Obesity and Foot Problems

With worldwide obesity having doubled since 1980**, more attention is being paid to the detrimental effects of obesity on health – more specifically its effect on foot health.

While preventable, obesity still remains rampant in most parts of the world with The Telegraph predicting that half of the British population would be clinically obese by the year 2050; this alarming statistic necessitates the promotion of weight management programs in conjunction with a comprehensive foot care regimen in households.

According to The World Health Organization, an individual is considered to be obese if their body mass index (BMI) exceeds or is equal to 30**. This is, however, a fairly rough estimate since individual weight differs according to height.

Numerous studies conducted in the past have determined the debilitating impact of excessive weight on the functionality of the foot.

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One study in particular by Dr. Karen Mickle, a postdoctoral research fellow within the Institute of Sport, Exercise and Active Living (ISEAL) in Australia, investigated foot pain, foot structure and foot function in obese individuals above the age of 60 years.

In addition to higher incidences of foot pain, the obese participants also recorded lower walking speeds, stride length and ankle dorsiflexion strength; thus, highlighting the importance of adopting a healthier lifestyle for reducing excess body mass and improving foot function.

A raised BMI also increases the risk of developing various foot conditions such as osteoarthritis, plantar fasciitis and tendinitis, due to the added pressure on the lower limbs and the consequential changes in gait cycle.

This was established in a study conducted by Carol Frey of the West Coast Sports Medicine Foundation, which analysed the influence of obesity on orthopaedic foot and ankle pathology.

By evaluating 1,411 adults who were classified as being either normal or overweight based on their BMI, Frey found that increased stress on the soft tissues and joints of the feet placed the overweight patients at a higher risk of overuse injuries, fractures and sprains.

This could be attributed to the biomechanical changes observed in obese individuals namely an increased Q angle, greater hip abduction angles, greater abducted foot angles and increased pronation.

While excessive weight can significantly affect an individual’s quality of life, painful foot conditions can make it difficult for an obese patient to engage in an active lifestyle involving high-impact exercises.

This creates unique challenges in devising appropriate treatment modalities for patients suffering from both excess weight and foot conditions.

In an article published by Lower Extremity Review in 2016, foot specialists recommend focused foot muscle strengthening exercises for treating foot pain in overweight/obese individuals; this can greatly improve strength in both the forefoot and the muscles of the ankle, helping the individual regain balance and stability.

Foot supportive devices can help promote an optimal distribution of plantar pressures in the foot in addition to improving foot loading patterns. The added support to the feet would reduce gait alterations and enforce proper movements of the feet and the whole body. 

Building strength in the intrinsic muscles such as the flexor digitorum and abductor hallucis would help to stabilise the arches of the foot.

By providing the correct balance of a resistant force, the intrinsic muscles will be able to work unaffected through their functional range of motion and the arches will become less susceptible to flattening.

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