Weight gain can trigger foot and ankle pain

Washington -- Add foot pain to the growing catalog of health concerns that result from weight gain. About a year ago, a group of foot and ankle specialists looked out at their full waiting rooms and asked: As we are getting heavier, are we crushing our feet?

Not surprisingly, the answer they found was yes.

The rising level of obesity now appears to be taking a toll on the nation's health from head to toe. Feet and ankle problems have been placed on the list of weight-related conditions, which already includes increased risk of strokes, diabetes and heart disease.

For example, respondents to an online survey who reported that they had had foot surgery, seen a physician for foot or ankle pain or changed shoes based on physician advice were also likely to be heavier than normal. Their average body mass index was 27.9 kg/m. Desireable BMI is 18.5 to 24.9 kg/m.

In addition, nearly 41% reported gaining weight before the onset of pain.

The online survey, which tallies more than 6,000 respondents, was launched early last year by the education committee of the American Orthopaedic Foot and Ankle Society and is being offered as evidence that weight gain is indeed triggering foot pain. The committee will continue to analyze the data and will present more complete findings at the society's meeting this summer in Boston.

The weight doesn't even have to be substantial to have an impact. The committee found that a gain of even 10 pounds could trigger a foot problem, said committee member Stuart D. Miller, MD, an orthopedic surgeon at Union Memorial Hospital in Baltimore, Md.

Dr. Miller was presenting the survey results Feb. 25 at the annual meeting of the American Academy of Orthopaedic Surgeons. The education committee is intent upon letting fellow physicians know what to look for among their overweight patients. Often misdiagnosed as a sprain, ankle pain can be the sign of an overloaded tendon, Dr. Miller said.

"When we went from four on the floor to two on the floor, we put a lot of stress on tendons," he said.

Bracing against trouble

Treatment with bracing or arch supports as early as possible can help reduce some stress and lower the odds that a tendon or ligament will be permanently damaged and repairable only with surgery, Dr. Miller said.

Common trouble spots include inflammation in the tendon that runs along the inside of the ankle, or posterior tibial tendonitis; an inflammation in the thick ligamentous connective tissue that runs from the heel to the ball of the foot, known as plantar fasciitis; and an inflammation in the back part of the foot, or hindfoot arthritis.

"In general, people carry approximately four to six times their body weight across the ankle joint when climbing stairs or walking on steep inclines," Dr. Miller said. "It is important for the public to know that obesity isn't just an aesthetic issue but a contributing cause of musculoskeletal health problems specifically with the feet and ankles."

Shoes are another important consideration, added Sharon M. Dreeben, MD, chair of the Foot and Ankle Society's education committee and an orthopedic surgeon in La Jolla, Calif. A 2½-inch high heel can increase the load on the forefoot by 75%, she said.

"An uncomfortable shoe can lead to more serious foot problems," Dr. Miller said. "It is important to wear proper shoes, because in the long run, fashion is not worth the price of pain."

High heels could be one of the reasons that the education committee survey found that women reported seeing a physician for foot pain more frequently than did men. Women also were more likely to change their shoes on the advice of a physician and were more likely to have undergone foot or ankle surgery.

Men, the survey found, were more likely to claim a specific injury as the source of foot or ankle pain and were more likely to wear orthotic inserts in their shoes.