Frequency of Achilles Tendonitis in Obese Patients

Background: Achilles Tendonitis discomforts signify difficulties of walking and running. Achilles tendon is the thickest and longest tendon of human body that holds the maximum mechanical stress of human body. High Body mass Index (BMI) causes the increase in mechanical stress on Achilles tendon that results into an inflamed tendon. Achilles Tendonitis complaints are significant throughout many obese patients. Obese and old patients are mostly vulnerable to Achilles Tendonitis. Increase in BMI causes pressure at planter fascia that increases its symptoms. Objective: The objective of the study was to determine the Frequency of Achilles tendonitis in obese patients. Methods: A cross sectional study was conducted and a standardized questionnaire (VISA A questionnaire) for Achilles tendonitis was used to collect the data by using the non-probability convenient technique. Data was collected from Bahria International hospital and University of Lahore (UOL) teaching hospital. It was collected through sample size of 126 obese patients. SPSS version 25.0 was used for data analysis. Results: According to the results of conducted study, about 11(8.7%) patients had Achilles tendonitis. 52(41.3%) patients had moderate pain. While, 63(50.0%) of individuals had mild or no pain. In this study the number of males is 55(43.7%) and females are 71(56.3%). Conclusion: This study concluded that the frequency of Achilles tendonitis in obese patients is very low (8.7%). However, the reason of Achilles tendonitis is multifactorial

less vascularization of tissues and in combination with extremity mechanical imbalance [10]. There are numerous reasons that cause pain but most obvious reasons are extrinsic and intrinsic reasons. Extrinsic reasons are related to any hormone therapy, extreme physical activities. While, intrinsic reasons are related to any pathology such as diabetes, obesity or any genetic cause [11].
Obesity is considered as one of the risk factor of Achilles tendonitis.
Increase in Body mass exerts greater pressure at Achilles tendon as it is the tendon that holds the maximum load of human body [12].
Body Mass Index (BMI) is a measuring scale that is used to measure the obesity level in an individual. Individuals with body mass index greater than 30 are considered as obese patients, individuals with body mass index (BMI) from 18 to 25 is normal, the person greater than 24 to 30 is in overweight category while less than 18 BMI is considered underweight [13].
The association of sex, Body Mass Index was studied with tendon stiffness of lower extremity [14]. According to study conducted in 2016 the athletes with posterior heel pain were reported as obese later they studied patients of obese patients having Achilles Tendinosis. Calcaneal exostosis and Haglund's deformity with debridement of the degenerative tissue of the tendon were stated as obese [15]. In Past few years the proofs has arisen to defend the possible correlation between increased BMI and vulnerability to tendinopathy. The best evidences were found that proved that obesity is a risk factor of developing Achilles Tendonitis [16].
Achilles tendonitis is reported in people who are involved in walking and running sports. However, a little research was made to determine the incidence of Achilles tendonitis in obese patients which is an important risk factor of developing the disease [17].
The aim of present study is to determine the frequency of Achilles tendonitis in obese patients. The study provides the awareness about how increase in Body Mass Index (BMI) increases the stress at Achilles tendon leading to Achilles tendonitis.

Materials and Methods
This cross-sectional study was conducted on 126 obese patients in which 55(43.7%) were males and 71(56.3%) were females. The non-probability convenient technique was used in this study. The

Results and Discussion
In a study conducted to determine the frequency of Achilles It is considered as a risk factor for the development of Achilles BMI is the best scale used to sum the obesity of population [18].
From the results of the study it was concluded that the patients having high Body Mass Index developed Achilles Tendonitis. Obese patients develop more problems related to Achilles tendon. Giada studied in 2011 in Australia that the adaptable factor of tendinopathy is adiposity, the study was conducted on 298 individuals. Males of an older age established Achilles tendon pathology and they had central fat distribution [19]. In the previous studies there are clear evidences that proves that increase in BMI (Body Mass Index) causes increase in mechanical stress on Achilles tendon leading to Achilles tendonitis and tendinosis. The obesity is considered as a risk factor of the development of Achilles tendonitis. The obesity is a genetic factor that leads to many pathologies in adulthood, the ankle and foot pathologies are most common that occur in a genetically inherited obese patient. As overweight increases the workload on Achilles tendon leading to weakness of the tendon and results into tendonitis. .However there is an association between increased body mass index and mechanical stress on Achilles tendon, because it is the most largest and thickest tendon that have maximum mechanical stress when body mass increases, with increase in body mass the load over tendon also increases and it weakens, resulting into tendonitis or tendinopathy of Achilles tendon.