Elsevier

Clinical Biomechanics

Volume 25, Issue 5, June 2010, Pages 461-467
Clinical Biomechanics

Influence of obesity and sarcopenic obesity on plantar pressure of postmenopausal women

https://doi.org/10.1016/j.clinbiomech.2010.01.017Get rights and content

Abstract

Background

Menopause is associated with a decrease in fat-free mass and an increase in fat mass. Sarcopenic obesity is more strongly associated with physical limitations than either obesity or sarcopenia and their effect in plantar pressure is not known. Consequently, the scope of the present study was to examine the effect of obesity and sarcopenic obesity on plantar pressure of postmenopausal women, during walking.

Methods

Body composition and biomechanics parameters of plantar pressure were assessed in 239 postmenopausal women.

Findings

Compared to non-obese and non-sarcopenic women, obese postmenopausal women have higher peak pressure in the metatarsal areas 1, 4, 5, midfoot and lateral heel and higher absolute impulses in all metatarsal and heel areas. On the other hand, sarcopenic obese postmenopausal women presented higher peak pressure and absolute impulses under all metatarsal areas, midfoot and heels. When the absolute values of maximal peak pressures and absolute impulses were normalised to body mass, pressure increases were only perceived for midfoot.

Interpretation

The pressure increase found in different foot areas of obese and particularly in sarcopenic obese could cause discomfort and pain in the foot. Sarcopenic obese postmenopausal women also present a higher loading during the stance phase comparing with non-sarcopenic non-obese, fact that might limit their basic daily activity tasks, such as walking.

Introduction

Menopause is associated with modifications in body composition components like a decrease in fat-free mass and an increase in fat mass (Dionne et al., 2000). Obesity is a major health problem with an increasing incidence in many parts of the world and among numerous other medical conditions, a high incidence of osteoarthritis, painful feet, and symptomatic complaints in the joints of the lower extremities are frequently reported for overweight people (Wearing et al., 2006). Beginning in mid life, ageing is associated with a time dependent loss of muscle mass that is a major cause of disability, frailty and loss of independence (Dorrens and Rennie, 2003). Several studies suggested that the combination of sarcopenia and obesity (“sarcopenic obesity”) was more strongly associated with disability than either pathology alone (Baumgartner, 2000, Baumgartner et al., 2004).

Physically active lifestyle is associated with the maintenance and improvement of the body composition in postmenopausal women (PW) (Aubertin-Leheudre et al., 2005). Walking has proved an increasing interest in the promotion of well-being and health, being the most common activity among adults, suitable to decrease the risk of hip fracture in PW (Feskanich et al., 2002).

Few studies (Birtane and Tuna, 2004, Gravante et al., 2003, Hills et al., 2001, Teh et al., 2006) have addressed the gait characteristics of obese adults. As far as we know no study was made about the gait characteristics of sarcopenic and sarcopenic obese PW.

The human foot is a complex multi-articular mechanical structure that plays an important role in the biomechanical function of the lower extremity and is the only part of the body that acts on an external surface. It provides support and balance during standing and body stability during gait (Abboud, 2002). The lower extremity should distribute and dissipate compressive, tensile, shearing and rotatory forces during the stance phase of gait (Abboud, 2002). An inadequate distribution of these forces can lead to abnormal movement, which in turn produces excessive stress that can result in the breakdown of soft tissues and muscle (Abboud, 2002).

Plantar pressure analysis may provide additional insight into the etiology of pain and lower extremity complaints (Hennig, 2008). Namely, detecting deviant foot biomechanics, that can be associated with obesity and/or sarcopenia, particularly concerning local (over)loading of the plantar surface. Therefore the present study is the first to provide an objective summary of the plantar pressure data in PW with obesity and sarcopenic obesity, during walking.

Section snippets

Subjects

The sample was composed by 239 PW (age, 57.4 ± 6.6 years; height, 155.1 ± 5.1 cm and weight, 69.2 ± 11.2 kg). Before testing, all subjects visited a physician for a comprehensive injury history, in order to verify the inclusion criteria, and register some variables that must be under control of the investigator (Birtane and Tuna, 2004, Hills et al., 2001, Willems et al., 2005) such as absence of: (1) acute foot pain and deformities, (2) severe lower extremity trauma, (3) lower extremity surgery like

Results

Intra class correlation coefficients for peak pressure and absolute impulses are given in Table 1. All variables had an average intra class correlation above 0.75 (except for absolute impulses in T2-5, 0.68). The highest intra class correlation coefficients were found for HM and HL and the lowest intra class correlation values for the T2-5 and the M5.

Sarcopenic obese PW (Table 2) have higher values (P  0.01) of weight and BMI than their counterparts, but lower height and SMI. Obese but

Discussion

This study intended to analyse the effect of obesity and sarcopenic obesity on plantar pressure of postmenopausal women, during walking. The results indicated that the plantar pressures of obese PW during natural walking differ from the non-obese subjects. In general, the absolute load on the plantar surface of obese, but not sarcopenic, PW is higher. In subjects with obesity and sarcopenia these deviant characteristics are worsened, presenting higher peak pressures and absolute impulses.

Conclusions

The data suggests that the plantar pressures of obese PW during natural walking differ from the non-obese subjects, being higher. Postmenopausal women with obesity and sarcopenia have worsened characteristics, demonstrating higher absolute peak pressures and absolute impulses. When the peak pressures and absolute impulses are normalised to body mass, these differences seem to disappear, except in the MF where sarcopenic obesity subjects still presented significantly higher loads. The findings

Acknowledgements

This research was supported by the Portuguese Science and Technology Foundation (POCI/DES/59049/2004 and SFRH/BD/38776/2007) and Operational Program for Science and Innovation 2010 (POCI 2010) co-financed by Social European found (FEDER).

The authors acknowledge Dr. Ana Moutas Ribeiro and Dr. Miguel Maia for the technical support in this study.

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