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Increased stress on tendons can lead to reconstructive surgery if proper steps are not taken.
By Susan J. Landers, AMNews staff. March 21, 2005.
Quote:
Washington -- Add foot pain to the growing catalog of health concerns that result from weight gain. About a year ago, a group of foot and ankle specialists looked out at their full waiting rooms and asked: As we are getting heavier, are we crushing our feet?
Not surprisingly, the answer they found was yes.
The rising level of obesity now appears to be taking a toll on the nation's health from head to toe. Feet and ankle problems have been placed on the list of weight-related conditions, which already includes increased risk of strokes, diabetes and heart disease.
For example, respondents to an online survey who reported that they had had foot surgery, seen a physician for foot or ankle pain or changed shoes based on physician advice were also likely to be heavier than normal. Their average body mass index was 27.9 kg/m. Desireable BMI is 18.5 to 24.9 kg/m.
In addition, nearly 41% reported gaining weight before the onset of pain.
The online survey, which tallies more than 6,000 respondents, was launched early last year by the education committee of the American Orthopaedic Foot and Ankle Society and is being offered as evidence that weight gain is indeed triggering foot pain. The committee will continue to analyze the data and will present more complete findings at the society's meeting this summer in Boston....
I have a problem with the medical and paramedical profession jumping to 'weight' as the sole reason for (lower-limb) pain, particularly when symptoms are unilateral.
I concede that weight may be a factor, but hidden, is another more important underlying factor why one limb is affected, whilst contra-laterally, no signs and symptoms are evident/experienced.
Ress release from Reuters: Foot pain should not prevent obese from exercising
January 25, 2006 07:19:10 AM PST
Quote:
Obese people should seek immediate treatment for chronic foot and ankle problems that limit physical activity, the American College of Foot and Ankle Surgeons (ACFAS) urge.
"As our body weight increases, more load and stress are put on the feet," foot and ankle surgeon Dr. Sean Wilson of Aspen Ortho & Rehab Specialists in West Allis, Wisconsin, and ACFAS spokesman, told Reuters Health.
"Ligaments can stretch out more than they should, joints can get out of alignment, which can cause arthritis and pain in the foot. Tendonitis can occur, among a myriad of other things. But this should not be a reason to avoid physical activity."
Wilson suggests that before starting any type of exercise, obese adults should consult their family physician because they might have other medical conditions, such as high blood pressure, diabetes, or lung problems, which need treatment.
He also noted the importance of choosing the right shoe for each activity. "People who carry around more weight need shoes that are built sturdier, which are found at specialty type stores."
Wilson recommends a work-out routine that increases the heart rate and strengthens muscles. "High-impact type of activities such as running, are not the best to start. Obese people need to do exercises that also help support their body, such as weight training under the guidance of a trainer, swimming, and walking on stationary-type machines. But they should always start slow to help build a good foundation."
If any discomfort occurs with a particular type of exercise, they should stop until the discomfort resolves. "Trying to work through the pain is not a good idea."
Statistics show that with age, the American population is getting heavier, Wilson added. "We need to exercise, but we need to start at the base level up. If you keep the feet happy, it will hopefully affect the rest of your body as well."
In spite of significant advances in the knowledge and understanding of the multi-factorial nature of obesity, many questions regarding the specific consequences of the disease remain unanswered. In particular, there is a relative dearth of information pertaining to the functional limitations imposed by overweight and obesity. The limited number of studies to date have mainly focused on the effect of obesity on the temporospatial characteristics of walking, plantar foot pressures, muscular strength and, to a lesser extent, postural balance. Collectively, these studies have implied that the functional limitations imposed by the additional loading of the locomotor system in obesity result in aberrant mechanics and the potential for musculoskeletal injury. Despite the greater prevalence of musculoskeletal disorders in the obese, there has been surprisingly little empirical investigation pertaining to the biomechanics of activities of daily living or into the mechanical and neuromuscular factors that may predispose the obese to injury. A better appreciation of the implications of increased levels of body adiposity on the movement capabilities of the obese would afford a greater opportunity to provide meaningful support in preventing, treating and managing the condition and its sequelae. Moreover, there is an urgent need to establish the physical consequences of continued repetitive loading of major structures of the body, particularly of the lower limbs in the obese, during the diverse range of activities of daily living.
Musculoskeletal findings in obese subjects before and after weight loss following bariatric surgery. Int J Obes (Lond). 2006 Apr 25;
Quote:
Objective:To determine the point prevalence of painful musculoskeletal (MSK) conditions in obese subjects before and after weight loss following bariatric surgery.
