Functional Evaluation and Pain Symptomatology of the Foot and Ankle in Individuals with Severe Obesity - Controlled Transversal Study

doi:10.1055/s-0040-1713757

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Original Article • Rev. bras. ortop. 56 (2) • Mar-Apr 2021 • https://doi.org/10.1055/s-0040-1713757 copy

Functional Evaluation and Pain Symptomatology of the Foot and Ankle in Individuals with Severe Obesity - Controlled Transversal Study^* * Study developed at the Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brazil.

About the SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study aims to evaluate the prevalence of foot and ankle pain complaints, radiographic parameters, and functional performance in subjects with severe obesity (body mass index [BMI] > 40) who are candidates to bariatric surgery.

Methods

Forty severely obese patients were evaluated at a bariatric surgery outpatient facility. These severely obese subjects (BMI > 40) were divided into two subgroups: those with BMI < 50 (n = 24) and BMI > 50 (n = 16). These patients were compared with a control group of 42 volunteers with a mean BMI value of 24. The following parameters were assessed: foot pain (according to the visual analog scale [VAS]), functional performance (according to the American Orthopeadic Foot and Ankle Society [AOFAS] scale, including forefoot, midfoot and hindfoot domains), age, gender, hallux metatarsal-phalangeal angle, hallux intermetatarsal angle, talocalcaneal angle, calcanean pitch angle and Meary angle.

Results

Incidence of foot pain was higher in the severely obese group compared with the control group (p < 0.0001; odds ratio [OR]: 4.2). Functional performance according to the AOFAS scale was lower in obese subjects compared with the control group (p < 0.0001; OR for hindfoot, 4.81; OR for midfoot, 3.33).

Conclusion

The incidence of foot pain was higher in the group of severely obese patients compared with the control group. According to the AOFAS scale, functional forefoot, midfoot and hindfoot performance was worse in severely obese individuals.

