Original article
Obesity, foot pain and foot disorders in older men and women

https://doi.org/10.1016/j.orcp.2016.11.001Get rights and content

Summary

Objective

We investigated obesity, foot pain and selected foot disorders, and determined if associations differed by foot posture or dynamic foot function.

Methods

We included 2445 men and women (4888 feet) from the Framingham Foot Study (2002–2008). A foot examination assessed presence of disorders and pain on each foot. Body mass index (BMI, kg/m2) was categorized as normal (<25), overweight (25–29.99), moderate-obesity (30–34.99) severe-obesity (35+). Foot posture (normal, cavus, planus) and dynamic foot function (normal, supinated, pronated) were defined using plantar pressure measurement system. We used sex-specific logistic regression with generalized estimating equations to account for correlation between two feet of the same person, adjusted for age and stratified by foot posture and dynamic foot function.

Results

Average age was 68 ± 11 years, 56% female, average BMI 28 ± 5 kg/m2. 18% of feet had pain, 25% hallux valgus, 2% claw toes, 18% hammer toes, 7% overlapping toes. In men, severe-obesity was associated with foot pain (OR = 2.4, p = 0.002) and claw toes (OR = 3.4, p = 0.04). In women, overweight, moderate-obesity and severe-obesity were associated with foot pain. Women with severe-obesity were less likely to have hallux valgus. Similar patterns were evident after stratification by foot posture and dynamic foot function.

Conclusion

Both men and women were at increased odds of foot pain as BMI increased. Data suggested foot posture and dynamic foot function had no effect, thus are unlikely mechanisms.

Introduction

Data from the National Health and Nutrition Examination Survey 2009–2010 reported that 69% of all adults age 20 and older are overweight (BMI  25) [1]. Older adults (≥60 years) have an increased prevalence of being overweight, while 37% of men and 42% of women over age 60 have obesity (BMI  30) [1]. Many negative health-related outcomes have been associated with obesity, including increased risk for early death, cardiovascular disease, Type II diabetes, some cancers, osteoarthritis and disability [2]. Recent studies have also reported that adults who are overweight and those who have obesity are more likely than their normal weight counterparts to have foot pain [3], [4], [5], [6], [7], [8], [9], [10], flat feet and high peak planter pressures when walking [11].

Foot pain is also a common problem among older adults. A systematic review [12] found that nearly one quarter of adults over age 45 experienced frequent foot pain. Foot pain has been associated with poor balance and gait problems [13], [14], activities of daily living [15], [16] and health-related quality of life [17], [18]. In addition to foot pain, structural foot disorders affect up to 60% of community-dwelling older adults [19], [20] and are associated with mobility limitations [14], [21] and decreased health-related quality of life [7]. Given that the foot is the body’s main base of support and is a key basis for mobility, balance and activities of daily living, excess weight is likely to have a negative impact on foot function.

Several recent studies have reported associations between obesity and foot pain [3], [4], [5], [6], [7], [8], [9], [10]. However, the underlying mechanisms responsible for this association have not been explored in detail. We propose that this relationship may be mediated by the variation in foot posture and dynamic foot function, as this may alter the load bearing function of the foot. Therefore, the purpose of our current study was to describe the associations between obesity categories, foot pain and foot disorders (hallux valgus, claw, hammer, overlapping toes) in a community-based cross-sectional study of older men and women. Further, to add insight into the potential underlying mechanisms, we examined whether these associations differed by foot posture or by dynamic foot function.

Section snippets

Study sample

Participants in this study were from the Framingham Foot Study Cohort, which is comprised of members from the Framingham Heart Study Original Cohort and the Framingham Offspring Cohort who were examined between 2002 and 2008 (mean age 68 years), as described previously [22], [23]. In brief, the Framingham Study Original Cohort was formed in 1948 from a two-thirds sample of the town of Framingham, MA in order to study risk factors for heart disease and have been followed biennially since that

Results

We included 2445 men and women, contributing 4888 feet, who had valid information from the foot examination and body mass index. Of the participants, average age was 68 (SD 11) years, 56% were female, and mean BMI was 28 (SD 5) kg/m2. As seen in Table 1, 28% were in the normal BMI category, 38% were overweight, 24% had obesity and 10% were in the severely obese BMI category. Of the 4888 feet, 18% had pain, 25% hallux valgus, 2% claw toes, 18% hammer toes, and 7% had overlapping toes. In both men

Discussion

This study examined the association between obesity and foot problems in older adults and found that both men and women are at increased odds of foot pain with increasing BMI categories. Additionally, men with severe obesity were more likely to have claw toes, and severely obese women were less likely to have hallux valgus. We also examined foot posture and dynamic foot function with the thought that the patterns of results would inform our basic understanding of possible underlying mechanisms

Conclusion

In our study, women and men with obesity are more prone to foot pain compared to their normal weight counterparts. It was surprising that consideration of foot structure and foot function did not change the associations between foot problems and obesity as we had expected. We believe that our results indicate that either persons may adapt to the extremes of foot function and structure as seen at a population-level or these foot aspects are part of a different mechanism of a pain–weight load

Acknowledgments

Funding for this project was provided by the Rheumatology Research Foundation Scientist Development Award and the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging (R01-AR47853). We also acknowledge the National Heart, Lung and Blood Institute’s Framingham Heart Study (N01-HC-25195). All authors have no relevant financial relationships to disclose.

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