Weight management and your foot health

Successful weight loss programs always include a protocol for reducing caloric intake AND increasing physical activity. There is no quick way to lose weight successfully. Diet without exercise WILL NOT work. It will mean a lifestyle change which will include adequate regular exercise and diet. If you suffer from FOOT OR ANKLE PAIN that limits your ability to participate fully you will find that your results will be compromised.

The biomechanics

There is a substantial difference in the biomechanics of the lower extremity in the overweight patient. These patients take shorter steps, have a wider walking pattern, and move more slowly. The general biomechanical effects include outward rotation at the hips, alteration of knee position, and significant inward rolling of the ankles and collapsing of the foot structure. In general, patients carry approximately four to six times their body weight over the ankle when climbing stairs or walking up an incline. A 2 inch high heel will increase the load on the forefoot by 75 percent. Feet are small in relation to the rest of the body. The impact of every step exerts a significant force on them. This pressure is approximately 50 percent greater than the persons body weight. During a typical day the average patient will stand for hours on their feet and take between 8,000 and 10,000 steps. The end result is a combined force equivalent to several hundred tons each day. Increased weight results in excessive pressure with the greater effect under the arch and ball of foot. A recent study indicates even a 10 pound weight gain is sufficient to initiate the development of foot or ankle problems.


X-ray of side view of foot


X-ray of side view of foot

Painful foot and ankle conditions

Common foot and ankle pathology that develop as a result of an overweight condition include plantar fasciitis, heel spurs, tendonitis, arthritis, fractures, and ankle synovitis, just to name a few. It is important to remember these are not only adult problems.

Plantar fasciitis/Heel spurs

Patients that are prone to developing plantar fasciitis will evolve to heel spur formation without treatment. Generally speaking a genetic inherited weakness in the foot structure will place additional strain at the attachment site of the plantar fascia on the heel. When this situation is present coupled with any form of weight gain the strain will be magnified several fold. When the tearing and inflammation go unchecked, the body’s natural course is to begin bone formation. This condition is called periostitis. It is the precursor to the formation of a full blown heel spur. The heel spur usually grows parallel with the supporting surface, in the direction of the pull of the plantar fascia. Typically the first few steps out of bed in the morning and walking after resting produce the worst pain. Treatment options consist of exercises, physical therapy, oral anti-inflammatories, steroid injections, biomechanical orthotics (prescription shoe inserts), or any of the minimally invasive surgeries available today. Statistically approximately 70 percent of the patients suffering from heel pain syndrome will resolve with conservative care.

Tendonitis

The two most common tendons affected are the Achilles, and posterior tibial. The Achilles tendon is the large tendon in the back of the leg that attaches to the rear portion of the heel bone. The posterior tibial tendon also travels from the leg and attaches to the inside portion of the arch. The alteration of the biomechanical function of the foot and ankle place abnormal strain on the Achilles tendon during the time when the heel has contacted the ground just prior to the ball of the foot reaching the supporting surface to decelerate the impact. It is also responsible for the contraction to lift the heel from the ground and initiate a step. Obviously excessive weight increases the demand on this tendon substantially. The posterior tibial tendon strives to prevent collapse in the arch by contracting, and attempting to lift the bones in the middle of the foot. Again excessive strain produces inflammation. These structures may also suffer internal tears or ruptures as a result of their overworked status. Treatment options vary according to the severity of the condition the patient presents with. Splinting, bracing, immobilization, rest, ice, oral anti-inflammatories, and possibly surgery in severe circumstances may be offered. Biomechanical orthotics are almost always a must after successful resolution of the injury.

Arthritis

Osteoarthritis (wear and tear) is the most common type of cartilage pathology that joints may suffer as a result of excessive pressure. There is no prevention. It is part of the natural aging process. It is accelerated/complicated with increased weight. The larger joints tend to suffer first. The knee and ankle in the lower extremity are prime targets. Anti-inflammatories, reasonable exercise programs, weight loss, and joint reconstructions are frequent treatment alternatives.

Fractures

Fractures of the heel bone and long bones near the ball of the foot are the most frequent seen in the overweight patient. Treatment options are directed toward immobilization to permit natural healing to occur. Occasionally surgical reconstruction is necessary. After a satisfactory recovery has been achieved, reducing/eliminating the factor, or factors, that permitted the injury are a primary focus for the physician and patient.

Ankle synovitis

Severe inflammation in the ankle joint without the presence of arthritis or other traumatic injury may be identified as synovitis. This is an inflammation in the lining of the ankle joint capsule. The capsule is a membranous structure that encloses the ankle joint retaining the fluid within the joint for lubrication. The lining of this membrane is referred to as the synovial lining. It provides nutrition to the cartilage surfaces. Inflammation causes a swelling and enlargement of this lining. Feather-like projections may grow from the lining to the internal bony structures. With activity these attachments are torn, may bleed into the tissues, and create a significant state of inflammation and pain. Rest, biomechanical control, weight loss, physical therapy, oral anti-inflammatories, and possible arthroscopic surgery may be necessary to resolve the pain.

We are dedicated to helping your feet last a lifetime with as little or no pain as possible on a permanent basis. We want to be your partner and assist you in any way possible to enhance your chance for success. If you are dealing with any foot or ankle condition and think we may be of assistance, take the "first step" and contact our office.

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Weight Management and Your Foot Health