Many of the estimated 70 million obese Americans are trapped in a life-threatening cycle: Obesity aggravates foot problems, like heel pain and flat feet; sore feet make it hard to exercise and lose weight; and without exercise, obesity worsens and increases progression of diabetes, heart disease and other serious health threats.

But don't stop that from making weight loss your New Year's resolution. Foot or ankle pain should not stop patients from exercising. The first step toward breaking the cycle is to seek evaluation and treatment by a foot and ankle surgeon for chronic, activity-limiting foot and ankle problems to foster compliance with physician-directed exercise programs.

For those moderately to severely overweight, a thorough physical examination is mandatory before beginning an exercise program. Once cleared by your physician to begin exercising, don't try to do too much too soon. Follow a gradual routine until your body adjusts to the stress of regular physical activity. For example, overweight patients should avoid working out on treadmills or elliptical machines to minimize pounding and stress on their joints.

Many causes of foot pain can be relieved nonsurgically through stretching exercises, orthotics and athletic shoes with good shock absorption and support. If a bunion, heel pain or other condition requires surgery, patients can participate during their recovery in nonweightbearing activities, such as riding a stationary bike, swimming or weight training.

Shedding excess pounds also helps patients living with diabetes control their disease. Unfortunately, many who experience foot ulcerations and vascular problems caused by diabetes think they shouldn't exercise. Patients living with diabetes need regular foot exams to check for possible sore spots and to assess nerve sensation. With proper foot care and the right footwear, most patients living with diabetes can follow an exercise regimen that is safe and appropriate for them.