Design:Longitudinal, interventional, unblended.Subjects:Forty-eight obese subjects (47 women, one man, mean age 44+/-9 years; mean body mass index (BMI) 51+/-8 kg/m(2)) recruited from an academic medical center bariatric surgery program.Measurements:Comorbid medical conditions; MSK findings; BMI; Western Ontario McMaster Osteoarthritis Index (WOMAC) for pain, stiffness and function; and SF-36((R)) for quality of life.
Methods:Consecutive subjects were recruited from the University Hospitals of Cleveland Bariatric Surgery Program. Musculoskeletal signs and symptoms and non-MSK comorbid conditions were documented at baseline and at follow-up. Subjects completed the SF-36((R)) and the WOMAC questionnaires. Analyses were carried out for each MSK site, fibromyalgia syndrome (FMS) and for the cumulative effect on the spine, upper and lower extremities. The impact of change in comorbid medical conditions, BMI, physical and mental health domains of the SF-36((R)) on the WOMAC pain subscale score was evaluated. SF-36((R)) outcomes were compared to normal published controls.
Results:Forty-eight subjects were available for baseline and a follow-up assessment 6-12 months after gastric bypass surgery. They lost an average of 41+/-15 kg and the mean BMI decreased from 51+/-8 to 36+/-7 kg/m(2). Baseline comorbid medical conditions were present in 96% before surgery and 23% after weight loss. There was an increased prevalence of painful MSK conditions at baseline compared to general population frequencies. Musculoskeletal complaints had been present in 100% of obese subjects before, and 23% after weight loss. The greatest improvements occurred in the cervical and lumbar spine, the foot and in FMS (decreased by 90, 83, 83 and 92%, respectively). Seventy-nine percent had upper extremity MSK conditions before and 40% after weight loss. Before surgery, 100% had lower extremity MSK conditions and only 37% did after weight loss. The WOMAC subscale and composite scores all improved significantly, as did the SF-36((R)). Change in BMI was the main factor impacting the WOMAC pain score.
Conclusion:There was a higher frequency of multiple MSK complaints, including non-weight-bearing sites compared to historical controls, before surgery, which decreased significantly at most sites following weight loss and physical activity. These benefits may improve further, as weight loss may continue for up to 24 months. The benefits seen with weight loss indicate that prevention and treatment of obesity can improve MSK health and function
Objective:To investigate the effect of weight loss on balance control in obese and morbid obese men.
Methods:In a longitudinal and clinical intervention study, postural stability was measured with a force platform before and after weight loss in men. Weight loss was obtained in obese men (mean body mass index (BMI)=33.0 kg/m(2)) by hypocaloric diet until resistance and in morbid obese men (mean BMI=50.5 kg/m(2)) by bariatric surgery. Morbid obese men were tested before surgery, and 3 and 12 months after surgery when they had lost 20 and nearly 50% of initial body weight, respectively. Normal weight individuals (mean BMI=22.7 kg/m(2)) were tested twice within a 6- to 12-month period to serve as control. Body fatness and fat distribution measures, and posturographic parameters of the center of foot pressure (CP) along the antero-posterior and medio-lateral axes for conditions with and without vision were performed in all subjects.
Results:Weight loss averaged 12.3 kg after dieting and 71.3 kg after surgery. Body weight remained unchanged in the control group. After weight loss, nearly all measures of postural stability were improved with and without vision (i.e., CP speed and range in antero-posterior and medio-lateral axes). A strong linear relationship was observed between weight loss and improvement in balance control measured from CP speed (adjusted R (2)=0.65, P<0.001).
Conclusion:Weight loss improves balance control in obese men and the extent of the improvement is directly related to the amount of weight loss. This should decrease the habitual greater risk of falling observed in obese individuals.
The human skeleton is an amazing piece of engineering.
It enables us to walk about in search of food refreshment and sex. This enables our species to endure.
So if the skeleton has been designed to have specific load factors imposed upon it then it will function fine for a very long time. It will,amazingly repair some of the damage sustained over the years.
So if you increase by 50% the load it has to drag around then it is not surprising that various structures are damaged either severley or by recurrent overload over the years leading massive accumulated damage.
So the part of the skeleton that contacts the ground has the highest load factors both static and dynamic.
This should mean in real life that the obese cant run fast enough to catch their food water and indeed catch a potential mate. So they would die out and their gene pool would diminish.
trouble is in our civilised society someone else catches our food and water and mates sometimes find mutually obese mates so things continue.
So Take a truck designed to carry 20tons and put on it 30 tons and watch what happens .
Broken springs and shocks.
Damaged tyres.
Worn and damaged brakes.
