I debated about writing this blog, because it is an awkward topic. I halfway wrote a nice, inoffensive essay about comparing and contrasting the effects of taping versus bracing during injury rehab. But it was boring – I was bored writing it, and I figured nobody would want to read it. So here it goes: a blog about the problems with being overweight. If that doesn’t get you fired up, you’ve never had a cheeseburger.

I have so many patients who whisper to me during their evaluation, “I know I could stand to lose a little weight and that is not helping things…” And then in the next breath they say to me, “but my feet hurt so much that I can’t exercise…” These people are stuck in what I like to call the OSFS (Overweight, Sore Feet, Sedentary) cycle:

Like any good theory, this one has its merits. It’s a little bit true.

– If you are overweight, you will be putting more pressure on your feet with every step.

– If your feet are sore, you will be more likely to take fewer steps.

– If you take fewer steps, you are more likely to become overweight.

But here is another truth you have to keep in mind:

Correlation ≠ Causation

In other words – just because you notice that two things occur together, it does not necessarily mean that one event was triggered by the other. Here is a silly example, “whenever I wear my lucky socks I have a good hair day, therefore if I want to have a good hair day- all I have to do is wear my lucky socks.”

We laugh at this logic because we can clearly see that it is full of holes. But I think it is an important reminder to be sure that we are not making assumptions about other events in our lives.

It would be convenient if the OSFS cycle were always true. Then we would know exactly what to do to solve the problem. Just fix the sore feet and people would magically start exercising and lose weight and live happily ever after. But clearly, this does not always work. If it did, I would be in danger of working myself out of a job.

Here are some reasons that I know the OSFS cycle is not the complete picture:

– Even skinny people have sore feet

– Not all overweight people have foot problems

– Lastly (and unfortunately), when I fix someone’s feet, they do not necessarily begin exercising.

The truth is, there are myriad reasons for both sore feet and for obesity. The two conditions often occur together, and even usually contribute to one another, but I don’t think it is fair to blame one on the other.

I read an article (see link below) about how people who need knee or hip replacements often tell their doctor that they can’t wait until they feel better so that they can start exercising and lose weight. But the disturbing reality is, even after successful surgery, up to 75% of the patients gained weight in the next three years. Instead of getting healthier, these patients just continued on in their current trajectory. Only now, they didn’t have the excuse of a painful medical condition keeping them from exercise.

You may be wondering why I am bringing up this uncomfortable truth. Because, frankly, I am hoping that people read it and feel guilty. But, just in case guilt is not a powerful enough motivator, here are some other things to think about if you are overweight and you have sore feet:

– The 26 bones in your feet flex and move as you put weight on them. If you are too heavy, you are like an oversized load driving on a suspension bridge – the chances are good that you are eventually going to do some permanent damage to the support structures.

– Pedorthist like me can design orthotics to help your sore feet, but if you are overweight you significantly reduce our options of materials and techniques that we can use. We have to employ heavy duty materials that will resist the amount of force you put on them with each step. These adaptations mean that your orthotics will be bulkier and less comfortable.

– You are going to wear out your shoes and orthotics much more quickly. This is going to create additional expense and inconvenience; you may have to buy new shoes as frequently as every 2-3 months. You will need more orthotic adjustment appointments. All this takes more time and more money than would be needed to treat a patient who is not overweight.

– Patients who are overweight have a much lower success rate when it comes to orthotic treatment. They are also much more likely to develop complications such as pressure sores or blisters. These risk factors can discourage practitioners from using aggressive correction techniques. This often means that instead of correcting your underlying alignment problem, your orthotics might just be providing cushioning so that you can be comfortable.

All this to say, don’t use the OSFS cycle as your excuse. If your feet hurt, go get them checked out. Buy some supportive shoes and some orthotics if you need them and then get out and use them. What are you waiting for? If you wait until you are totally free of aches and pains to begin leading an active lifestyle, you will never get started. Be creative, adapt and overcome. You can exercise without putting too much stress on your feet. Try swimming laps, stationary bicycling or lifting weights. Just make a small change for now, but whatever you do – don’t wait until you feel better.

Walk well.

Link to Lower Extremity Review Article: