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Journal of Foot and Ankle Research

Open Access

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

  • Paul A Butterworth1, 2, 3Email author,
  • Hylton B Menz2,
  • Donna M Urquhart4,
  • Flavia M Cicuttini4,
  • Julie A Pasco5, 6,
  • Sharon L Brennan5, 6, 7,
  • Anita E Wluka4,
  • Boyd J Strauss4,
  • Joseph Proietto8,
  • John B Dixon9,
  • Graeme Jones10 and
  • Karl B Landorf1, 2
Journal of Foot and Ankle Research20158(Suppl 2):O5

Published: 22 September 2015




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.

Authors’ Affiliations

Department of Podiatry, La Trobe University, Bundoora, Australia
Lower Extremity and Gait Studies Program, La Trobe University, Bundoora, Australia
School of Health and Human Sciences, Southern Cross University, Bilinga, Australia
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
School of Medicine, Deakin University, Geelong, Australia
North-West Academic Centre, University of Melbourne, Melbourne, Australia
Australian Institute of Musculoskeletal Sciences, Melbourne, Australia
University of Melbourne and Austin Health Melbourne, Melbourne, Australia
Baker IDI Heart and Diabetes Institute and Alfred Hospital, Melbourne, Australia
Menzies Research Institute, Hobart, Australia


© Butterworth et al. 2015

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.