Influence of obesity and sarcopenic obesity on plantar pressure of postmenopausal women

Influence of motor capacity of the lower extremity and mobility performance on foot plantar pressures in community-dwelling older women

Objectives

To investigate the associations of motor capacity of the lower extremity and mobility performance in daily physical activities with peak foot plantar pressures during walking among older women.

Methods

Using the data collected among 58 community-dwelling older women (68.66 ± 3.85 years), Pearson correlation and multiple linear regression analyses were performed to analyze the associations of motor capacity of the lower extremity (the 30-s chair stand test, the timed one-leg stance with eyes closed, and the Fugl-Meyer assessment of lower extremity), mobility performance in daily physical activities (the average minutes of moderate to vigorous physical activity every day and the metabolic equivalents), and foot plantar pressures (peak force and peak pressure) with the age and body fat percentage as covariates.

Results

(1) The motor capacity of the lower extremity has higher explanatory power for peak foot plantar pressures compared with the mobility performance in daily physical activities. (2) Higher body fat percentage was positively associated with peak force and pressure, while a lower score on the Fugl-Meyer assessment of lower extremity was negatively associated with both of them. (3) The metabolic equivalents were positively associated with the peak force, while the 30-s chair stand test was negatively associated with it.

Conclusions

Mobility performance in daily physical activities can be significant predictors for peak foot plantar pressures among older women. The significant predictor variables include the Fugl-Meyer assessment of lower extremity, the 30-s chair stand test, and metabolic equivalents.

The distribution of pressure forces of the foot on the ground during gait in patients with hip osteoarthritis

BACKGROUND

Hip osteoarthritis is a major civilizational challenge of the ageing population, usually due to the reduced function of gait. In the light of this fact, gait analysis has become an important issue for the doctor, the physiotherapist and the patient, as it serves as a useful tool in diagnosis, recovery, and rehabilitation. Pedobarography is one of the most modern gait analysis methods.

OBJECTIVE

The aim of this study is to assess the distribution of pressure forces of the foot on the ground during gait in patients with hip osteoarthritis.

METHODS

Dynamic foot tests were performed by means of a two-meter RSscan® International platform, equipped with 16.384 sensors with the scanning frequency level exceeding 500 Hz. Patients were divided into two groups: the research group of N= 60 individuals with hip osteoarthritis, aged 52-84; and the control group of N= 32 individuals without hip osteoarthritis, aged 50-74. Data distribution analysis was performed with the Shapiro-Wilk test, followed by a non-parametric Mann-Whitney U test.

RESULTS

The differences between the mean results of maximal peak values of pressure and force in such areas as the big toe, metatarsal I, III, IV, V, lateral and medial heel are significantly lower in the research group than in the control group. Only in the area of metatarsal II, the mean value of pressure is higher in the research group than in the control group. For all metatarsals, the midfoot and medial heel mean results of the contact area are significantly higher in the research group than in the control group. The differences between mean load rate were also tested. The test revealed statistical significance of metatarsal II and III, and the medial heel while metatarsal II displayed a higher mean value in the research group than in the control group.

CONCLUSION

The distribution of the pressure forces of the foot can indicate imbalances which cause degenerative changes. Therefore, early detection of changes can help in prevention or delay of hip osteoarthritis in conjunction with proper therapy.

Sarcopenia, Obesity, and Sarcopenic Obesity: Relationship with Skeletal Muscle Phenotypes and Single Nucleotide Polymorphisms

