title: Comparing tendinous and ligamentous ankle pathology in atraumatic overweight and nonoverweight patients: a comprehensive MRI review.
abstract: With the increased prevalence of obesity, there has been a parallel rise in musculoskeletal disorders. However, the effect of body mass index (BMI) on pathology of the hindfoot and ankle is scarcely understood. The purpose of the present report was to compare the number of tendinous and ligamentous pathologies within the hindfoot and ankle between overweight (BMI ≥ 25.00 kg/m(2)) and nonoverweight (BMI < 25.00 kg/m(2)) atraumatic patients. We hypothesized that overweight patients would demonstrate more tendinous and ligamentous pathologies compared with their nonoverweight counterparts. Five hundred consecutive magnetic resonance images were reviewed. One hundred eight patients met the inclusion and exclusion criteria. Sixty-six patients were overweight and 42 patients were nonoverweight. Ninety-eight percent of overweight patients demonstrated pathology of a tendinous or ligamentous nature, whereas 62% of nonoverweight patients demonstrated pathology of a tendinous or ligamentous nature. Thus, the prevalence of pathology was 1.59 times higher among overweight patients compared with nonoverweight patients. Moreover, controlling for age, overweight patients demonstrated approximately twice as many tendinous and ligamentous pathologies compared with nonoverweight patients (adjusted mean ± SD = 4.44 ± 2.14 vs 1.98 ± 2.07, respectively), which was statistically significantly different (P < .001). To definitively assess causation and the clinical evolution of hindfoot and ankle pathology, prospective, longitudinal cohort studies are warranted.
  
  
  METHODS
  Diagnostic, Level III: Case series.
authors.affiliation: Coordinated Health, Bethlehem, Pennsylvania, USA (MMG, NMP, EMM, AM, ES, SAB).
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Galli
authors.affiliation: Coordinated Health, Bethlehem, Pennsylvania, USA (MMG, NMP, EMM, AM, ES, SAB).
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Protzman
authors.affiliation: Coordinated Health, Bethlehem, Pennsylvania, USA (MMG, NMP, EMM, AM, ES, SAB).
authors.forename: Eiran M
authors.initials: EM
authors.lastname: Mandelker
authors.affiliation: Coordinated Health, Bethlehem, Pennsylvania, USA (MMG, NMP, EMM, AM, ES, SAB).
authors.forename: Amit
authors.initials: A
authors.lastname: Malhotra
authors.affiliation: Coordinated Health, Bethlehem, Pennsylvania, USA (MMG, NMP, EMM, AM, ES, SAB).
authors.forename: Edward
authors.initials: E
authors.lastname: Schwartz
authors.affiliation: Coordinated Health, Bethlehem, Pennsylvania, USA (MMG, NMP, EMM, AM, ES, SAB) drsbrigido@mac.com.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Brigido
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000473:pathology*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D050177:Overweight / Q000473:pathology*; D012189:Retrospective Studies; D013710:Tendons / Q000473:pathology*; D016474:Weight-Bearing; D055815:Young Adult
keywords: body mass index; lateral ankle ligaments; magnetic resonance imaging; obesity; tendons