Keywords
foot; obesity; pain; AOFAS scale

	GENDER	AGE (years)	WEIGHT (kg)	CLASSIFICATION	HEIGHT (m)	BMI	VAS	SIDE	H	M	F	AMF	AIMº	APCº	ATC
1	Female	61	92	PATIENT	1.5	40.9	9	LEFT	47	79	93	normal	normal	NORMAL	FLAT
2	Female	42	110	PATIENT	1.64	40.9	9	RIGHT	49	60	95	mild	normal	NORMAL	NORMAL
3	Female	64	105	PATIENT	1.6	41	8	RIGHT	28	52	100	normal	normal	NORMAL	FLAT
4	Female	45	108	PATIENT	1.62	41.2	10	LEFT	65	53	74	normal	mild	NORMAL	NORMAL
5	Female	32	99	PATIENT	1.55	41.6	8	RIGHT	50	65	93	normal	moderate	FLAT	NORMAL
6	Male	27	158	PATIENT	1.95	41.6	8	LEFT	85	82	85	normal	normal	NORMAL	NORMAL
7	Female	47	97.5	PATIENT	1.52	42.2	7	RIGHT	67	64	95	normal	normal	NORMAL	NORMAL
8	Male	47	123	PATIENT	1.7	42.6	0	LEFT	80	85	85	normal	normal	NORMAL	NORMAL
9	Male	62	108	PATIENT	1.59	42.7	8	RIGHT	72	76	93	normal	moderate	NORMAL	NORMAL
10	Male	25	143	PATIENT	1.83	42.7	10	RIGHT	67	100	100	moderate	moderate	NORMAL	NORMAL
11	Male	30	128	PATIENT	1.73	42.77	7	RIGHT	82	100	73	normal	mild	NORMAL	NORMAL
12	Male	40	150	PATIENT	1.87	42.9	6	RIGHT	79	85	82	normal	normal	NORMAL	FLAT
13	Female	58	136	PATIENT	1.77	43.4	9	RIGHT	30	32	83	moderate	severe	NORMAL	NORMAL
14	Female	53	102	PATIENT	1.52	44.15	5	RIGHT	67	100	100	moderate	moderate	NORMAL	NORMAL
15	Female	19	109	PATIENT	1.57	44.2	8	RIGHT	67	49	100	moderate	mild	NORMAL	NORMAL
16	Female	38	122	PATIENT	1.66	44.3	9	LEFT	80	82	93	normal	mild	FLAT	NORMAL
17	Female	49	103	PATIENT	1.52	44.58	8	RIGHT	71	56	100	normal	normal	NORMAL	NORMAL
18	Female	47	124	PATIENT	1.65	45.5	7	RIGHT	72	60	77	normal	moderate	NORMAL	CAVUS
19	Female	53	97	PATIENT	152	45.8	0	RIGHT	88	89	90	normal	mild	NORMAL	NORMAL
20	Female	43	126	PATIENT	1.65	46.3	8	RIGHT	68	45	90	normal	normal	NORMAL	CAVUS
21	Female	63	116	PATIENT	1.58	46.5	7	RIGHT	52	87	100	normal	mild	CAVUS	NORMAL
22	Male	50	142	PATIENT	1.72	48	6	RIGHT	60	100	78	moderate	moderate	NORMAL	NORMAL
23	Female	63	115	PATIENT	1.55	48.87	8	LEFT	82	100	73	moderate	mild	FLAT	NORMAL
24	Female	33	140	PATIENT	1.68	49.6	5	RIGHT	67	89	70	mild	moderate	NORMAL	NORMAL
25	Female	52	130	PATIENT	1.61	50.2	3	LEFT	78	75	100	moderate	mild	NORMAL	NORMAL
26	Male	61	146	PATIENT	1.69	51.12	10	LEFT	57	100	57	mild	mild	NORMAL	FLAT
27	Female	45	120	PATIENT	1.53	51.26	3	RIGHT	73	62	100	moderate	moderate	NORMAL	NORMAL
28	Female	41	140	PATIENT	1.65	51.42	8	RIGHT	93	53	100	moderate	mild	NORMAL	NORMAL
29	Female	44	120	PATIENT	1.52	51.94	5	LEFT	84	82	100	mild	mild	FLAT	NORMAL
30	Female	55	116	PATIENT	1.48	52.16	8	LEFT	51	100	100	mild	moderate	NORMAL	NORMAL
31	Female	42	113	PATIENT	1.47	52.29	6	RIGHT	50	45	72	normal	normal	NORMAL	CAVUS
32	Female	36	123	PATIENT	1.53	52.59	5	LEFT	58	100	100	moderate	moderate	NORMAL	NORMAL
33	Female	27	135	PATIENT	1.58	54.08	7	RIGHT	41	61	100	normal	normal	NORMAL	NORMAL
34	Female	37	145	PATIENT	1.62	55.25	7	LEFT	64	100	100	mild	mild	NORMAL	NORMAL
35	Female	51	133	PATIENT	1.55	55.4	10	LEFT	29	39	90	normal	normal	NORMAL	NORMAL
36	Female	40	132	PATIENT	1.54	55.66	8	RIGHT	81	100	83	moderate	moderate	NORMAL	NORMAL
37	Male	40	165	PATIENT	1.72	55.77	5	LEFT	69	100	70	moderate	mild	NORMAL	NORMAL
38	Female	36	162	PATIENT	1.65	59.5	7	LEFT	88	73	95	normal	mild	NORMAL	NORMAL
39	Female	37	153	PATIENT	1.58	61.29	5	RIGHT	55	64	100	normal	normal	NORMAL	NORMAL
40	Male	59	181	PATIENT	1.79	71.6	7	RIGHT	89	100	100	normal	severe	NORMAL	NORMAL