Obesity may aggravate the effects of sarcopenia on skeletal muscle structure and function in the elderly, but no study has attempted to identify the gene variants associated with sarcopenia in obese women. Therefore, the aims of the present study were to: (1) describe neuromuscular function in sarcopenic and non-sarcopenic women with or without obesity; (2) identify gene variants associated with sarcopenia in older obese women. In 307 Caucasian women (71 ± 6 years, 66.3 ± 11.3 kg), skeletal muscle mass was estimated using bioelectric impedance, and function was tested with a 30 s one-leg standing-balance test. Biceps brachii thickness and vastus lateralis cross-sectional area (VL_ACSA) were measured with B-mode ultrasonography. Handgrip strength, maximum voluntary contraction elbow flexion (MVC_EF), and knee extension torque (MVC_KE) were measured by dynamometry, and MVC_KE/VL_ACSA was calculated. Genotyping was performed for 24 single-nucleotide polymorphisms (SNPs), selected based on their previous associations with muscle-related phenotypes. Based on sarcopenia and obesity thresholds, groups were classified as sarcopenic obese, non-sarcopenic obese, sarcopenic non-obese, or non-sarcopenic non-obese. A two-way analysis of covariance was used to assess the main effects of sarcopenia and obesity on muscle-related phenotypes and binary logistic regression was performed for each SNP to investigate associations with sarcopenia in obesity. There were no significant obesity * sarcopenic status interactions for any of the investigated muscle-related phenotypic parameters. Neither sarcopenia nor obesity had a significant effect on biceps brachii thickness, but sarcopenia was associated with lower VL_ACSA (p = 0.003). Obesity was associated with lower MVC_EF (p = 0.032), MVC_KE (p = 0.047), and MVC_KE/VL_ACSA (p = 0.012) with no significant effect of sarcopenia. Adjusted for age and height, three SNPs (ACTN3 rs1815739, MTHFR rs1801131, and MTHFR rs1537516) were associated with sarcopenia in obese participants. Sarcopenia was associated with a smaller muscle size, while obesity resulted in a lower muscle quality irrespective of sarcopenia. Three gene variants (ACTN3 rs1815739, MTHFR rs1801131, and MTHFR rs1537516) suspected to affect muscle function, homocysteine metabolism, or DNA methylation, respectively, were associated with sarcopenia in obese elderly women. Understanding the skeletal muscle features affected by sarcopenia and obesity, and identification of genes related to sarcopenia in obese women, may facilitate early detection of individuals at particular risk of sarcopenic obesity.

Children with Obesity Experience Different Age-Related Changes in Plantar Pressure Distributions: A Follow-Up Study in China

Age is a key factor in plantar pressure distributions during the development of obese children. However, the existing evidence for age-related plantar pressures of obese children is not sufficient to make clear how the plantar pressures would change with the increasing age. This study aimed to evaluate the plantar pressure redistributions of obese children after a three-year follow-up and to further compare these changes with normal-weighted children. Ten obese children and eleven normal-weighted counterparts were involved in this study. Plantar pressure measurements were undertaken using a Footscan^® plantar pressure plate on two test sessions three years apart. Peak pressure, pressure-time integral, standard maximum force, and z-scores of these variables were analyzed. Loading transference analyses were applied to detect the different loading transferring mechanisms between obese and normal-weighted children. Significantly increased plantar pressures were observed at the lateral forefoot and midfoot for obese children, which gradually deviated from those of normal-weighted children over the 3 years. With the increasing age, obese children displayed a lateral loading shift at the forefoot in contrast to the normal-weighted. Early interventions are cautiously recommended for obese children before the plantar loading deviation gets worse as they grow older.

Effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity in women

PURPOSE

This study investigated the effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity participation in women living independently in the community.

METHODS

A total of 378 women were divided into 3 groups (Not Overweight: body mass index (BMI) = 22.5 ± 0.2 kg/m² (mean ± SE); Overweight: BMI = 27.4 ± 0.3 kg/m²; Obese: BMI = 35.4 ± 0.3 kg/m²). Outcome variables of breast volume (mL), thoracic flexion torque (N·m), thoracic kyphosis (degrees), upper torso musculoskeletal pain (score) and time spent in physical activity (min) were calculated and compared among the 3 groups, adjusting for between-group differences in age.

RESULTS

There was a significant main effect of BMI on all outcome variables. Participants classified as Obese displayed significantly larger breasts, had greater thoracic flexion torques and reported less time participating in physical activity relative to the participants who were classified as Not Overweight and Overweight. Participants in the Obese group also displayed significantly more thoracic kyphosis and reported significantly more upper torso musculoskeletal pain compared to their counterparts who were classified as Not Overweight.

CONCLUSION

This study is the first to demonstrate that increased obesity levels were associated with compromised kyphosis and loading of the thoracic spine, as well as increased symptoms of upper torso musculoskeletal pain and reduced time spent in physical activity in women living in the community. We recommend further research to determine whether evidence-based interventions designed to reduce the flexion torque generated on the thoracic spine can improve these symptoms of upper torso musculoskeletal pain and the ability of women with obesity to participate in physical activity.