Damage to the chassis and bodywork.
and a shorter working life.
With a truck you buy a better chassis etc.
With the human body you have to die and hopefully god will give you another shot at life with a new body. It may be as cockroach though.
Despite the multifactorial nature of musculoskeletal disease, obesity consistently emerges as a key and potentially modifiable risk factor in the onset and progression of musculoskeletal conditions of the hip, knee, ankle, foot and shoulder. To date, the majority of research has focused on the impact of obesity on bone and joint disorders, such as the risk of fracture and osteoarthritis. However, emerging evidence indicates that obesity may also have a profound effect on soft-tissue structures, such as tendon, fascia and cartilage. Although the mechanism remains unclear, the functional and structural limitations imposed by the additional loading of the locomotor system in obesity have been almost universally accepted to produce aberrant mechanics during locomotor tasks, thereby unduly raising stress within connective-tissue structures and the potential for musculoskeletal injury. While such mechanical theories abound, there is surprisingly little scientific evidence directly linking musculoskeletal injury to altered biomechanics in the obese. For the most part, even the biomechanical effects of obesity on the locomotor system remain unknown. Given the global increase in obesity and the rapid rise in musculoskeletal disorders, there is a need to determine the physical consequences of continued repetitive loading of major structures of the locomotor system in the obese and to establish how obesity may interact with other factors to potentially increase the risk of musculoskeletal disease.
Computerized baropodometry in obese patients. Obes Surg. 2006 Dec;16(12):1574-8
Fabris SM, Valezi AC, de Souza SA, Faintuch J, Cecconello I, Junior MP
Quote:
BACKGROUND: Few studies have investigated the influence of obesity on the structural and functional performance of the feet, and its potential implications for the musculoskeletal system. Computerized baropodometric analysis (CPA) is a new investigation for the center of pressure, plantar surface area and plantar pressure while standing on the platform of a specialized apparatus. CPA is relevant to gait and posture, and may be important as well for postoperative musculoskeletal disorders. We investigated the biomechanical dysfunctions of foot pressure by means of CPA in bariatric and non-bariatric subjects.
METHODS: Subjects (n=67, 71.6% females, age 40.8 +/- 13.8 years, BMI 31.4 +/- 11.0 kg/m(2)) included obese (BMI 30.0-60.0 kg/m(2), n=27), overweight (BMI 25.0-29.9 kg/m(2), n=12) and normal-weight controls (BMI 20.0-24.9 kg/m(2), n=28) of equivalent age and gender. Variables included center of pressure location, plantar ground contact area and pressure, and pressure patterns (maximum and average) in different regions of the foot, during quiet standing on the platform of the baropodometer.
RESULTS: A significant increase was detected for peak pressure on forefoot and plantar ground contact area in the obese group, compared to control and overweight cases, during quiet standing.
CONCLUSION: Excessive forefoot pressure and enlarged support area were a consequence of obesity, mirroring the efforts of the obese subject to acquire a wider and stronger support base. Although this is originally a physiological change, it may result in maladaptative and degenerative musculoskeletal consequences. Re-education exercises may be advised, in combination with bariatric surgery in the morbidly obese, aiming at restoration of normal gait and posture, as well as at minimization of stress damage to bones and joints in the axial skeleton.
Effects of Obesity on the Biomechanics of Walking at Different SpeedsRaymond C. Browning; Rodger Kram Full text from Medscape (free registration required)
Quote:
Purpose: Walking is a recommended form of exercise for the treatment of obesity, but walking may be a critical source of biomechanical loads that link obesity and musculoskeletal pathology, particularly knee osteoarthritis. We hypothesized that compared with normal-weight adults 1) obese adults would have greater absolute ground-reaction forces (GRF) during walking, but their GRF would be reduced at slower walking speeds; and 2) obese adults would have greater sagittal-plane absolute leg-joint moments at a given walking speed, but these moments would be reduced at slower walking speeds.
Methods: We measured GRF and recorded sagittal-plane kinematics of 20 adults (10 obese and 10 normal weight) as they walked on a level, force-measuring treadmill at six speeds (0.5-1.75 m.s-1). We calculated sagittal-plane net muscle moments at the hip, knee, and ankle.
Results: Compared with their normal-weight peers, obese adults had much greater absolute GRF (N), stance-phase sagittal-plane net muscle moments (N.m) and step width (m).
