The Effects of Smoking on the Lower Limbs

The Effects of Smoking on the Lower Limbs

The large-scale consumption of tobacco causes an increase in smoking-related mortality; the World Health Organization reports that tobacco kills more than 7 million people each year**.

The widespread use of tobacco is also responsible for a number of irreversible health effects that can significantly alter an individual’s quality of life and lead to increased health care costs.

Exposure to cigarette smoke has a detrimental impact on the musculoskeletal system of an individual increasing the likelihood of developing a number of conditions such as osteoporosis, rheumatoid arthritis and peripheral vascular disease.

Abate et al. discussed cigarette smoking and musculoskeletal disorders extensively in their review on the subject, highlighting the fact that smoking plays a central role in the development of bone loss at all skeletal sites.

The loss of bone mineral content is associated with increased incidences of fractures in smokers, with nicotine shown to alter vitamin D metabolism and affect bone metabolism in a biphasic manner.

As mentioned in the review, the prevalence of hypercortisolism in smokers may impact osteoblastic/osteoclastic activity causing an indirect influence on bone metabolism with impairment of gastrointestinal and renal tubular calcium reabsorption.

The incidences of fractures can also be linked to the systemic effects of smoking, for instance, the negative influence on the vascular system, oxygen supply, muscle strength and an overall reduced muscle performance which influences balance and increases the risk of falls.

Reduction of muscle mass and strength in smokers was established in detail by Hans Degens, from the School of Healthcare Science at the Manchester Metropolitan University, who attributed smoking to the development of skeletal muscle dysfunction, even before the onset of pulmonary pathology.

The study outlined the fact that muscles of non-symptomatic smokers are weaker and less fatigue resistant than those of non-smokers; the constituents of cigarette smoke in conjunction with systemic inflammatory mediators enhance proteolysis and inhibit protein synthesis.

The interaction of carbon monoxide with haemoglobin, myoglobin and components of the respiratory chain affects the ability of the mitochondria to generate ATP which leads to reduced skeletal muscle contractile endurance in smokers.

Cessation of smoking has been routinely advocated by clinicians due to the considerable health improvements and decline in risks associated with a number of musculoskeletal disorders; pulmonary function, for instance, is shown to improve by approximately 5 percent within months of quitting smoking.

A detailed assessment of an individual’s gait is an important consideration, especially for chronic smokers. This is because the existence of postural disparities can further compound biomechanical stresses on the lower extremity, aggravating muscular dysfunctions or stress fractures in the region.

MASS4D® foot orthotics, which are customised according to an individual’s foot structure and condition, help place the lower limbs in a biomechanical advantageous position so as to prevent the onset of any additional structural or functional problems.

**World Health Organization fact sheet – May 2017**

Related Links


  1. Degens, H., Gayan-Ramirez, G., van Hees, H. W. H. (2015) Smoking-induced Skeletal Muscle Dysfunction. American Journal of Respiratory and Critical Care Medicine: March 2015, Vol. 191, No. 6, pp. 620-625
  2. Abate, M., Vanni, D., Pantalone, A., Salini, V. (2013) Cigarette Smoking and Musculoskeletal Disorders. Muscles, Ligaments and Tendons Journal: 2013, Vol. 3, No. 2, pp. 63-69
  3. Fagerström, K. (2002) The Epidemiology of Smoking. Drugs: February 2002, Suppl. 2, pp. 1-9

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