Impact of rocker sole footwear on plantar pressure distribution during standing and walking in adult obese women

Purpose: Obesity increases the stresses applied to the foot. Ergonomic rocker sole shoes increase energy expenditure of standing and walking in obese individuals but could potentially alter plantar pressure distribution. The aim of this study was to compare plantar pressure distribution during standing and walking between rocker sole and flat-bottomed shoes in obese subjects.Methods: Twenty adult obese women were asked to stand quietly and to walk at their preferred walking speed whilst wearing flat-bottomed or rocker sole shoes. Plantar pressure distribution was assessed using instrumented insoles.Results: During standing, toe pressure and as well as midfoot force were higher with rocker sole than with flat-bottomed shoes (p < 0.05). During walking with rocker sole shoes, mean pressure and maximal force were lower under the toes and the forefoot, but higher under the midfoot and rearfoot regions with respect to flat-bottomed shoes (p < 0.05).Conclusions: While standing with rocker sole shoes, obese subjects showed augmented pressure under the toes whereas forefoot and heel pressure had no significant difference compared to the flat-bottomed shoes. As walking with rocker sole shoes resulted in decreased forces and pressures under the forefoot but increased overload at heel and midfoot regions, obese individuals may not benefit from wearing rocker sole shoes during walking, at least from a plantar pressure distribution perspective.Implications for rehabilitationThe use of ergonomic rocker sole shoes causes a redistribution of in-shoe plantar pressures leading to potentially detrimental adjustments that fail to attenuate the obesity-related increase in midfoot pressure during standing, while accentuating this region-specific impairment in dynamic conditions.Rocker sole shoes may best be avoided for walking in obese patients with heel pain or with any midfoot/rearfoot alteration such as medial arch flattening.

Use of various obesity measurement and classification methods in occupational safety and health research: a systematic review of the literature

BACKGROUND

This study systematically examined obesity research in occupational safety and health regarding the use of various obesity measurement and classification methods.

METHODS

A systematic search of the PubMed database on English language publications from 2000 to 2015 using related keywords and search of citations resulted in selection of 126 studies. They were categorized into two groups based on their main research question: 1) general physical or mental work-related functioning; and 2) task or body part specific functioning.

RESULTS

Regardless of the study group, body mass index (BMI) was the most frequently used measure. Over 63% of the studies relied solely on BMI to define obesity. In only 22% of the studies, body fat was directly measured by methods such as dual energy x-ray absorptiometry. Abdominal obesity was defined using waist circumference in recent years, and waist-hip ratio in earlier years. Inconsistent cut-offs have also been used across studies investigating similar topics.

CONCLUSIONS

Few authors acknowledged the limitations of using indirect obesity measures. This is in part due to the limited understanding of some occupational safety and health researchers regarding the complex issues surrounding obesity classification and also the mixed recommendations over the past 2-3 decades and across populations. Efforts need to be made to promote appropriate obesity measurement and reporting in this field.

Differences in foot contact times between obese and non-obese postmenopausal women when crossing obstacles

OBJECTIVE

This study aimed to investigate the foot contact time differences between obese and non-obese subjects during walking when crossing obstacles.

METHODS

Ninety-eight postmenopausal women were assigned to four groups, and their plantar pressure temporal data were collected using a two-step protocol during walking when crossing an obstacle set at 30% height of lower limb length of each subject. The initial, final, and duration of contact of 10 foot areas were measured.

RESULTS

Leading limb: (1) the heel groups initiated foot contact using the heel, and the non-heel groups initiated contact using the metatarsals; (2) heel obese subjects showed an earlier initial contact and a longer contact duration of metatarsals 2-3; (3) non-heel obese subjects showed an earlier midfoot initial contact. Regarding the trailing limb: (4) heel obese subjects showed an earlier midfoot initial contact and a longer contact duration of metatarsal 5; (5) non-heel obese subjects showed an earlier initial contact and a longer contact duration of metatarsals 4-5.

CONCLUSIONS

(1) The non-heel groups' foot rollover pattern may result from an attempt of rapidly restoring stability; (2) the heel obese subjects seem to regulate their plantar foot muscles to overcome their overweight; (3) the overweight of the non-heel obese subjects leads to a quicker backward foot roll-over from the metatarsals to the heel; (4) the overweight of the heel obese subjects can distort their footprints and/or their higher inertia may precipitate an anticipation of the midfoot contact, which can also explain the result observed for 5.

