Does Plantar Fasciitis Have to Lead to a Sedentary Lifestyle for Patients with Obesity?
— By Dawn M. Sweet, Ph.D
Plantar fasciitis and its associated discomfort lead to decreased mobility and decreased quality of life — but stretching and lifestyle changes can help.
For patients with obesity, daily activities such as standing or walking can be painful or uncomfortable, particularly if they have plantar fasciitis. Experiencing foot pain can cause people to avoid exercise and continue living a sedentary lifestyle. This is problematic, particularly for patients with obesity because this could lead to further weight gain. Because patients with obesity are at an increased risk of type 2 diabetes and cardiovascular disease, attendance to podiatric issues may not considered primary concerns when treating patients with obesity. However, podiatric health is health is important for quality of life.
Being overweight increases one’s chances of developing foot issues such as flat feet, ankle pain, and plantar fasciitis.1 This is particularly problematic for older adults (> 45). It’s been reported1 that nearly 25 percent of adults over 45 experience some type of foot pain or discomfort. Foot pain and discomfort can lead to problems with balance and gait as well limitations in mobility and decreases in quality of life. Our feet support us as we literally move through our day, and when we live at an unhealthy weight, our foot function is negatively affected. To be sure, it is critically important for patients with obesity to address comorbidities such as type 2 diabetes and cardiovascular disease, but it is also important to attend to foot health.
Diagnosing, Treating, and Managing Plantar Fasciitis
Plantar fasciitis affects millions of people each year. Comprised of three segments that form the calcaneus, the plantar fascia is the foot’s workhorse. It is implicated in the proper biomechanics of the foot, providing arch support and shock absorption.2 Commonly caused by stress from overuse or tight muscles and characterized by localized sharp pain, plantar fasciitis is also associated with a high BMI.3
Diagnostic tests for plantar fasciitis include a radiographic lateral weight-bearing view of the foot. This is done to exclude other conditions such fractures. Ultrasonography is an effective diagnostic tool when ruling out plantar fascia fibromatosis.3 In the context of ultrasonography, thickening of the plantar > 4.0 mm is considered abnormal while the healthy ranges are 3.3 ± 0.3 mm to 3.9 ± 0.5 mm.
While surgery is an option, patients with obesity may not be good candidates for surgical procedures for planar fasciitis because of the increased risks associated with anesthesia. Consequently, nonsurgical treatments represent a good place to start and have been associated with resolving plantar fasciitis symptoms in 12-18 months for 90 to 95 percent of patients. Treatments for plantar fasciitis can begin with more conservative approaches such as:3
1. Plantar fascia stretching and icing. This is a low cost, easy to learn, and efficacious strategy that involves dorsiflexing the toes with one’s hand and palpating the plantar fascia with the other hand, three times for 30 seconds. This should be performed daily, each morning. Icing the plantar fascia is also efficacious. This can be done by using a frozen can or freezing water in a bottle ad then rolling the foot with moderate pressure for 5-10 minutes at the end of the day.
2. Night splints. Dorsiflexion night splinting has also been found to improve plantar fasciitis symptoms. Night splints have been found to yield positive outcomes withing 12 weeks.
3. Orthotics. Orthotic inserts that increase support of the medial arch are also effective. Heel cups were also found to be effective. The appropriate orthotic should be determined by each patient’s presentation of and severity of symptoms.
4. NSAIDS. Nonsteroidal anti-inflammatory medications can be effective for patients who can tolerate them. The benefits of NSAIDS, although effective, yield shorter term results.
5. Steroid Injections. The use of localized steroid injections has also been found to be effective for pain relief for periods up to three months.
Lifestyle Changes and Plantar Fasciitis for Patients with Obesity
For patients with obesity, lifestyle changes that include exercise can still be advised. Modifying current exercise programs to include low-impact or non-weight bearing exercise such as swimming, cycling, or rowing should be considered. Because the pain of plantar fasciitis impedes one’s ability to walk comfortably, introducing non-weight bearing activities can help patients maintain cardiovascular health, expend calories, and lead an active lifestyle as they heal. In addition to non-weight bearing activities, health care professionals should consider re-evaluating their patients’ current diet and making tailored adjustments that support a Low Calorie Diet (LCD), Very Low Calorie Diet (VLCD), and/or meal replacements.
The pain and discomfort of plantar fasciitis for patients with obesity does not need to undermine their ongoing weight loss efforts. An added benefit of considering a LCD, VLCD, and/or meal replacements is that these approaches can help patients not only lose weight but also maintain a healthy weight, thereby mitigating the risks of foot pain or discomfort. With proper diagnosis, treatment, and weight loss, patients with obesity can be transition back to weight-bearing activities and live a healthy life at a healthy weight.