Obesity and Achilles tendon strain

NewsBot · Jan 4, 2013

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Overweight and obesity alters the cumulative transverse strain in the Achilles tendon immediately following exercise
Scott C. Wearing, Sue L. Hooper, Nicole L. Grigg, Gregory Nolan, James E. Smeathers
Journal of Bodywork and Movement Therapies; Available online 22 December 2012

This research evaluated the effect of obesity on the acute cumulative transverse strain of the Achilles tendon in response to exercise. Twenty healthy adult males were categorized into ‘low normal-weight’ (BMI <23 kg m−2) and ‘overweight’ (BMI >27.5 kg m−2) groups based on intermediate cut-off points recommended by the World Health Organization. Longitudinal sonograms of the right Achilles tendon were acquired immediately prior and following weight-bearing ankle exercises. Achilles tendon thickness was measured 20-mm proximal to the calcaneal insertion and transverse tendon strain was calculated as the natural log of the ratio of post- to pre-exercise tendon thickness. The Achilles tendon was thicker in the overweight group both prior to (t18 = −2.91, P = 0.009) and following (t18 = −4.87, P < 0.001) exercise. The acute transverse strain response of the Achilles tendon in the overweight group (−10.7 ± 2.5%), however, was almost half that of the ‘low normal-weight’ (−19.5 ± 7.4%) group (t18 = −3.56, P = 0.004). These findings suggest that obesity is associated with structural changes in tendon that impairs intra-tendinous fluid movement in response to load and provides new insights into the link between tendon pathology and overweight and obesity.
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Admin2 · Jan 4, 2013

Related Threads:
Other threads tagged with achilles tendon
Other threads tagged with obesity

David Smith · Jan 4, 2013

Micron. 2012 Feb;43(2-3):463-9. doi: 10.1016/j.micron.2011.11.002. Epub 2011 Nov 18.

Implications of obesity for tendon structure, ultrastructure and biochemistry: a study on Zucker rats.
Biancalana A, Velloso LA, Taboga SR, Gomes L.
Source
Department of Anatomy, Cell Biology and Physiology and Biophysics, Institute of Biology, CP 6109, State University of Campinas - UNICAMP, 13083-863 Campinas, SP, Brazil.
Abstract
The extracellular matrix consists of collagen, proteoglycans and non-collagen proteins. The incidence of obesity and associated diseases is currently increasing in developed countries. Obesity is considered to be a disease of modern times, and genes predisposing to the disease have been identified in humans and animals. The objective of the present study was to compare the morphological and biochemical aspects of the deep digital flexor tendon of lean (Fa/Fa or Fa/fa) and genetically obese (fa/fa) Zucker rats. Ultrastructural analysis showed the presence of lipid droplets in both groups, whereas disorganized collagen fibril bundles were observed in obese animals. Lean animals presented a larger amount of non-collagen proteins and glycosaminoglycans than obese rats. We propose that the overweight and lesser physical activity in obese animals may have provoked the alterations in the composition and organization of extracellular matrix components but a genetic mechanism cannot be excluded. These alterations might be related to organizational and structural modifications in the collagen bundles that influence the mechanical properties of tendons and the progression to a pathological state.
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Copyright © 2011 Elsevier Ltd. All rights reserved.
PMID: 22137973 [PubMed - indexed for MEDLINE]

David Smith · Jan 4, 2013

Even though the biological structure and the physiological mechanism is altered mechanical tendon pathology is still not the result of these changes but rather the effect of of applied force.

I find that most people I treat with mechanical tendon pathology are not obese but usually active individuals with what would appear to be BMI lower than 27.5 (not that I measure this as a matter of course so this is just my impression)

This would seem to make sense tho since fat people are generally not very active people, hence they are fat. Therefore the forces applied to the tendon of a low activity person might be lower than someone who is engaged in high activity sporting
person. While there may be the tendency to mechanical trauma at lower stress levels in the tendon of the obese these pathological stress levels may not be attained as often as they are in the more active person.