Sex Differences in Pedobarographic Findings and Relationship between Radiographic and Pedobarographic Measurements in Young Healthy Adults

Background

Although pedobarographic measurement is increasingly used for clinical and research purposes, relatively few published studies have investigated normative data. This study examined pedobarographic findings in young healthy adults with regard to sex-related differences and correlations among measurement indices.

Methods

Twenty young healthy adults (mean age, 22.4 years; standard deviation, 1.2 years; and 10 males and 10 females) were included. Weight bearing anteroposterior (AP) and lateral foot radiographs were taken, and dynamic pedobarographic data during treadmill walking and maximum ankle dorsiflexion were obtained. AP talo-first metatarsal angle, naviculocuboid overlap, lateral talo-first metatarsal angle, and plantar soft tissue thickness were measured on foot radiographs. Pedobarographic data including peak pressure and pressure-time integral were measured on five plantar segments: medial forefoot (MFF), lateral forefoot (LFF), medial midfoot (MMF), lateral midfoot (LMF), and heel.

Results

Male and female subjects significantly differed in body mass index (BMI, p < 0.001), AP talo-first metatarsal angle (p = 0.018), soft tissue thickness under the metatarsal head (p = 0.040) and calcaneal tuberosity (p < 0.001), maximum dorsiflexion during stance phase (p = 0.041), peak pressure on the MFF (p = 0.005) and LFF (p = 0.004), and pressure-time integral on the MFF (p = 0.018) and heel (p = 0.001). BMI was significantly correlated with soft tissue thickness under the metatarsal head (r = 0.521, p = 0.018) and calcaneal tuberosity (r = 0.585, p = 0.007), peak pressure on the MFF (r = 0.601, p = 0.005) and LFF (r = 0.487, p = 0.029), pressure-time integral on the heel (r = 0.552, p = 0.012), and total pressure-time integral (r = 0.755, p < 0.001). Maximum dorsiflexion demonstrated significant negative correlations with pressure-time integral on the MFF (r = −0.595, p = 0.007) and total pressure-time integral (r = −0.492, p = 0.032). Pressure-time integral varus/valgus index was significantly correlated with pressuretime integral forefoot/heel index (r = 0.472, p = 0.036).

Conclusions

Sex-related differences in pedobarographic examination were observed, which could provide useful information in setting appropriate treatment goals and obtaining appropriate control data. The effects of subtalar motion in distributing plantar pressure should be investigated in a future study.

Obesity is Associated With Altered Plantar Pressure Distribution in Older Women

Increased plantar pressure has been found to be related with greater risk of falling. Although there is evidence suggesting that obesity is linked to foot disorders, the association between obesity and plantar pressure of older adults has been poorly investigated. The purpose of this study was to examine the association between obesity and plantar pressure distribution and to explore its relationship with body fat distribution. Two hundred and eleven older women took part in this cross-sectional study. Body mass index was taken for obesity classification. Whole body, android, and gynoid fat percentage was assessed using dual-energy x-ray absorptiometry. Peak plantar pressure was evaluated during gait using an Emed AT-4 pressure platform. Obese volunteers generated greater peak pressure at midfoot (187.26 kPa) compared to both normal weight (128.52 kPa, p < .001) and overweight (165.74 kPa, p < .001). Peak plantar pressure at midfoot was also greater in overweight compared to normal weight (p < .001). At forefoot, peak pressure was higher in the obese (498.15 kPa) compared to normal weight volunteers (420.41 kPa, p = .007). Additionally, whole body, android, and gynoid fat percentage were significantly associated with peak pressure at midfoot and forefoot. Therefore, clinicians dealing with falls should consider the effect of increased body weight on plantar pressure.

Evaluation of Plantar Pressure Distribution in Relationship to Body Mass Index in Czech Women During Walking

BACKGROUND

Excessive body weight seems to be a risk factor for foot loading. We sought to investigate the effect of different body mass index (BMI) levels on plantar pressure distribution during walking.

METHODS

In total, 163 women aged 45 to 65 years (mean ± SD: age, 57.4 ± 5.3 years; BMI, 27.0 ± 5.3) participated in the study. The women were divided, on the basis of BMI, into a normal-weight, overweight, or obese group. The study used the four following plantar pressure parameters (PPPs): contact percentage, absolute pressure impulse, relative pressure impulse, and absolute peak pressure, which were recorded in ten foot regions using a pressure measurement system.