Conclusions: Greater sagittal-plane knee moments in the obese subjects suggest that they walked with greater knee-joint loads than normal-weight adults. Walking slower reduced GRF and net muscle moments and may be a risk-lowering strategy for obese adults who wish to walk for exercise. When obese subjects walked at 1.0 versus 1.5 m.s-1, peak sagittal-plane knee moments were 45% less. Obese subjects walking at approximately 1.1 m.s-1 would have the same absolute peak sagittal-plane knee net muscle moment as normal-weight subjects when they walk at their typical preferred speed of 1.4 m.s-1.
BACKGROUND: It is believed that obese individuals may have an increased number of foot and ankle problems. The World Health Organization recommends a standard classification of adult overweight and obesity using the following body mass index (BMI) calculations: a BMI of 25.0 to 29.9 kg per m(2) is defined as overweight; a BMI of 30.0 kg per m(2) or more is defined as obesity. The purpose of this paper was to report a survey of 1411 patients in an orthopaedic foot and ankle practice and compare the incidence of orthopaedic foot and ankle complaints with the BMI.
METHOD: One thousand four hundred and eleven adults, including 887(62.4%) women and 535(37.6%) men, were evaluated in this study. The BMI was calculated for each subject using the standards of the World Health Organization. The subjects were divided into two groups: normal and overweight. The normal weight subjects had a BMI of 18.5 to 24.9 (n = 684; 48.1%) and the overweight or obese group had a BMI greater than or equal to 25 (n = 738; 51.9%).
RESULTS: In this study, being overweight or obese significantly increased the chances of having tendinitis in general. If the subjects were overweight or obese, there was an increased likelihood, although not significant, of plantar fasciitis and osteoarthritis. If the individuals were of normal weight, there was an increased likelihood of hallux valgus.
CONCLUSIONS: Tendinitis, plantar fasciitis, and osteoarthritis usually are secondary to overuse and increased stress on the soft tissues and joints, which may be directly related to increased weight on these structures.
Three-dimensional gait analysis of obese adults
Peggy P.K. Lai, Aaron K.L. Leung, Agnes N.M. Li, M. Zhang Clinical Biomechanics (in press)
Quote:
Background
Obesity has been clinically associated with musculoskeletal disorders. However, the findings were mainly focused on the analysis in the sagittal plane. The objectives of this study were to investigate the three-dimensional gait characteristics of Chinese obese adults and to compare the results with normal subjects.
Methods
Fourteen obese subjects, mean age 35.4 (8.8)years, eight females and six males, with body mass index 33.06 (4.2)kg/m2 and 14 non-obese subjects, mean age 27.6 (8.6)years, eight females and six males, with body mass index 21.33 (1.5)kg/m2 participated in this study. All subjects did not have current or past neurological or cardiovascular illness, orthopaedic abnormality, or pain which might affect gait. The kinematics and kinetics data of all subjects were recorded during their self-selected walking speed with a three-dimensional motion analysis system.
Findings
The obese group walked slower and had a shorter stride length. They also spent more time on stance phase and double support in walking. Greater hip adduction was shown in the obese group during terminal stance and pre-swing. The maximum knee adduction angles of the obese group in both stance and swing phases were significantly higher. The ankle eversion angle of the obese group was significantly higher from mid stance to pre-swing. There were reduction of peak ankle plantar flexor moment, and increase of ankle inversion moment.
Interpretation
There were some significant differences in temporal–spatial, joint motion and joint moment data between the obese and the non-obese participants. The obese individuals might adjust their gait characteristics in response to their heavy bodies to reduce the moment about the knee and the energy expenditure per unit time.
Irving DB, Cook JL, Young MA, Menz HB. Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched casecontrol study. BMC Musculoskelet Disord. 2007;8:41.
Regards
__________________ "Ciencia es aquello sobre lo cual se puede siempre discutir" Ortega y Gasset. "Absence of evidence is not evidence of absence." Mi localización / My location
The Telegraph are reporting: Obesity crisis 'causing painful foot problems'
The number of people needing treatment for serious foot problems has doubled in a decade because of Britain's obesity crisis experts have warned.
Quote:
Doctors warn that more people than ever are seeking help for painful and crippling foot problems as the country puts on weight.
Too much weight on the foot and ankle can cause tendon damage and even lead to bone problems such as osteoarthritis, they warn.
A spokesman for the Society of Chiropodists and Podiatrists said that anecdotal evidence suggested that there were around twice as many patients with serious foot problems as 10 years ago.
Mike O'Neill, a consultant podiatric surgeon, said: "It is becoming a really serious problem – people who are bigger put more pressure on their ankles, knees and hips as well as feet.
"This can lead to a range of very serious foot problems, not helped by the fact that obese people often struggle to reach their feet and tend to wear shoes with little support, such as low flat slip ons or flip flops."
