The connection between diabetes and serious foot problems is well-established in the medical field. However, the medical community focuses on the two main foot issues related to diabetes – Charcot foot and diabetic foot ulcers. Given the serious nature of these conditions that is understandable. But they aren’t the only foot conditions with a connection to diabetes. While researchers continue to explain the exact links, early results show a link between diabetes and plantar fasciitis, a painful heel condition affecting one percent of adults in the U.S. each year.
What is Plantar Fasciitis?
Plantar fasciitis is one of the most common causes of heel pain in adults. With plantar fasciitis, inflammation occurs in the plantar fascia, or the fibrous ligament that connects your heel to the front of your foot. This ligament functions as a shock absorber and supports the arch of your foot, making it easier for you to walk. When this band becomes overstretched or overloaded, small tears occur in the ligament. The body responds to this injury with inflammation in order to heal.
This inflammation causes increased stiffness in the ligament as well as the resulting heal pain.
While anyone can suffer from plantar fasciitis, there are certain factors that can increase your risk. These risk factors can include:
- Tight calf muscles that make it difficult for you to flex your foot
- High arches or flat feet
- Repetitive impact activities such as running
- New or increased activity levels
- Increasing age as flexibility decreases
- Working a job where you spend most of the day on your feet
Symptoms of Plantar Fasciitis
The main symptom is pain in the heel of the foot. However, this pain is not always constant. The worst heel pain typically occurs in the morning when you take your first steps. After walking, the pain often subsides and becomes manageable. Unfortunately, pain can again be triggered after long periods of standing or your first steps after prolonged sitting.
How Does Diabetes Increase the Risk of Plantar Fasciitis?
While the exact connection between plantar fasciitis and diabetes is still not determined, numerous studies show that there is a connection. For example, a 2019 that was study published in the Journal of Diabetes and its Complicationslooked at the connection between type I and type II diabetes with plantar fasciitis. What they discovered was that hyperglycemia common in diabetics leads to an increase in advanced glycation end products. This increase in production contributes to increased plantar facial thickness, which in turn increases the risk of plantar fasciitis. They found that the rate of plantar fasciitis was much higher in those with diabetes than those without and especially in those with type II diabetes.
Another common link between diabetes and the increased risk of plantar fasciitis is weight. Many people with diabetes are overweight for their body structure. In fact, studies show that as many as 85 percent of people with diabetes are overweight. As a major risk factor for plantar fasciitis, this additional weight, along with the productions of the advanced glycation end products, puts diabetics at a much greater risk.
Common Treatment Options for Plantar Fasciitis
Treatment for plantar fasciitis typically begins with a conservative approach. This includes over-the-counter pain relievers that help reduce inflammation and manage pain. Physical therapy can help stretch and strengthen the fascia, as well as the Achilles tendon and lower leg muscles. Night splints are specially made boots that help to stretch the calf and foot arch while you sleep. By holding the ligaments in a stretched position, the goal is to promote stretching and relax the tendon for normal function. Custom-made arch supports can also help to support the ligaments and reduce pain.
If these treatment options are unsuccessful, other treatment options include:
- Foot injections – Steroid injections into the foot can cause temporary pain relief while platelet-rich plasma injections can promote damaged tissue healing.
- Extracorporeal shock wave therapy – this treatment uses sound waves to stimulate healing in the heal.
- Surgery – This is a last resort treatment option that detaches the plantar fascia from the heel.
Treatment Options for Diabetics with Plantar Fasciitis
While conservative treatments work well for those with diabetes, some of the other treatment options can cause complications. For example, the use of steroid injections is not recommended for patients with diabetes. Corticosteroids can increase blood glucose levels and contribute to complications.
A 2015 study published in the Journal of the American Podiatric Medical Association showed that transcranial direct current stimulation, or tDCS, was a suitable treatment option to ease plantar fasciitis pain in diabetic patients. Transcranial direct current stimulation is a non-invasive and painless method of stimulating the brain. Using direct electrical low intensity currents via electrodes to either excite neuronal activity or reduce it. In the case of plantar fasciitis pain, tDCS inhibits pain receptors in the brain, reducing the sensation of pain.
Reduce Your Risk of Plantar Fasciitis
While many different treatment options can be effective, reducing your risk of plantar fasciitis is critical, especially if you have diabetes. Because diabetes is already a risk factor, reducing other possible risk factors is the place to start. If you have diabetes, consider some of these risk reduction tips:
- Maintain a healthy body weight – while maintaining a healthy body weight can be difficult with diabetes, a healthy weight greatly reduces your risk of plantar fasciitis. Meet with your physician and a nutritionist to establish a healthy diet plan that will not only help manage your diabetes, but also help you reduce your weight.
- Participate in a regular exercise program – Exercise helps to keep your calf muscles and ligaments in shape, reducing your risk of plantar fasciitis. This does not mean that you need to join a gym and work out every day. A simple, 30-minute walk three times a week is often enough to stimulate your muscles and get them in better shape.
- Talk with a foot doctor – if you suffer with high arches or flat feet, ask your regular doctor to refer you to a foot specialist. They can often recommend inserts or orthopedic shoes that can help better support your arch and reduce your plantar fasciitis risk. If you are a runner, talk with them about the best shoes to wear when running in order to reduce repetitive strain.
- Adjust your work routine – If your job requires you to work on your feet for long periods of time, be sure to take regular breaks that allow you to get off your feet. Even a short 10-minute break can make a difference.
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