RESULTS

The normal-weight group, compared with the overweight and obese groups, had significantly lower absolute PPP values. In the hallux, second through fifth metatarsals, midfoot, and heel regions, we observed significant between-group differences in the two absolute PPPs (peak pressure and pressure impulse) (P < .001). Between-group differences in the relative PPPs were found in the fourth metatarsal, midfoot, and medial heel (relative impulse) and in the second metatarsal (contact percentage) (P < .001).

CONCLUSIONS

Higher BMI values correspond to a higher load on the foot during walking in women. The relative foot load in obese women is characterized by a pressure increase in the lateral forefoot and midfoot and by a pressure decrease in the medial heel.

The relationship between foot posture index, ankle equinus, body mass index and intermetatarsal neuroma

Background

The main purpose of this study was to investigate the presence of an association between intermetatarsal neuroma and foot type, as measured by the Foot Posture Index. The study also examined whether there was a relationship between foot type and the interspace affected with intermetatarsal neuroma, and whether ankle equinus or body mass index had an effect.

Methods

In total, 100 participants were recruited from The University of Western Australia’s Podiatry Clinic, 68 of whom were diagnosed with inter-metatarsal neuroma from 2009 to 2015. There were 32 control participants recruited from 2014 to 2015. The age of subjects was recorded, as were weight and height, which were used to calculate body mass index. The foot posture index and ankle dorsiflexion were measured using standard technique. Independent t-tests and Kruskal-Wallis tests were used to compare differences in foot posture index, body mass index and ankle dorsiflexion between the inter-metatarsal neuroma and control groups. Multivariable logistic regression was also used to model relationships for outcome.

Results

The 68 intermetatarsal neuroma subjects had a mean age of 52 years (range 20 to 74 years) and comprised of 56 females and 12 males. The 32 control subjects had a mean age of 49 years (range 24 to 67 years) with 26 females and six males. There were no significant differences between the control and the intermetatarsal neuroma groups with respect to the mean foot posture index scores of the left and right foot (p = 0.21 and 0.87, respectively). Additionally no significant differences were detected between the affected intermetatarsal neuroma interspace and foot posture index (p = 0.27 and 0.47, respectively). There was no significant difference in mean body mass index between the intermetatarsal neuroma (26.9 ± 5.7) and control groups (26.5 ± 4.1) (p = 0.72). There was, however, a significant difference in mean ankle dorsiflexion between the intermetatarsal neuroma and control groups (p < 0.001 for both feet). Logistic regression models, adjusted for age, sex, foot posture index and body mass index estimated that the odds of having an intermetatarsal neuroma in the right foot increased by 61% (OR 1.61; 95% CI 1.32–1.96) with each one degree reduction of ankle dorsiflexion, and in the left foot by 43% (OR 1.43; 95% CI 1.22–1.69).

Conclusion

No relationships were found between foot posture index and body mass index with intermetatarsal neuroma, or between foot posture index and the interspaces affected. However, a strong association was demonstrated between the presence of intermetatarsal neuroma and a restriction of ankle dorsiflexion.

Effects of Age on Strength and Morphology of Toe Flexor Muscles

Study Design Descriptive, cross-sectional. Background Age-related muscle atrophy is common in lower-limb muscles. We therefore speculated that foot muscles may also diminish with age. However, there is a paucity of literature characterizing foot muscle strength and morphology, and any relationship between these 2, in older people. Objective To compare the strength and size of the toe flexor muscles of older adults relative to their younger counterparts. Methods Seventeen young adults with a normal foot type were matched by sex and body mass index to 17 older adults with a normal foot type, from an available sample of 41 younger (18 to 50 years of age) and 44 older (60 or more years of age) adults. Among the matched groups (n = 34), muscle thickness and cross-sectional area for 5 intrinsic and 2 extrinsic toe flexor muscles were obtained using ultrasound. Toe strength was assessed using a pressure platform. Differences in toe flexor strength and muscle size between the young and older matched groups were determined using analysis of covariance (controlling for height). Correlations between strength and size of the toe flexor muscles of the pooled group (n = 34) were also calculated. Results Toe strength and the thickness and cross-sectional area of most foot muscles were significantly reduced in the older adults (P<.05). Hallux and toe flexor strength values were strongly correlated with the size of the intrinsic toe flexor muscles. Conclusion The smaller foot muscles appear to be affected by sarcopenia in older adults. This could contribute to reduced toe flexion force production and may affect the ability of older people to walk safely. Interventions aimed at reversing foot muscle atrophy in older people require further investigation. J Orthop Sports Phys Ther 2016;46(12):1065-1070. Epub 29 Oct 2016. doi:10.2519/jospt.2016.6597.