	GENDER	AGE	WEIGHT (kg)	CLASSIFICATION	HEIGHT (m)	BMI	VAS	SIDE	H	M	F	AMF	AIM	APC	ATC	AM
1	Female	61	80	CONTROL	1.62	30.48	3	LEFT	49	66	100	normal	normal	CAVUS	NORMAL	CAVUS
2	Female	58	61	CONTROL	1.54	25.72	3	LEFT	41	58	100	moderate	mild	NORMAL	NORMAL	NORMAL
3	Female	45	62	CONTROL	1.54	26.14	0	RIGHT	100	100	100	normal	mild	NORMAL	NORMAL	NORMAL
4	Female	44	65	CONTROL	1.68	23.03	0	RIGHT	58	58	100	normal	moderate	FLAT	NORMAL	FLAT
5	Female	38	74	CONTROL	1.74	22.4	0	LEFT	60	90	90	normal	normal	NORMAL	NORMAL	NORMAL
6	Female	54	89	CONTROL	1.7	30.45	3	RIGHT	41	56	100	normal	moderate	FLAT	NORMAL	FLAT
7	Female	27	57	CONTROL	1.71	19.15	0	RIGHT	100	100	100	normal	normal	NORMAL	NORMAL	NORMAL
8	Female	38	59	CONTROL	1.63	22.21	5	LEFT	100	100	100	moderate	mild	NORMAL	NORMAL	NORMAL
9	Female	60	62	CONTROL	1.59	24.52	0	RIGHT	57	53	100	mild	mild	NORMAL	NORMAL	NORMAL
10	Female	35	69	CONTROL	1.71	23.6	0	RIGHT	100	100	100	mild	mild	NORMAL	NORMAL	NORMAL
11	Female	37	72	CONTROL	1.73	24.06	6	LEFT	100	100	100	mild	mild	FLAT	NORMAL	FLAT
12	Female	53	69	CONTROL	1.62	26.29	7	RIGHT	58	66	100	moderate	moderate	FLAT	NORMAL	FLAT
13	Female	41	72	CONTROL	1.7	24.91	4	LEFT	100	100	100	mild	mild	NORMAL	NORMAL	NORMAL
14	Female	20	54	CONTROL	1.59	21.36	0	RIGHT	100	100	100	normal	normal	NORMAL	NORMAL	NORMAL
15	Male	42	87	CONTROL	1.81	26.56	0	RIGHT	100	100	100	normal	normal	NORMAL	NORMAL	NORMAL
16	Male	30	70	CONTROL	1.71	23.66	0	RIGHT	100	100	100	moderate	moderate	NORMAL	NORMAL	NORMAL
17	Male	47	74	CONTROL	1.73	25.01	4	LEFT	100	100	100	normal	mild	NORMAL	NORMAL	NORMAL
18	Male	24	76	CONTROL	1.74	25.1	0	RIGHT	100	100	100	moderate	normal	NORMAL	NORMAL	NORMAL
19	Male	27	78	CONTROL	1.7	26.99	0	RIGHT	100	100	100	normal	normal	NORMAL	NORMAL	NORMAL
20	Male	35	76	CONTROL	1.69	26.61	6	LEFT	100	100	100	moderate	mild	NORMAL	NORMAL	NORMAL
21	Male	61	76	CONTROL	1.72	25.69	0	RIGHT	53	49	100	normal	normal	NORMAL	NORMAL	NORMAL
22	Male	56	92	CONTROL	1.79	28.71	3	RIGHT	100	100	100	mild	mild	NORMAL	NORMAL	NORMAL
23	Female	25	50	CONTROL	1.65	18.4	0	LEFT	100	100	100	normal	mild	NORMAL	NORMAL	NORMAL
24	Female	56	52	CONTROL	1.6	20.3	0	RIGHT	100	100	100	normal	normal	NORMAL	NORMAL	CAVUS
25	Female	35	55	CONTROL	1.53	23.5	0	RIGHT	100	100	75	moderate	normal	NORMAL	NORMAL	NORMAL
26	Female	50	57	CONTROL	1.6	22.3	3	RIGHT	100	90	100	normal	normal	NORMAL	NORMAL	CAVUS
27	Female	33	65	CONTROL	1.68	23	1	RIGHT	100	100	92	normal	mild	NORMAL	NORMAL	NORMAL
28	Male	34	79	CONTROL	1.81	24	0	RIGHT	100	100	100	normal	mild	NORMAL	NORMAL	CAVUS
29	Female	60	60	CONTROL	1.54	25.3	2	LEFT	88	100	100	normal	mild	NORMAL	NORMAL	NORMAL
30	Female	47	575	CONTROL	1.67	20.4	0	RIGHT	100	100	100	normal	normal	NORMAL	NORMAL	NORMAL
31	Female	61	57	CONTROL	1.53	24.3	0	RIGHT	100	100	100	normal	normal	NORMAL	NORMAL	NORMAL
32	Female	51	54	CONTROL	1.55	22.5	0	LEFT	100	100	100	normal	normal	CAVUS	NORMAL	CAVUS
33	Male	58	73	CONTROL	1.7	25.3	0	RIGHT	100	100	100	normal	normal	NORMAL	NORMAL	NORMAL
34	Male	52	83	CONTROL	1.8	25	0	LEFT	100	100	100	normal	normal	NORMAL	NORMAL	CAVUS
35	Female	40	62	CONTROL	1.71	21.2	0	LEFT	100	100	100	normal	mild	NORMAL	NORMAL	NORMAL
36	Female	42	58	CONTROL	1.55	24.1	5	LEFT	90	100	100	normal	normal	NORMAL	NORMAL	NORMAL
37	Female	53	60	CONTROL	1.57	24.3	2	RIGHT	87	92	92	moderate	moderate	NORMAL	FLAT	NORMAL
38	Female	60	49	CONTROL	1.55	20.4	6	LEFT	64	95	100	normal	normal	NORMAL	NORMAL	NORMAL
39	Male	27	82	CONTROL	1.79	25.2	0	RIGHT	100	100	100	normal	moderate	NORMAL	NORMAL	NORMAL
40	Female	43	54	CONTROL	1.53	23.1	0	LEFT	85	85	75	normal	moderate	NORMAL	NORMAL	NORMAL
41	Female	48	63	CONTROL	1.59	24.9	0	LEFT	75	72	75	moderate	severe	NORMAL	NORMAL	NORMAL
42	Female	35	75	CONTROL	1.75	24.5	0	LEFT	100	100	100	normal	mild	NORMAL	NORMAL	NORMAL

