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publicado em 12/03/2013 às 12h43:00
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Changes in the bone structure of the feet cause pain in severely obese

USP Research shows that pain-induced severe obesity can lead to functional impairment of these people

 
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Foto: Sonia Maria Fabris Luiz
Prevalence of flat foot was tested from x-rays and baropodometry
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Prevalence of flat foot was tested from x-rays and baropodometry

The pain caused by changes in bone structure and joints of the feet in patients with severe obesity represent key role in the deficiency of these people, affecting their ability to perform activities of daily living, such as walking. The pain induced by severe obesity can lead to functional impairment of these people, like muscle weakness, and a worsening in their quality of life, explains physiotherapist Sonia Maria Fabris Luiz.

In his doctoral thesis impact of two levels of severe obesity on changes ostearticulares and functional knee and foot, developed at the Faculty of Medicine of the USP (USP), Sonia evaluated the impact of excess weight on the knee and foot, trying to verify the prevalence of flat foot in super obese, as well as its repercussions.

The study evaluated a population of 81 outpatients from gastrointestinal surgery, Base Hospital Medical School in São José do Rio Preto (FAMERP), who were on the waiting list for the realization of gastroplasty (reduction surgery stomach). There were representatives from two levels of severe obesity: with Body Mass Index (BMI) from 40 to 50 kilograms per square meter (kg / m²) and greater than 50 kg / m². BMI, a measure used to determine if someone is in the ideal weight is calculated by dividing the person's weight by the square of your height. Participants underwent an initial assessment of age, weight and height, and then go through specific tests for measuring plantar arch (curvature) of the feet and verifying the presence of osteoarthritis in the knees.

<b> presence of flat feet and osteoarthritis </ b>

Although one of the baropodometry exams, which assesses the surface of the foot print of the results has shown that only 20% of patients had flat feet, evaluation of existing radiographic images showed flattening of the plantar arch, with varying degrees, in 100% them. The excess weight that these patients might have plantar arch toward the ground. There is, then, a region stretching this muscle, tendon, muscle weakness. With that the foot becomes more flattened, explains Sonia. The difference between the results can be explained by the nature of each exam, since radiography allows the observation of the bone structure of the foot, while the baropodometry evaluates the ratios between the rearfoot and midfoot regions (respectively the anterior and middle portions of the foot) footprint.

Most patients said they had difficulties to perform simple everyday exercises such as regular walking

Now with regard to the presence of osteoarthritis of the knee, tests showed that 81.5% of patients had degeneration in the joints at different levels. However, it was not possible to associate statistically wear this to BMI. The distribution between the degree of osteoarthritis was heterogeneous, says Sonia. She explains that the possible reason for the lack of relationship between the two variables is the fact that patients are still young, with a maximum age of 50 years. I believe that these people accompany him in the coming years, we would see a progression of knee osteoarthritis related to BMI says.

<b> Effect on daily activities </ b>

In addition to examinations, patients also answered two questionnaires related to the functional aspects of the feet and knees: the Western Ontario and McMaster Universities Ostheoarthritis Index (WOMAC), to evaluate the stiffness and function in relation to the knee osteoarthritis, and the Foot and Ankle Outcome Score (FAOS), which gives the perception of the person presenting the amendments in the foot and ankle.

Questionnaires allow the knowledge of the degree of pain in relation to a number of everyday activities, like walking on the plane, climb stairs, get into cars, and get put on socks, move the foot in various positions, etc.. Based on the result of tests and questionnaires, we had an overall evaluation, not only in terms of structural change, but also in terms of symptoms of pain and functionality, reports the physiotherapist.

Most patients said they had difficulties to perform simple everyday exercises such as regular walking, because of pain in the foot and knee. We saw that the pain induced by obesity may favor the abandonment of patient physical activity programs for weight loss and thus promote sedentary this population, adds Sonia.

The research also suggests a possible relationship between the morphological and foot pain and dysfunction in the knee joint during activities.

Source: USP
   Palavras-chave:   Obesity    Bone    Joint    Quality of life    Physical therapy    USP    Universidade de São Paulo   
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