Sarcopenic Obesity: An Appraisal of the Current Status of Knowledge and Management in Elderly People

Today's increased life expectancy highlights both age-related changes in body composition and a higher prevalence of obesity. Sarcopenic obesity (SO) is assuming a prominent role in cardio-metabolic risk because of the double metabolic burden derived from low muscle mass (sarcopenia) and excess adiposity (obesity). This review evaluates the related studies that have been published over the past 10 years in order to give an updated overview of this new syndrome. There is no consensus on the definition of SO due to the wide heterogeneity of diagnostic criteria and choice of body composition components needed to assess this phenotype. There is a growing body of evidence that the ethio-pathogenesis of SO is complex and multi-factorial, as the consequences are a combination of the outcomes of both sarcopenia and obesity, where the effects are maximised. In order to manage SO, it is important to make lifestyle changes that incorporate weight loss, physical exercise and protein supplementation.

The effects of backpack loads and spinal stabilization exercises on the dynamic foot pressure of elementary school children with idiopathic scoliosis

[Purpose] The purpose of this study was to measure and observe the changes in dynamic plantar pressures when school children carried specific bag loads, and to determine whether improved physical balance after an eight-week spinal stabilization exercise program can influences plantar pressures. [Subjects] The subjects were 10 school students with Cobb angles of 10° or greater. [Methods] Gait View Pro 1.0 (Alfoots, Korea) was were based on to measure the pressure of the participants' feet. Spinal stabilization exercises used TOGU Multi-roll Functional (TOGU, Germany) training. Dynamic plantar pressures were measured with bag loads of 0% no bag and 15% of subjects' body weight. The independent t test was performed to analyze changes in plantar pressures. [Results] The plantar pressure measurements of bag load of 0% of subjects' body weight before and after the spinal stabilization exercise program were not significantly different, but those of two foot areas with a 15% load were statistically significant (mt5, 67.32±24.25 and 51.77±25.52 kPa; lat heel, 126.00±20.46 and 102.08±23.87 kPa). [Conclusion] After performance of the spinal stabilization exercises subjects' overall plantar pressures were reduced, which may suggest that physical balance improved.

Chronic pain management in the obese patient: a focused review of key challenges and potential exercise solutions

In obese persons, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity modulates pain via several mechanisms such as mechanical loading, inflammation, and psychological status. Pain in obesity contributes to deterioration of physical ability, health-related quality of life, and functional dependence. We present the accumulating evidence showing the interrelationships of mechanical stress, inflammation, and psychological characteristics on pain. While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%-71.4% depending on the study design and intervention used. While published attrition rates with regular exercise are high (∼50%), adherence to exercise may be enhanced with modification to exercise including the accumulation of several exercise bouts rather than one long session, reducing joint range of motion, and replacing impact with nonimpact activity. This field would benefit from rigorous comparative efficacy studies of exercise intensity, frequency, and mode on specific and general musculoskeletal pain in young and older obese persons.

Foot posture, range of motion and plantar pressure characteristics in obese and non-obese individuals

Obesity is a world-wide health problem and is strongly associated with musculoskeletal disorders of the lower limb. The aim of this study was to evaluate plantar loading patterns in obese and non-obese individuals, while accounting for the contribution of foot structure, range of motion and walking speed. Sixty-eight participants (mean±SD age, 52.6±8.0 years), including 47 females (69%), underwent assessments of body mass index, foot pain and foot structure. Plantar pressures were also obtained, using a floor-mounted resistive sensor mat system. Multiple regression analysis was used to determine which variables were most strongly associated with plantar loading patterns. Obese individuals exhibited flatter feet, reduced inversion-eversion range of motion, and higher peak plantar pressures when walking. After accounting for foot structure and walking speed, bodyweight was found to be significantly associated with elevated loading of the foot, particularly the forefoot and midfoot. These findings suggest that obesity increases the stresses applied to the foot directly, via increased bodyweight, and indirectly, via alterations to foot structure, which may partly explain the link between obesity and the development of foot pain. Clinicians dealing with foot problems should consider the effect of increased bodyweight on plantar loading in obese patients.

