Question: My 45 year old daughter has terrible plantar fasciitis. It came on after her last baby three years ago and never went away. She’s tried everything: insoles, physio, but nothing seems to help. She is very overweight – around 3 kilos – and refuses to believe it has anything to do with it. What do you think? Wouldn’t being overweight do that?
dr Grant replies: A While the exact underlying cause of plantar fasciitis is poorly understood, there are several risk factors. Obesity – or even a body mass index over 27 – is one of the known risk factors
The peak incidence of plantar fasciitis occurs between the ages of 40 and 60. It generally occurs in one foot, but about a third of cases are bilateral (both feet are affected). Other risk factors include running, prolonged standing or jumping (e.g., ballet dancers), flat feet, and—due to the natural biomechanics of your foot—poor ankle dorsiflexion.
The plantar fascia is a supporting connective tissue on the sole of the foot with longitudinal fibers. It is tightly attached to the middle of the foot and divided into five briefs, one for each toe, extending across the sole. This helps create the windlass mechanism, or bowstring effect, which raises the arch of the foot as the toes straighten during the push-off phase of walking.
Diagnosis is generally based on a good history of symptoms and clinical examination of the foot. The typical pain is described as heel pain that gets worse in the morning or after a period of rest. The pain typically subsides with gradually increasing activity, but worsens with prolonged weight bearing towards the end of the day.
In one exam, the toes are grasped with one hand and dorsiflexed (pushed up) while the other hand feels the sole of the foot, starting at the heel and working up to the toes. Tenderness is produced in specific locations, particularly when pressing along the ligaments that compress the plantar fascia. Identifying points of discrete tenderness is useful when considering one of the treatment options, steroid injections to relieve the pain.
Initial treatment strategies include weight loss measures, footwear assessment to ensure good arch support (especially important for people with flat feet), and daily foot stretching techniques under the guidance of a physical therapist.
By improving diet and exercising for 30-40 minutes a day, there can be an automatic mood lift and a surge in energy levels. This alone can lead to a reduced perception of pain.
After a few weeks of sustained lifestyle improvements, I recommend adding 20 minutes of yoga, pilates, or tai chi (freely available on YouTube—no excuses!) at least three days a week. Again, I suggest building this up to 30 minutes a day if possible. Invest time in your health and you will feel the fruits very quickly. Also, try taking a high-dose omega-3 supplement with vitamin D daily.
The fantastic news is that approximately 80 percent of patients experience complete pain relief within a year. If the pain persists after a year, there may be a number of other conditions that could explain foot pain. A specialist orthopedic foot surgeon or consultant rheumatologist could work through the list of possible other diagnoses.
dr Jennifer Grant is a GP at Beacon HealthCheck
https://www.independent.ie/life/health-wellbeing/health-features/ask-the-doctor-my-daughter-is-very-overweight-after-having-children-does-this-make-plantar-fasciitis-worse-41942996.html Ask the doctor: My daughter is very overweight after giving birth. Does this make plantar fasciitis worse?