Regards Dave Smith

NewsBot · May 18, 2013

Body Mass Index and Achilles Tendonitis; A 10-Year Retrospective Analysis
Erin E. Klein, Lowell Weil Jr, Lowell Scott Weil Sr, Adam E. Fleischer, DPM, MPH
Foot Ankle Spec May 17, 2013

Introduction. High body mass index (BMI) has been implicated as an etiologic agent in Achilles tendonitis (AT) and may contribute to poorer treatment outcomes. The purpose of this study was to better elucidate the role of BMI in both the development and treatment of AT.

Methods. A matched case–control (1:1) study design was used. Matching criteria were age, gender, and year of presentation. Consecutive patients who presented with a diagnosis of AT between 2002 and 2011 at a single foot and ankle specialty clinic were identified. Patients who presented with other foot pain at the same clinic served as controls (CG). The AT group was further stratified into treatment responders and nonresponders. The main effect measure for both analyses was an adjusted odds ratio.

Results. A total of 944 patients (472 AT; 472 CG) were included. AT patients had higher BMI than those in the CG (30.2 ± 6.5 vs 25.9 ± 5.3, P < .001). Overweight and obese patients were 2.6 to 6.6 times more likely than those with a normal BMI to present with Achilles tendonitis (P < .001). There was also elevated risk of presenting with AT at higher BMI categories (Mantel–Haenszel χ2 = 8.074, P = .004). However, only age, not BMI, correlated with having failed conservative treatment among the AT group, with patients older than 65 years at the greatest risk (odds ratio = 2.4, 95% confidence interval = 1.5 to 4.1, P < .001).

Conclusion. BMI plays a role in the development of AT but does not appear to influence patient response to conservative treatment.
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NewsBot · May 18, 2013

The Correlation of Achilles Tendinopathy and Body Mass Index
Ryan T. Scott, Christopher F. Hyer, Angela Granata
Foot Ankle Spec May 17, 2013

With this study we intend to determine if there is a correlation between body mass index (BMI) and Achilles tendon pathology. A retrospective chart review of 197 patients was performed with CPT codes of Achilles tendinosis/tendonitis. These 197 patients were then compared with 100 random new patient encounters excluding Achilles pathology, plantar fasciitis, and surgical consults. Statistical analysis was then performed to identify correlation of BMI to incidence of Achilles tendinosis compared with patients without Achilles pathology. A total of 197 Achilles tendon pathology patients (113 male, 84 female) were analyzed and had a mean age of 52.77 ± 11.8 years (21-82) with a BMI of 34.69 ± 7.54 (17.9-75.9). The control group had a mean age of 42.74 ± 12.1 years (21-78) and mean BMI of 30.56 ± 7.55 (19.7-61.5). A significant difference was found in mean BMI between the Achilles tendinopathy group versus the control group (P < .001). There was a very significant difference in age noted between the 2 cohorts (52.77 years vs 42.74 years, P < .001), perhaps reenforcing the involvement of age-related degenerative changes. In this study, patients with Achilles pathology exhibited a significantly higher BMI than non-Achilles patients (P < .001) even after accounting for age.
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NewsBot · Jul 23, 2013

NewsBot said: ↑

Body Mass Index and Achilles Tendonitis; A 10-Year Retrospective Analysis
Erin E. Klein, Lowell Weil Jr, Lowell Scott Weil Sr, Adam E. Fleischer, DPM, MPH
Foot Ankle Spec May 17, 2013
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NewsBot said: ↑

Body Mass Index and Achilles Tendonitis; A 10-Year Retrospective Analysis
Erin E. Klein, Lowell Weil Jr, Lowell Scott Weil Sr, Adam E. Fleischer, DPM, MPH
Foot Ankle Spec May 17, 2013
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Press Release on this study:

A new study published in the journal Foot and Ankle Specialist by physicians at Weil Foot & Ankle Institute demonstrates that body mass index (BMI ) and age may play significant roles in the development and treatment of Achilles tendonitis...

Age and BMI have been linked to higher risks for a number of medical conditions that require care, from diabetes to cancer.

Achilles tendonitis is an inflammation of the Achilles tendon. Inflammation is a natural response to injury or disease, and often causes swelling, pain and irritation in the area that is affected.

The study examined nearly 1000 patients who presented to the Weil clinic with plantar fasciitis between 2002 and 2011. The researchers studied data from the patients, whose ages ranged from 18 to 88 years old. The study used body weight and height to calculate BMI figures as well as patient records to determine treatment outcomes.

