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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
  1. K D B van Leeuwen1,
  2. J Rogers2,
  3. T Winzenberg3,
  4. M van Middelkoop1
  1. 1Department of General Practice, Erasmus MC University Medical Center Rotterdam, The Netherlands
  2. 2Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  3. 3Faculty of Health, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
  1. Correspondence to Dr M van Middelkoop, Department of General Practice, Erasmus MC Medical University Rotterdam, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands; m.vanmiddelkoop{at}


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.

  • Foot
  • Review
  • Epidemiology

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