The relationship between body mass index and footprint parameters in older people

BACKGROUND

The relationship of body mass index (BMI) with footprint parameters has been studied in paediatric populations, but there are limited data regarding the effects of BMI on parameters in the elderly.

OBJECTIVES

To establish the relationship between BMI and static footprint parameters in the elderly population.

METHODS

128 subjects aged 65 and above with no history of lower extremity surgical intervention and no significant lower extremity weakness were included in the current study. BMI and footprint parameters of arch angle, Chippaux-Smirak index (CSI), Staheli index (SI), arch index (AI) and footprint index (FI) were measured for each subject, and statistical analysis was done to investigate the correlation between BMI and the parameters.

RESULTS

Weak correlations detected between all calculated indices and angles with BMI, except the left foot arch angle. CSI, SI and AI of the right foot were found to be positively correlated with BMI, while a negative correlation between the arch angle and FI of right foot was shown with BMI.

CONCLUSIONS

The results reveal a relationship between BMI and footprint parameters that are indicative of flatfoot in the elderly. This could be due either to confounding of the footprint measure by fat or possibly due to an as yet unknown structural change that requires further evaluation.

C677T gene polymorphism of MTHFR and metabolic syndrome: response to dietary intervention

BACKGROUND

Methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms were found associated with body mass index (BMI)-defined obesity and lean mass. The aim of our study was to examine the role of the C677T MTHFR gene polymorphism in the response to diet in the management of metabolic syndrome. We investigated the body composition and metabolic factor changes after an hysocaloric balanced diet (HBD), in Italian obese women affected by metabolic syndrome (MS).

METHODS

Forty four obese women affected by MS were eligible for the study. A HBD for 12 weeks was assigned. Study participation included a complete screening for dietary habits, anthropometry, body composition, blood biochemical markers and C677T MTHFR polymorphism genotyping. The study has been registrated by ClinicalTrials.gov Id: NCT01890070.

RESULTS

The highest number of responders to HBD nutritional intervention were T(-) carriers (p ≤ 0.05). In the 81% of the total population a loss of Total Body Lean was observed. A significative loss (p ≤ 0.05) of Total Body Lean was observed in the 47% of T(-) carriers and in the 53% of T(+) carriers. Diastolic and systolic blood pressure, and waist circumference were reduced (p ≤ 0.05). The prevalence of MS parameters decreased by 84% for systolic and diastolic blood pressure; 79,5% for HDL cholesterol, 82% for fasting glucose and 77% for triglycerides.

CONCLUSIONS

MTHFR genetic variations analysis would be an innovative tool for the nutritional assessment. Our data provide the basis for personalized dietary recommendations based on the individual's genetic makeup and nutritional status.

TRIAL REGISTRATION

The study has been registrated by ClinicalTrials.gov Id: NCT01890070.

OPTIMAL ESTIMATION OF TOTAL PLANTAR FORCE FOR MONITORING GAIT IN DAILY LIFE ACTIVITIES WITH LOW-PRICE INSOLE SYSTEM

This study presented optimal estimation of total plantar force with a suitable sensor layout and a reliable equation for monitoring gait in daily life activities. The plantar pressure of 10 subjects during level walking was measured by Pedar® insoles at 100 Hz for establishing models and selecting the optimal one. Four types of virtual sensors with different sizes were designed. Stepwise linear regressions were performed to reconstruct total plantar force based on each particular type of virtual sensor. 14 models were established, which met the requirements of the explained variance of the regression model and the multicollinearity of the predictors. Estimated total plantar force from each model was compared with the real data from the Pedar® insoles. According to the correlation coefficient (R) and the root mean square error divided by the peak force (RMSE/PF), the optimal model had three sensors located under the heel and metatarsal. Another four subjects were used for validating the optimal model by performing level walking, running, vertical jump-landing, stair ascending and descending. For these five common activities, the correlation was high (R > 0.970) and the error was low (RMSE/PF < 10%). Therefore, this model can accurately estimate total plantar force in daily life activities.