The study’s authors — podiatrists Dr. Erin Klein, Dr. Lowell Weil Jr., and Dr. Adam Fleischer — discovered patients seeking care for Achilles tendonitis are 2.6 to 6.6 times more likely to be overweight or obese than patients who visit a foot and ankle specialist for other conditions. This finding is important because Achilles tendonitis can be a debilitating condition of the foot and ankle that can be costly and painful to treat.

Additionally, this study found that advanced age at initial clinic visit, particularly if the patient is over 65, can lead to failure of conservative treatment methods. These patients are 2.4 times more likely to require advanced or surgical treatment for this condition.

“Achilles tendonitis can be debilitating and frustrating to treat for both the patient and the physician,” said study author Dr. Erin Klein. “This research provides some insight as to why some patients see little to no improvement, and reminds us of the costly toll obesity and age can take on our health.”
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Deka08 · Jul 24, 2013

"The study examined nearly 1000 patients who presented to the Weil clinic with plantar fasciitis between 2002 and 2011."

Is this an error? Ie supposed to be Achilles tendonitis not plantar fasciitis.
Or was there a coincidental plantar fasciitis/achilles tendonitis study or retro spective link?

Cheers

admin · Jul 24, 2013

It is confusing as the heading for the actual press release (which we deliberately left out) actually said "heel pain"....someone at the Weil F & A Institute must have got it wrong.

This was the press release title: "Age and Body Mass Index Linked to Heel Pain" http://www.pr.com/press-release/504251

NewsBot · Jan 25, 2014

From latest LER:
Achilles tendinopathy and body mass index

Lizzy_b · Oct 31, 2014

I just read through the article and i would like to ask if it is acceptable to extrapolate the results from "... thirty health adult males from a university faculty..." (Wearing 2013) to children under the age of 12?
A. Elizabeth

NewsBot · Dec 23, 2021

Inflammatory mechanisms linking obesity and tendinopathy
Pauline Po YeeLuiPatrick Shu HangYung
Journal of Orthopaedic Translation Volume 31, November 2021, Pages 80-90

Chronic tendinopathy is a debilitating tendon disorder with disappointing treatment outcomes. This review focuses on the potential roles of chronic low-grade inflammation in promoting tendinopathy in obesity. A systematic literature search was performed to identify all clinical studies supporting the actions of obesity-associated inflammatory mediators in the development of tendinopathy. The mechanisms of obesity-induced chronic inflammation in adipose tissue are firstly reviewed. Common inflammatory mediators potentially linking obesity and the development of tendinopathy, and their association with mechanical overuse, are discussed, along with pre-clinical evidences and a systematic literature search on clinical studies. The potential contribution of local adipose tissues in the promotion of inflammation, pain and tendon degeneration is then discussed. The future research directions are proposed.
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NewsBot · Feb 9, 2022

The association of body mass index and waist circumference with the risk of Achilles tendon problems: A nationwide population-based longitudinal cohort study
Hyeong SikAhna et al
Foot and Ankle Surgery; 8 February 2022

Background
The purpose of this study was to evaluate the association of body mass index (BMI) and waist circumference (WC) with the risk of Achilles tendinopathy (AT) or tendon rupture (ATR) by using data from a nationwide population-based cohort. We hypothesized that higher BMI and WC can be independently associated with the risk of AT or ATR. In addition, a higher WC may potentiate the association between BMI and the risk of Achilles tendon problems.

Methods
We used the National Health Insurance database that covers the entire South Korean population to follow-up subjects who participated in the National Health Screening Program (NHSP) from January 2009 to December 2010. The NHSP data include subjects’ BMI, WC, blood test results, blood pressure, and information about lifestyle. Among the subjects, those who were newly diagnosed as having AT or ATR before December 31, 2017, were selected. To examine the association of the variables with the risk of AT or ATR and determine whether the effect of higher BMI varied according to WC, multivariate Cox proportional hazards regression was used.

