Excessive Weight Bearing Compromises Foot Structure and Function Across the Lifespan

Abstract

The base of support for the musculoskeletal system during most physical activities is the feet. Feet are highly unique and flexible structures, which are required to perform extremely diverse functions, particularly during weightbearing tasks. Although feet that are structurally sound can usually perform tasks of daily living with ease, deviations from normal foot structure or alignment can compromise foot function and, in turn, cause discomfort or pain. Extensive research has confirmed that obesity negatively affects foot structure and function. Obese individuals have been found to have broader, thicker and flatter feet; generate significantly higher dynamic plantar pressures; and alter their foot mechanics during walking relative to their non-overweight counterparts. The need for overweight and obese individuals to bear excess body mass has also been associated with the development of musculoskeletal pain and discomfort in the feet, which can be severe enough to limit these individuals from participating in activities of daily living, work and recreation. As this can perpetuate the cycle of obesity, the compromised foot structure of obese individuals is deemed a major health issue. In this chapter, we review the effects of bearing excessive body mass on foot structure and function across a lifespan and, where possible, highlight the impact of this excessive weight bearing on the ability of individuals to perform activities of daily living. Based on the studies reviewed we recommend that evidence-based interventions be designed to reduce excess fat mass in overweight and obese individuals, focussing on non-weight bearing activities to relieve loading of their foot structures and, in turn, improve the quality of life of these individuals.

Flatfoot and obesity in school‐age children: a cross‐sectional study

“…School children with excess weight have been found to not enjoy physical activity as much as those with normal weight . This withdrawal from physical activity can exacerbate weight gain which aggregates the structural complications at the foot .…”

“…Excessive range of motion at two or more joints was considered as the sole requirement to diagnose whole‐body joint laxity . The presence of joint laxity in children with flatfoot is thought to be the underlying mechanism of flatfoot deformity . To measure the range of dorsiflexion, the fulcrum of goniometer was below the lateral malleolus, the fixed arm placed on the lateral longitudinal line of the shank (lining up with the head of the fibula) and moveable arm positioned parallel to the longitudinal axis of the fifth metatarsal .…”

“… Longitudinal arch angle. The superior angle between lines connecting navicular tuberosity to the medial malleolus and the head of metatarsal bone was measured. …”

“…It is therefore crucial to be aware of the occurrence of musculoskeletal problems in children with excess weight to use the appropriate interventions to address these problems proactively. The foot provides a base of support for the musculoskeletal system and thus plays an essential role during weight‐bearing activities . The factors affecting the normal development of the foot in children can induce persistent problems in both childhood and adulthood .…”

“…The other type of flatfoot, which is believed to be a pathologic condition, involves structural deformities with higher complaints and is therefore entitled ‘rigid flatfoot’ . Rigid flatfoot requires extensive care, whereas the flexible flatfoot often could be modified in developing feet . Despite this perceived difference, there was no clear distinction between flexible and rigid flatfoot within the previous literature reporting the effects of childhood obesity on the foot structure.…”