PARAMETER	OBESE GROUP	CONTROL GROUP	STATISTICAL ANALYSIS
Gender	Male. 25%; Female. 75%	Male. 28.5%; Female. 71.5%	p= 0.539
Age	44.85	43.8 (Mean value)	p= 0.3554
VAS	95% with pain	40% with pain	p= 0.0001
AOFAS H (mean value)	65.87	88.23	p < 0.0001
AOFAS M (mean value)	76.1	91.19	p< 0.0001
AOFAS F (mean value)	89.59	97.59	p< 0.0001
APC	N = 87.5%	N = 85.71%	p= 0.8585
	C = 2.5%	C = 4.70%
	F = 10%	F = 9.52%
ATC	N = 82.5%	N = 97.6%	p= 0.031
	C = 7.5%	C = 0%
	F = 10%	F = 2.6%
AM	N = 67.5%	N = 76.2%	p= 0.743
	C = 12.5%	C = 14.3%
	F = 17.5%	F = 9.5%
AMF	N = 45%	N = 66.6%	p= 0.743
AIM	N = 30%	N = 42.85%	p= 0.54
Gender x VAS	----------------------------	--------------------------	p= 0.33 for obese subjects
Gender x VAS	----------------------------	--------------------------	p= 0.6417 for control subjects
BMI X VAS	----------------------------	--------------------------	p= 0.1407 for obese subjects
BMI X VAS	----------------------------	--------------------------	p= 0.2343 for control subjects

PARAMETER	OBESE BMI < 50	OBESE BMI > 50	STATISTICAL ANALYSIS
VAS	91.6	100%	p= 0.075
VAS	Severe pain = 58%	Severe pain = 31.2%	p= 0.075
AOFAS Hindfoot domain	65.62	66.25	p= 0.428
AOFAS Midfoot domain	74.58	78.37	p= 0.264

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E-mail: rbo@sbot.org.br

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[1] Address for correspondence Glaucus Cajaty Martins, MD, PhD, Rua Jangadeiros, 67/69, Ipanema, Rio de Janeiro, RJ, 22420010, Brazil (e-mail: glaucusc@terra.com.br).

Brasil

Brasil

Functional Evaluation and Pain Symptomatology of the Foot and Ankle in Individuals with Severe Obesity - Controlled Transversal Study* * Study developed at the Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brazil.

Abstract

Objective

Methods

Results

Conclusion

Functional Evaluation and Pain Symptomatology of the Foot and Ankle in Individuals with Severe Obesity - Controlled Transversal Study^* * Study developed at the Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brazil.