Results
Among a total of 16,830,532 subjects, 125,814 and 31,424 developed AT and ATR. A higher BMI showed a greater association with the increased risk of ATR than AT (adjusted hazard ratio [HR], 3.49 vs 1.96). A higher WC was associated with the increased risk of AT (adjusted HR, 1.22) but not ATR. In a separate analysis, the association between higher BMI and the risk of AT was higher when subjects had higher WC as compared to those lower WC, being most significant in individuals with both higher BMI and higher WC.

Conclusion
Our results support that higher BMI was associated with the increased risk of ATR more than AT. Moreover, a high central fat distribution played an independent and potentiating role in the development of AT. This implies the greater importance of a high central fat distribution contributing to the development of AT in obese subjects.
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NewsBot · Mar 16, 2023

The Association of Body Mass Index and Waist Circumference with the Risk of Achilles Tendon Problems: A Nationwide Population-Based Longitudinal Cohort Study
Hyeong Sik Ahn et al
Clin Orthop Surg. 2023;15:e14

Background
The purpose of this study was to evaluate the association of body mass index (BMI) and waist circumference (WC) with the risk of Achilles tendinopathy (AT) or Achilles tendon rupture (ATR), using data from a nationwide population-based cohort. We hypothesized that higher BMI and WC would be independently associated with the increased risk of AT or ATR. In addition, a higher WC may potentiate the association between BMI and the risk of Achilles tendon problems.

Methods
We used the National Health Insurance database that covers the entire South Korean population to follow up subjects who participated in the National Health Screening Program (NHSP) from January 2009 to December 2010. The NHSP data include subjects’ BMI, WC, blood test results, blood pressure, and information about lifestyle. Among the subjects, those who were newly diagnosed as having AT or ATR before December 31, 2017, were selected. To examine the association of the variables with the risk of AT or ATR and determine whether the effect of higher BMI varied according to WC, multivariate Cox proportional hazards regression was used.

Results
Among a total of 16,830,532 subjects, 125,814 and 31,424 developed AT and ATR, respectively. A higher BMI showed a greater association with the increased risk of ATR than AT (adjusted hazard ratio [HR], 3.49 vs. 1.96). A higher WC was associated with the increased risk of AT (adjusted HR, 1.22), but not ATR. In a separate analysis, the association between BMI and the risk of AT was higher when subjects had higher WC as compared to those with lower WC, being most significant in individuals with both higher BMI and higher WC.

Conclusions
Higher BMI was more associated with the increased risk of ATR than AT. Moreover, a high central fat distribution played an independent and potentiating role in the development of AT. This implies the greater importance of a high central fat distribution contributing to the development of AT in obese people.
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NewsBot · Apr 3, 2023

Added mass increases Achilles tendon stress in female runners
Katelyn R. De Starkey, Ashley M. Groth, Ryan R. Thyssen, Thomas W. Kernozek
The Foot; Volume 56, September 2023, 102028

Highlights
•This study compared the effects of added loads to female runners.
•Achilles tendon stress and strain increased with added loads.
•Changes in hip and knee kinematics were observed with added loads.
•Cadence, stride length and stance time did not change with added loads.
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Context
Achilles tendon (AT) injuries are common in female runners and military personnel where increased AT loading may be a contributing factor. Few studies have examined AT stress during running with added mass. The purpose was to examine the stress, strain, and force placed on the AT, kinematics and temporospatial variable in running with different amounts of added mass.

Design
Repeated measure design

Methods
Twenty-three female runners with a rear-foot strike pattern were participants. AT stress, strain, and force were measured during running using a musculoskeletal model that used kinematic (180 Hz) and kinetic data (1800 Hz) as input. Ultrasound data were used to measure AT cross sectional area. A repeated measures multivariate analysis of variance (α = 0.05) was used on AT loading variables, kinematics and temporospatial variables.

Results
Peak AT stress, strain, and force were greatest during the 9.0 kg added load running condition (p < .0001). There was a 4.3% and 8.8% increase in AT stress and strain during the 4.5 kg and 9.0 kg added load conditions, respectively, compared to baseline. Kinematics at the hip and knee changed with added load but not at the ankle. Small changes in temporospatial variables were seen.

Conclusion
Added load increased stress on the AT during running. There may be an increased risk for AT injury with added load. Individuals may consider slowly progressing training with added load to allow for increased AT loading.
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