Original articleObesity, foot pain and foot disorders in older men and women
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.
References (34)
- et al.
Predictors and persistence of foot problems in women aged 70 years and over: a prospective study
Maturitas
(2011) - et al.
Obese older adults suffer foot pain and foot-related functional limitation
Gait Posture
(2015) - et al.
Foot posture, range of motion and plantar pressure characteristics in obese and non-obese individuals
Gait Posture
(2015) - et al.
The population prevalence of foot and ankle pain in middle and old age: a systematic review
Pain
(2011) - et al.
The Framingham Offspring Study. Design and preliminary data
Prev Med
(1975) - et al.
Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study
Osteoarthritis Cartilage
(2010) - et al.
Prevalence of hallux valgus and risk factors among Japanese community dwellers
J Orthop Sci
(2014) - et al.
Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010
JAMA
(2012) - et al.
Scoping review report: obesity in older adults
Int J Obes (Lond)
(2012) - et al.
The association between body mass index and musculoskeletal foot disorders: a systematic review
Obes Rev
(2012)
Fat mass is associated with foot pain in men: the Geelong Osteoporosis Study
J Rheumatol
Fat mass is a predictor of incident foot pain
Obesity (Silver Spring)
Are knee and foot orthopedic problems more disabling in the superobese
Obes Surg
Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study
J Foot Ankle Res
Relationship between obesity and foot pain and its association with fat mass, fat distribution, and muscle mass
Arthritis Care Res (Hoboken)
Foot and leg problems are important determinants of functional status in community dwelling older people
Disabil Rehabil
The contribution of foot problems to mobility impairment and falls in community-dwelling older people
J Am Geriatr Soc
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