Foot and Ankle Specialist: Obesity, Feet, and the Impact on Health Care

Dr. Weil Jr., who also serves as the editor of Foot and Ankle Specialist, wrote an editorial entitled, Obesity, Feet, and the Impact on Health Care, for the publication's latest issue. We have provided a sample of the article here on the blog, but be sure to head over to our site or the Foot and Ankle Specialist to read the full publication.

Over the last year, my Fellow Erin Klein, decided to take on projects looking at how Body Mass Index (BMI) influences several common foot and ankle problems.  Our data base includes BMI measurements for all patients dating back to before 2000.  She was able to isolate thousands of patients with diagnoses of plantar fasciitis, Achilles tendonapathy and adult onset flatfoot deformity.  She created a control group of patients whose diagnosis would not typically be associated with increased BMI (toenail conditions, neuroma, ankle sprains).  Comparisons were made between the control groups and the conditions that would be associated with increased BMI.  Additionally, the BMI measurements were assessed to evaluate success of treatment in the study groups.  Many conclusions were made from the research including: 1. Patients in the plantar fasciitis, Achilles tendonapathy, and adult onset flatfoot had higher BMI than control group, 2. Patients with higher BMI had less success with typical conservative alternatives, and 3. Our patients, as a whole, had a high BMI. Obesity in the United States is reaching epidemic proportions.  Statistics on the growth of obesity are staggering.  This was once considered a problem of the United States but other countries around the globe are starting to have similar problems and in India, the second most populous country in the world, their obesity rates are increasing at a much higher rate than in the U.S. Obesity is often associated with lower socioeconomics due to poor nutrition and healthcare.  However, our practice is heavily weighted toward middle to upper middle class.  This is not a problem of a certain class but a problem with all society. We looked at some common foot and ankle conditions and the influence of obesity.  Clearly these are not the most important problems associated with the disease, but illustrate the influence that obesity has on people’s lives.  Diabetes, heart disease, hypertension, and cancer are examples of critical medical problems associated with obesity.  There are few medical conditions that cannot be negatively associated with obesity. As we treat foot and ankle problems, we are in the trenches of how obesity affects people.  We illustrated how common foot and ankle problems are associated with increased BMI.  With these foot and ankle problems, people are unable to exercise due to the pain of the condition.  Lack of exercise often results in increased BMI and now we get a downward spiral.  This all leads to worsening of the patients overall health and we see it in advanced diabetic problems (neuropathy, PVD, wounds, Charcot) and worsening deformities that require surgical intervention, but that surgery becomes more difficult and risky with increased BMI and their co-morbidities.