The foot is designed to absorb the shock of walking and running but can come under pressure from too much excess weight.
One painful problem is that too much pressure can weaken the muscle which gives the foot its arch.
This in turn can cause sufferers to change how they walk, which can eventually cause damage to bones and lead to osteoporosis, Mr O'Neill said.
Studies in children have shown that extra body weight can lead to structural changes in their feet.
David Pryke, spokesman for the Independent Footwear Retailers Association, said: "We are getting calls every day from people complaining about foot problems and looking for help."
Almost one in four Britons is now thought to be obese.
By 2050 it is estimated that half of the British population will be clinically obese.
I have a problem with the medical and paramedical profession jumping to 'weight' as the sole reason for (lower-limb) pain, particularly when symptoms are unilateral.
I concede that weight may be a factor, but hidden, is another more important underlying factor why one limb is affected, whilst contra-laterally, no signs and symptoms are evident/experienced.
I totally agree and the most common anomoly consistently overlooked is the limb length difference often created by a smaller (varus) heel bone measured from the inferior medial malleolus to the the weight bearing surface - in comparison to the opposite leg/foot (both feet in neutral ankle and patient supine after hip muscle mobilisation. The significant difference can be as little as 6-8mm in the recently overweight. There is often also contralateral sacroiliac/piriformis irritation.
"I have a problem with the medical and paramedical profession jumping to 'weight' as the sole reason for (lower-limb) pain, particularly when symptoms are unilateral."
I don't think anyone said that (apart from some sloppy newspaper article).
Excess weight can certainly be a contributory factor in lower limb/foot pain, as it can in many other health issues.
Here in the UK we have approximately 50% of women and 75% of men now either overweight or obese (extrapolated from DOH figures for England and Wales). It is a bigger problem than, say, a pair of mis-matched heel bones.
Just out of interest, do you have a ref for your mismatched heel-bone theory?
I am not negating the effects of excess weight - 5 kg sudden gain seems to trip a unilateral foot problem. I come back to the question - why one foot/hip only in pain?
In nature perfect symmetry is not the norm for most body paired parts (the optometrist, shoe fitter, corsetier will attest). Most of my patients in this catagory present with one longer slimmer foot and one shorter wider foot. The smallness of the heel is in all dimensions ( 3 planes) and the foot is generally more mobile at STJ and particularly the MTJ, but with a lesser ROM at the hip than the contralateral hip.With feet , neonatal compression in utero ensures that one foot is inverted more than the other. (usually the left) . With assuming of weight bearing in the first two years, it is quite possible for the smaller heel to receive less force and remain less "developed" - basic laws of Wolfe about bone modelling responding to the amount and direction of force upon it. Re the varus angle contributing to the lesser force upon the smaller heel -
An excellent account of neonatal and parediatric development is found in the physio "bible" :"Progressive casting and splinting for Lower Extremity Deformities in Children with Neuromotor Dysfunction" Beverley Cusick MS PT 1990 USA ISBN 0-88450-454-9 Cat No: 4182. She quotes (chap 2)Tachdjan (1985); Sgarlato (1971);Jordan et al( 1983) and Tax(1985); McCrae (1985). Chap 2, Page 32:
"Hindfoot varus - the talocalcaneal angle is one of varus when the subtalar joint is aligned in congruity. Persistence of the calcaneal torsion seems to account for this varus disposition of the neutral hindfoot (and forefoot)."The author is the first to admit that further research is needed
To my younger colleagues I offer this advice: Study the abnormal neuromotor patterns to learn what is "normal". Oldies often revert to compensatory mechanisms with age. Too much research is done on the other end of the spectrum of the young and fit . Like with astronomy and archeology , you have to examine the past (as evidenced in fully compensated pathology) to determine the present . Now in my 60s , I have had the priviledge of treating 3 generations of the same family , as did the greats of early work such as Herman Tax.(see Podopaediatrics 2nd Ed1980 ISBN -0-683-08118-7). The refernces are a life time of study.
Babies have not changed much since then. It would be interesting to see if the increase in older, more overweight mothers produces a greater incidence of unilateral lower limb problems in the offspring????? And ....whether the smaller heel on one side correlates with sacroliliac /piriformis/ sciatic irritation on the contralateral side by way of compensation. Ask the therapeutic masseurs!or better still ..... get them to massage you and explain what they are looking at!
Robyn Hood
Last edited by Robyn Elwell-Sutton : 11th September 2009 at 11:40 PM.
Reason: Font too small -can't find computer glasses.
Weight gain can trigger foot and ankle pain
Martin
(apart from some sloppy newspaper article).
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