Elsevier

Gait & Posture

Volume 42, Issue 4, October 2015, Pages 442-447
Gait & Posture

Full length Article
Obese older adults suffer foot pain and foot-related functional limitation

https://doi.org/10.1016/j.gaitpost.2015.07.013Get rights and content

Highlights

  • Obese older adults have disabling foot pain and altered foot structure.

  • Obese older adults also exhibit impaired foot function.

  • Obese older adults have reduced health-related quality of life.

  • Interventions to reduce excess fat mass may improve foot pain, mobility and QoL.

Abstract

There is evidence to suggest being overweight or obese places adults at greater risk of developing foot complications such as osteoarthritis, tendonitis and plantar fasciitis. However, no research has comprehensively examined the effects of overweight or obesity on the feet of individuals older than 60 years of age. Therefore we investigated whether foot pain, foot structure, and/or foot function is affected by obesity in older adults. Three hundred and twelve Australian men and women, aged over 60 years, completed validated questionnaires to establish the presence of foot pain and health related quality of life. Foot structure (anthropometrics and soft tissue thickness) and foot function (ankle dorsiflexion strength and flexibility, toe flexor strength, plantar pressures and spatiotemporal gait parameters) were also measured. Obese participants (BMI >30) were compared to those who were overweight (BMI = 25–30) and not overweight (BMI <25). Obese participants were found to have a significantly higher prevalence of foot pain and scored significantly lower on the SF-36. Obesity was also associated with foot-related functional limitation whereby ankle dorsiflexion strength, hallux and lesser toe strength, stride/step length and walking speed were significantly reduced in obese participants compared to their leaner counterparts. Therefore, disabling foot pain and altered foot structure and foot function are consequences of obesity for older adults, and impact upon their quality of life. Interventions designed to reduce excess fat mass may relieve loading of the foot structures and, in turn, improve foot pain and quality of life for older obese individuals.

Introduction

The prevalence of obesity is rising at an alarming rate worldwide. The elderly are no exception with up to 42% of men and women aged over 60 years classified as obese [1], [2]. As the number of elderly people is rapidly increasing and the negative health consequences of obesity are numerous and well documented [3], it is imperative that interventions aimed at combating obesity are developed and implemented. It has been suggested that the difference between the current upward trend in obesity and a downward trend could be as simple as an additional 3-min walk per day [4]. However, interventions targeted at older individuals, are often confounded by pain or diseases affecting the musculoskeletal system which can be a barrier to older people participating in physical activity [5].

The feet are the base of support of the musculoskeletal system during most physical activities. Although feet that are structurally sound can perform daily tasks with ease, deviations from normal foot structure can compromise foot function and, in turn, cause discomfort and/or pain [6]. Extensive research has confirmed that overweight and obesity negatively affect foot structure and function in children, whereby obese children have been found to have flatter feet and generate significantly higher plantar pressures during walking relative to non-overweight children [7], [8], [9], [10], [11], [12], [13]. High plantar pressures, which describe the potential damaging effects of increased load on the plantar tissues [14], have been found to correlate with reduced physical activity and more time spent in sedentary behaviour, possibly due to foot pain and discomfort experienced during weight-bearing activities [15]. Furthermore, high plantar pressures in older people have been found to be associated with a higher incidence of foot pain and a greater risk of falling [16].

Although there is some evidence to suggest being overweight or obese places adults at greater risk of developing foot complications such as osteoarthritis, tendonitis and plantar fasciitis [17], there is only limited research investigating the effects of obesity on the feet of adults [18], [19]. No research has comprehensively examined the effects of overweight or obesity on the feet of older individuals (i.e. >60 years).

Given the role of feet as the base of support during weight-bearing activities, it would seem logical that foot pain or alterations to foot structure and function as a result of bearing excessive mass would be associated with gait changes in obese individuals, although this notion remains unexplored. Therefore, the purpose of this study was to determine whether obese older adults report a greater incidence of foot pain and display significant changes in foot structure and function compared to non-overweight older individuals. We hypothesized that obese older adults would report a greater incidence of foot pain and display significant changes in foot structure and function compared to non-overweight older individuals. Obesity affected foot structure and function resulting in foot pain is a potential deterrent to participate in physical activity, deeming it a major health issue for older people.

Section snippets

Methods

One hundred and fifty eight men and 154 women aged 60–90 years were randomly recruited via the electoral roll using methods previously described [20]. Briefly, all participants were independently living and ambulatory, but were excluded if they had neurological diseases or cognitive impairment. Each participant gave written informed consent before any testing commenced. The University's Human Research Ethics Committee (HE05/169) approved all recruiting and testing procedures.

Each participant's

Obesity prevalence

One hundred and five (34%) participants were identified as obese (BMI >30) and 128 (41%) were overweight (25 < BMI < 30) [28]. Seventy-nine individuals (25%) had a BMI less than 25 and were therefore classified as not overweight (Table 1). The distribution of genders differed significantly between the three groups whereby there were a higher proportion of men in the overweight group (63.3%), whereas the non-overweight group had a higher percentage of women (62%).

Foot pain and health status

Obese participants had a

Discussion

This study comprehensively highlights the effects of obesity on foot structure and function, as well as the disabling foot pain suffered by community-dwelling older adults. Of concern was the finding that almost two-thirds of the obese participants reported foot pain, with 40% classified as having disabling foot pain. It is possible that foot pain severity was reflected in the SF-36 scores, whereby obese participants had a significantly lower total score, with the physical health dimension

Conclusions

Our study demonstrates that foot pain, foot structure, and foot function are compromised by excess mass in older adults. These changes to foot pain, structure and function resulted in functional limitations and a reduction in health-related quality of life, particularly in older adults classified as obese. Further research is recommended to determine whether interventions designed to reduce excess fat mass may relieve loading of the foot structures and, in turn, improve foot pain and quality of

Conflict of interest

There are no known relationships which could cause a conflict of interest between anyone involved in conducting this research.

Acknowledgements

This work was supported by the National Health and Medical Research Council, Australia (grant number 209799) and the Australian Podiatry Education and Research Foundation. The manuscript was written while Dr Mickle was a National Health and Medical Post-doctoral Fellow (Overseas Clinical Training Fellowship, ID 1016521).

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