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The association between obesity and foot pain: metabolic, biomechanical or both?


Foot pain is a common complaint amongst adults. Foot pain has been associated with body and fat mass, as well as foot function. We conducted a series of studies to investigate the relationship between these variables and foot pain.


Initially, two systematic reviews were undertaken to assess: (i) the relationship between body mass index with musculoskeletal foot disorders, and (ii) the relationship between body composition and foot structure and function. Following this, we undertook a longitudinal and cross-sectional study of fat mass and foot pain to determine any association. Finally, a cross-sectional study of foot posture, range of motion and plantar pressure characteristics in obese and non-obese individuals was undertaken.


The findings of this work demonstrate that in adults:

– General foot pain and plantar heel pain is strongly associated with increasing body mass index

– Obesity is strongly associated with planus (low-arched) foot posture, pronated dynamic foot function and increased plantar pressures when walking

– Obese individuals exhibited flatter feet, reduced inversion-eversion range of motion, and higher peak plantar pressures

– Body weight is independently associated with plantar loading after accounting for foot characteristics (e.g. under the midfoot)

– Fat mass, not fat-free mass, is a predictor of foot pain; thus, foot pain in overweight and obese individuals may be attributed to metabolic and biomechanical factors


Increased fat mass is significantly associated with foot pain and increased body mass is associated with poor foot function. Considering that the prevalence of obesity is increasing worldwide, the incidence of musculoskeletal foot disorders is also likely to increase. Therefore, the role of the podiatrist should include appropriate discussions with patients and health practitioners regarding the association between obesity and foot pain.

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Correspondence to Paul A Butterworth.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Butterworth, P.A., Menz, H.B., Urquhart, D.M. et al. The association between obesity and foot pain: metabolic, biomechanical or both?. J Foot Ankle Res 8 (Suppl 2), O5 (2015).

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