the foot develops.

Metabolic dysfunction changes tendons and connective tissue.

This one is well established. Diabetes is associated with changes in tendon structure, collagen organization, remodeling, and healing. The Achilles and the structures under the foot are right in the middle of it.

A 2026 review looks at advanced glycation end products (AGEs), which build up with metabolic dysfunction, and how they may interfere with collagen organization and tendon healing. The authors are careful to say the mechanisms are still being worked out.

So here's my question. If metabolic dysfunction can change connective tissue in adults, what happens when it starts in childhood, while that tissue is still being built?

Nobody has traced that progression yet. That's the gap.

## High, rigid arches are a different story

Flat feet and rigid high arches are not the same condition. I don't assume they share a cause.

High, rigid arches are often neurological. Inherited peripheral neuropathies like Charcot-Marie-Tooth disease create muscle imbalances that gradually pull the foot into shape, sometimes starting in childhood.

There's no good evidence that eating too many carbohydrates as a child gives you rigid high arches. I want to say that plainly.

But the nerve connection is what made me look harder.

## Where nerves come in

Long-term metabolic disease damages peripheral nerves. We know that.

The TODAY study followed young people diagnosed with type 2 diabetes. Over about ten years, a substantial share developed peripheral neuropathy. Poorer blood sugar control meant higher risk.

Nerves run the foot. They decide which muscles fire, what you feel, how you balance, how the foot adjusts to load with every step.

So could metabolic disturbance early in life start shifting that relationship between nerve, muscle, and mechanics long before anyone calls it a metabolic problem?

It's a fair question. The research doesn't answer it yet.

## What I'm actually proposing

For some people, I think foot pain may be the end of a long process, not the beginning of one.

A childhood heavy in refined carbohydrates and sugar may push susceptible kids toward metabolic dysfunction. If that dysfunction sticks around, it may affect muscle performance, nerve health, and how connective tissue remodels. Eventually it shows up in how the feet handle ordinary daily load.

Pain. Lost function. Injuries that don't quite add up.

Diet isn't working alone, either. Kids move less than they used to. So do adults. So do horses. Less movement means worse metabolic health, and feet that get less of the loading they need to develop and stay strong.

What interests me most is whether this happens in people who were never noticeably overweight. Metabolic stress with nothing on the outside to show for it.

And whether some of what we call structural problems have a systemic piece we're not looking at.

Some foot problems have clear genetic, neurological, traumatic, or mechanical causes. I'm not arguing with that. I'm asking whether, by staring at the foot, we miss the environment the foot grew up in.

## Looking past the foot

The usual question is: what's wrong with this person's feet?

I'd add two more.

What was happening metabolically while their muscles, nerves, bones, and connective tissue were developing?

And what's been happening metabolically since?

Sometimes the answer isn't where the pain is. It's further back.

— Zsuzsu

This piece is an exploratory hypothesis alongside published research. The studies cited show specific associations and biological mechanisms. They do not show that childhood diets high in refined carbohydrates cause adult foot deformities or chronic pain.

1. Childhood Sugar-Sweetened Beverages and Weight Gain — NEJM⁠

2. Childhood Obesity and Flat Feet — Systematic Review⁠

3. Effect of Diabetes on Tendon Structure and Function⁠

4. Advanced Glycation End Products and Tendon Health — 2026 Review⁠

5. Pes Cavus and Hereditary Neuropathies⁠

6. Peripheral Neuropathy in Youth-Onset Type 2 Diabetes — TODAY Study⁠