The association between body composition and foot structure and function: a systematic review

The aim of this systematic review was to investigate the relationship between body composition and foot structure and function. Six electronic databases (Ovid MEDLINE, Ovid EMBASE, Ovid AMED, CINAHL, Scopus and The Cochrane Library) and reference lists from relevant papers were searched on 2 September 2013. Sixteen papers that reported on the association between body composition and foot structure and function met our inclusion criteria and were reviewed. The evidence indicates that obesity is strongly associated with planus (low-arched) foot posture, pronated dynamic foot function and increased plantar pressures when walking. However, there is limited evidence to support an association between other body composition measures, such as fat mass, with foot structure or function.

Fat mass is a predictor of incident foot pain

OBJECTIVE

Foot pain is a common complaint in adults. Increased BMI and fat mass have been linked only to foot pain prevalence. Therefore, a longitudinal study to examine the relationship between body composition and incident foot pain over 3 years was conducted.

DESIGN AND METHODS

Sixty-one community dwelling participants from a previous study of musculoskeletal health, who did not have foot pain at study inception in 2008, were invited to take part in this follow-up study in 2011. Current foot pain was determined using the Manchester Foot Pain and Disability Index, and body composition was measured using dual X-ray absorptiometry at study baseline.

RESULTS

Of the 51 respondents (84% response rate, 37 females and 14 males), there were 11 who developed foot pain. BMI ranged from underweight to morbidly obese (17-44 kg/m2), mean 27.0 ± 6.0 kg/m2. Incident foot pain was positively associated with both fat mass (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.03-1.20) and fat-mass index (OR 1.28, 95% CI 1.04-1.57) in multivariate analysis.

CONCLUSIONS

Fat mass is a predictor of incident foot pain. This study supports the notion that incident foot pain in overweight individuals is associated with fat mass rather than body mass alone.

Association of body composition with sarcopenic obesity in elderly women

The aim of the present study was to investigate the prevalence of sarcopenic obesity and its association with obesity and sarcopenia in elderly Brazilian women. Two hundred and seventy-two sedentary women with a mean age of 66.75 ± 5.38 years were recruited for participation in this study. Obesity was determined by both body mass index and dual-energy X-ray absorptiometry (DXA) evaluations. Sarcopenic obesity diagnosis was established from the ratio between fat-free mass and body surface area as obtained by DXA. There was no association of obesity with sarcopenic obesity (P = 0.424). In contrast, sarcopenia was significantly related to sarcopenic obesity (P < 0.001), although most of the elderly women with sarcopenia (n = 171) did not exhibit sarcopenic obesity. These results highlight the importance of diagnosing sarcopenic obesity as elderly women exhibiting sarcopenia could be either eutrophic or obese.

The association between body mass index and musculoskeletal foot disorders: a systematic review

The primary aim of this systematic review was to investigate the relationship between body mass index (BMI) and foot disorders. The secondary aim was to investigate whether weight loss is effective for reducing foot pain. Five electronic databases (Ovid MEDLINE, Ovid EMBASE, Ovid AMED, CINAHL and The Cochrane Library) and reference lists from relevant papers were searched in April 2011. Twenty-five papers that reported on the association between BMI and musculoskeletal foot disorders met our inclusion criteria and were reviewed. The evidence indicates: (i) a strong association between increased BMI and non-specific foot pain; and (ii) a strong association between increased BMI and chronic plantar heel pain in a non-athletic population. The evidence is inconclusive regarding the relationship between BMI and the following specific disorders of the foot; hallux valgus, tendonitis, osteoarthritis and flat foot. With respect to our second aim, there were only two prospective cohort studies that reported a reduction in foot symptoms following weight loss surgery. In summary, increased BMI is strongly associated with non-specific foot pain in the general population and chronic plantar heel pain in a non-athletic population. However, there is currently limited evidence to support weight loss to reduce foot pain.

Sarcopenia and obesity

Four body composition phenotypes exist in older adults: normal, sarcopenic, obese, and a combination of sarcopenic and obese. There is no consensus, however, on the definitions and classifications of these phenotypes and their etiology and consequences continue to be debated. The lack of standard definitions, particularly for sarcopenia and sarcopenic obesity, creates challenges for determining prevalence across different populations. The etiology of these phenotypes is multifactorial with complex covariate relationships. This review focuses on the current literature addressing the classification, prevalence, etiology, and correlates of sarcopenia, obesity, and the combination of sarcopenia and obesity, referred to as sarcopenic obesity.