Friday, March 14, 2014

Weight loss key to releiving Plantar Fasciitis pain in obese patients

Obese patients may have less severe plantar fasciitis (PF) if they lose weight, either by surgery or dieting, researchers said November 14 at Obesity Week 2013, the first annual joint meeting of the American Society for Metabolic and Bariatric Surgery (ASMBS) and The Obesity Society (TOS).

"We saw improvement after surgery and fewer visits for treatment, suggesting that the symptoms were resolving as the weight loss occurred. This implies that our patients are able to get more active and exercise more during their initial weight loss period after surgery, which is quite important to their success," co-author Dr. Stacy Brethauer of the Cleveland Clinic told Reuters Health.

Investigating the possible benefit of either bariatric surgery or a protein-sparing modified fast (PSMF) diet on plantar fasciitis, Dr. Brethauer and his co-authors reviewed data on 545 patients in the Cleveland Clinic's prospective bariatric database who had been diagnosed with plantar fasciitis between 2004 and 2012. These patients accounted for about 5% of their total bariatric cohort.

The prevalence of PF was 6.4% among patients who underwent weight-loss surgery and 4.59% in those treated medically. At their first bariatric evaluation, the surgical group's average duration of PF was 30.1 months and the diet group's was 41.1 months (p=0.018).
The mean pre-op BMI was 45.3 kg/m2 in the surgical group and 40.5 kg/m² in the diet group.
After a mean follow-up of 32.7 months, the surgical group had a mean BMI and estimated weight loss (EWL) of 43.6 kg/m² and 12.6%, while the PSMF group, after a mean follow-up of 19.4 months, had a mean BMI of 38.7 kg/m² and an EWL of 7.5%

Patients in both groups saw their plantar fasciitis improve, and some saw it resolve, after an EWL of "as little as 12.6%," the researchers said.

After bariatric treatment, patients in the diet group had an average of 7.0 visits for PF compared with the surgical group's average of 4.4 visits (p=0.042). Also, the authors reported, 18.4% of patients in the diet group obtained additional care for PF compared with 20.9% in the surgical group (p=0.70). Orthotic devices were the most common follow-up treatments (81.6%), followed by non-steroidal anti-inflammatory drugs, physical therapy, and injections.

"We would expect any weight- or pressure-related comorbidities to improve after weight loss, and we often see inflammatory conditions improve after surgical weight loss," said Dr. Brethauer.
"We can add plantar fasciitis to the list of comorbidities that improve after bariatric surgery and that may need to be addressed with our podiatrist colleagues to help manage patients after surgery so they can continue to be active," he said.

"About 6% of our patients suffer with plantar fasciitis, which can severely limit their ability to exercise. That PF is a weight-related issue is well established but poorly studied. So it is important to raise this issue, especially because exercise is such an important part of the pre- and post-operative management of obesity. There is very little in the literature about PF after bariatric surgery, so our research is a start. I think prospective, more detailed evaluations would be helpful," he added.

Dr. Scott Shikora, director of the Center for Metabolic Health of Brigham and Women's Hospital in Boston, who was not involved in the study, commented by phone, "Plantar fasciitis is yet another health issue that improves with weight loss. It is important to recognize that patients with obesity may be more prone to plantar fasciitis, which may limit their ability to ambulate and exercise after surgery."

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