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Higher body mass index is associated with plantar fasciopathy/'plantar fasciitis': systematic review and meta-analysis of various clinical and imaging risk factors

journal contribution
posted on 2023-05-18, 15:11 authored by van Leeuwen, KD, Jason RogersJason Rogers, Tania WinzenbergTania Winzenberg, van Middelkoop, M

Question: What (risk) factors are associated with plantar fasciopathy (PF)?

Design: Systematic review with meta-analyses.

Participants: Patients with PF.

Factors: All factors described in prospective, case-control or cross-sectional observational studies.

Results: 51 included studies (1 prospective, 46 case-control and 4 cross-sectional studies) evaluated a total of 104 variables. Pooling was possible for 12 variables. Higher body mass index (BMI) (BMI > 27, OR 3.7 (95% CI 2.93 to 5.62)) in patients with PF was the only significant clinical association, and its effect was the strongest in the non-athletic subgroup. In people with PF compared to controls, pooled imaging data demonstrated a significantly thicker, hypoechogenic plantar fascia with increased vascular signal and perifascial fluid collection. In addition, people with PF were more likely to have a thicker loaded and unloaded heel fat pat, and bone findings, including a subcalcaneal spur and increased Tc-99 uptake. No significant difference was found in the extension of the first metatarsophalangeal joint.

Conclusions: We found a consistent clinical association between higher BMI and plantar fasciopathy. This association may differ between athletic and non-athletic subgroups. While consistent evidence supports a range of bone and soft tissue abnormalities, there is lack of evidence for the dogma of clinical and mechanical measures of foot and ankle function. Clinicians can use this information in shared decision-making.


Publication title

British Journal of Sports Medicine








Menzies Institute for Medical Research


B M J Publishing Group

Place of publication

British Med Assoc House, Tavistock Square, London, England, Wc1H 9Jr

Rights statement

Copyright 2015 The Authors

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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