Obesity Linked to Foot Disorders

Yael Waknine

April 17, 2012

April 17, 2012 — Increased body mass index (BMI) is strongly linked to nonspecific foot pain in the general population and chronic plantar heel pain in nonathletes, according to a systematic review published online April 13 in Obesity Reviews.

Researchers led by Paul A. Butterworth, associate lecturer and PhD candidate at the La Trobe University Department of Podiatry in Victoria, Australia, used 5 electronic databases (Ovid MEDLINE/EMBASE/AMED, CINAHL, and the Cochrane Library), in addition to reference lists from relevant papers, to identify 25 relevant papers.

Four cross-sectional studies indicated a strong association between increased BMI and nonspecific foot pain.

Of note, a large population-based Danish study (n = 2179) reported significantly higher BMI in people with foot pain; obese men were 3 times more likely to have foot pain than those with normal BMI (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.6 - 6.1).

These findings were supported by age- and sex-adjusted data from a large Australian population-based study (n = 3206) showing that people with foot pain (after adjustment for age and sex) were nearly twice as likely to be obese (OR, 1.9; 95% CI, 1.57 - 2.31).

A smaller third study of individuals with high-arched feet (n = 130) found an increased BMI (in the obese range) for those with pain in 3 locations (forefoot, midfoot, and rearfoot) compared with that in patients with pain in 1 or 2 locations (P = .049).

The fourth study investigated disabling foot pain in 176 retirement village residents and found a significantly higher BMI that was not independently linked to foot pain after pain in other parts of the body were included in a regression model.

Plantar Heel Pain

With respect to chronic plantar heel pain, researchers identified 12 relevant studies (9 matched case-control and 3 cross-sectional). Eight of 10 studies specific for nonathletes linked heel pain with significantly increased BMI or obesity; 6 studies showed the effect size as "large" or greater.

Only 1 of the 9 case-control studies failed to find a difference in BMI between groups, which the authors attribute to small sample size (n = 20).

Although the evidence supports an association between an increased BMI and chronic plantar heel pain in nonathletes, the authors note the possibility for reverse causality, in which heel pain leads to decreased activity and obesity. Another limitation is that many of the studies did not control for potential confounders.

Can Weight Loss Improve Foot Pain?

Researchers also attempted to find a connection between weight loss and reduced foot pain. They identified only 2 relevant studies, both of which revealed significant improvement.

In 1 of those studies, a prospective cohort study, 24 patients achieved a 67% improvement in foot pain on the Western Ontario McMaster Osteoarthritis Index score for pain, stiffness, and function after weight loss with bariatric surgery and physical exercise (mean [±SD], 150 ± 75 vs 49 ± 51; P < .001).

The second study simply described the outcome of weigh loss after bariatric surgery on musculoskeletal conditions (n = 105; 21% with foot pain), in which only 1% of those afflicted continued to experience pain.

The authors note that the evidence on the relationship between BMI and hallux valgus, tendonitis, osteoarthritis, and flat foot is inconclusive.

"Considering that the prevalence of obesity is increasing world-wide, the incidence of musculoskeletal foot disorders is likely to increase," write Butterworth and colleagues, noting that the potential role of weight loss in addition to existing treatments for foot disorders warrants further investigation.

Mr. Butterworth is funded by an Australian postgraduate award. Another author is currently a National Health and Medical Research Council senior research fellow. No other sources of funding were provided for this review. The authors have disclosed no relevant financial relationships.

Obes Rev. Published online April 13, 2012. Abstract


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.