Avaliação funcional e de sintomatologia dolorosa do pé e tornozelo em indivíduos com obesidade grave – Estudo controlado transversal^[*]

Resumo

Objetivo Avaliar a prevalência de queixas álgicas no pé e tornozelo, parâmetros radiográficos e o desempenho funcional de indivíduos com obesidade grave, Índice de Massa Corpórea (IMC) com valor > 40 e indicação de cirurgia bariátrica.

Métodos Foram avaliados 40 pacientes com obesidade grave acompanhados em ambulatório de cirurgia bariátrica. Este grupo de obesos graves (IMC > 40) foi subdividido em dois subgrupos: obesos com IMC < 50 (n = 24); e outro de obesos com IMC > 50 (n = 16). Foi realizada comparação com grupo controle de 42 indivíduo voluntários com IMC médio de 24. Foram avaliados a presença de dor no pé pela escala visual (EVA), o desempenho funcional pela escala da Associação Americana de Cirurgia do Pé e Tornozelo (AOFAS, na sigla em inglês) (domínios antepé, mediopé e retropé), idade, gênero, ângulo (âng) metatarso-falangeano do hálux, âng intermetatarsal do hálux , âng talocalcaneano, “pitch” calcaneano e âng de Meary.

Resultados Foi observada maior incidência de dor no pé no grupo de obesos graves em relação ao controle (p < 0,0001, razão de chances [odds ratio, OR]: 4,2). O desempenho funcional pela escala AOFAS foi inferior no grupo de obesos em relação ao controle (p < 0,0001, retropé com OR = 4,81; mediopé com OR = 3,33).

Conclusão Houve maior incidência de dor no pé no grupo de obesos graves em relação ao controle. Houve pior desempenho funcional pela escala AOFAS nas regiões do antepé, mediopé e retropé no grupo de obesos graves.

Palavras-chave

pé - obesidade - dor - escala AOFAS

^* Trabalho desenvolvido no Hospital Federal de Ipanema, Rio de Janeiro, RJ, Brasil.

Publication History

Received: 08 August 2019

Accepted: 15 April 2020

Article published online:
29 October 2020

• Referências

• 1 Thomas D, Elliott EJ. Low glycaemic index, or low glycaemic load, diets for diabetes mellitus. Cochrane Database Syst Rev 2009; (01) CD006296
• 2 Butterworth PA, Landorf KB, Smith SE, Menz HB. The association between body mass index and musculoskeletal foot disorders: a systematic review. Obes Rev 2012; 13 (07) 630-642
• 3 Harms S, Larson R, Sahmoun AE, Beal JR. Obesity increases the likelihood of total joint replacement surgery among younger adults. Int Orthop 2007; 31 (01) 23-26
• 4 Jinks C, Jordan K, Croft P. Disabling knee pain--another consequence of obesity: results from a prospective cohort study. BMC Public Health 2006; 6: 258
• 5 Martins GC, Martins Filho LF, Raposo AH, Gamallo RB, Menegazzi Z, Abreu AV. Radiographic evaluation and pain symptomatology of the knee in severely obese individuals - controlled transversal study. Rev Bras Ortop 2018; 53 (06) 740-746
• 6 Mickle KJ, Steele JR. Obese older adults suffer foot pain and foot-related functional limitation. Gait Posture 2015; 42 (04) 442-447
• 7 Fabris SM, Faintuch J, Brienze SL. et al. Are knee and foot orthopedic problems more disabling in the superobese?. Obes Surg 2013; 23 (02) 201-204
• 8 Sowers M, Karvonen-Gutierrez CA, Palmieri-Smith R, Jacobson JA, Jiang Y, Ashton-Miller JA. Knee osteoarthritis in obese women with cardiometabolic clustering. Arthritis Rheum 2009; 61 (10) 1328-1336
• 9 Li H, George DM, Jaarsma RL, Mao X. Metabolic syndrome and components exacerbate osteoarthritis symptoms of pain, depression and reduced knee function. Ann Transl Med 2016; 4 (07) 133
• 10 Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15 (07) 349-353
• 11 Menz H. Two feet, or one person? Problems associated with statistical analysis of paired data on foot and ankle medicine. Foot 2004; 14 (01) 2-5
• 12 Melo IT, São-Pedro M. Musculoskeletal pain in lower limbs in obese patients before and after bariatric surgery. Arq Bras Cir Dig 2012; 25 (01) 29-32
• 13 Walsh TP, Butterworth PA, Urquhart DM. et al. Increase in body weight over a two-year period is associated with an increase in midfoot pressure and foot pain. J Foot Ankle Res 2017; 10: 31
• 14 Gandhi R, Takahashi M, Smith H, Rizek R, Mahomed NN. The synovial fluid adiponectin-leptin ratio predicts pain with knee osteoarthritis. Clin Rheumatol 2010; 29 (11) 1223-1228
• 15 Kalichman L, Li L, Kobyliansky E. Prevalence, pattern and determinants of radiographic hand osteoarthritis in Turkmen community-based sample. Rheumatol Int 2009; 29 (10) 1143-1149
• 16 de Mello AP, Martins GCDS, Heringer AR. et al. Back pain and sagittal spine alignment in obese patients eligible for bariatric surgery. Eur Spine J 2019; 28 (05) 967-975
• 17 Dumond H, Presle N, Terlain B. et al. Evidence for a key role of leptin in osteoarthritis. Arthritis Rheum 2003; 48 (11) 3118-3129
• 18 Abdel-Fattah MM, Hassanin MM, Felembane FA, Nassaane MT. Flat foot among Saudi Arabian army recruits: prevalence and risk factors. East Mediterr Health J 2006; 12 (1-2): 211-217
• 19 Otsuka R, Yatsuya H, Miura Y. et al. [Association of flatfoot with pain, fatigue and obesity in Japanese over sixties]. Nippon Koshu Eisei Zasshi 2003; 50 (10) 988-998
• 20 Kinds MB, Welsing PM, Vignon EP. et al. A systematic review of the association between radiographic and clinical osteoarthritis of hip and knee. Osteoarthritis Cartilage 2011; 19 (07) 768-778
• 21 Frilander H, Viikari-Juntura E, Heliövaara M, Mutanen P, Mattila VM, Solovieva S. Obesity in early adulthood predicts knee pain and walking difficulties among men: A life course study. Eur J Pain 2016; 20 (08) 1278-1287
• 22 Frey C, Zamora J. The effects of obesity on orthopaedic foot and ankle pathology. Foot Ankle Int 2007; 28 (09) 996-999
• 23 Cho NH, Kim S, Kwon DJ, Kim HA. The prevalence of hallux valgus and its association with foot pain and function in a rural Korean community. J Bone Joint Surg Br 2009; 91 (04) 494-498
• 24 Nguyen US, Hillstrom HJ, Li W. et al. Factors associated with hallux valgus in a population-based study of older women and men: the MOBILIZE Boston Study. Osteoarthritis Cartilage 2010; 18 (01) 41-46
• 25 Menz HB, Dufour AB, Casey VA. et al. Foot pain and mobility limitations in older adults: the Framingham Foot Study. J Gerontol A Biol Sci Med Sci 2013; 68 (10) 1281-1285