Plantar Fasciitis Causes Beyond the Foot: Weight, Diabetes, Cholesterol and Shoes

Written by AT. Chintan Dalal, N.D. · Reviewed by Dr Krushal Pabari, Clinical Team, Cure4Pain · Updated 30 October 2026

Key facts

Plantar fasciitis comes from strain on the band under the foot, and the NHS notes that it is not always clear why this happens [1]. Higher body weight has the most consistent link: a 2016 meta-analysis of observational studies found about 3.7 times the odds with a body mass index (BMI) above 27, strongest in people who are not athletes [2]. In about 720,000 patients of a US health system, plantar fasciitis was recorded 64% more often in type 2 diabetes than without diabetes [3]. Small studies link plantar fasciitis with higher cholesterol, while findings on triglycerides disagree [4] [5]. Harder-heeled shoes and heel spurs are also more common in people with heel pain [6] [7]. These are associations, not proven causes, and in our PubMed searches on 30 October 2026 we found no randomised trial of weight loss, lipid lowering or blood sugar control for heel pain.

Scientific explainer videos in our Resources section

In our Resources section, our clinical team discusses vitamin D, its cofactors and how autoimmune, lifestyle and pain conditions develop.

Watch our scientific explainer videos

What causes plantar fasciitis?

Plantar fasciitis is caused by straining the plantar fascia, the band that connects the heel bone to the toes, and “it’s not always clear why this happens”, according to the NHS [1]. The 2024 Singapore consensus guideline describes it as usually multifactorial, often with more than one risk factor in the same person, and says risk factors should be assessed and addressed [8]. Beyond the foot itself, this article covers body weight, diabetes, blood fats, footwear and time spent standing.

Factor	What studies show	Strength of the evidence
Higher body weight	About 3.7 times the odds with BMI above 27 [2]	Consistent, but observational
Type 2 diabetes	Recorded 64% more often than without diabetes [3]	One large records study; shared risk factors
Cholesterol	Higher in people with plantar fasciitis in small studies [9] [4]	Small studies; one links it to severity only [5]
Triglycerides	Higher in one study [4], no link in another [5]	Conflicting
Shoes	Harder heels in people with heel pain [6]	Small cross-sectional studies
Long standing	Linked in a 2015 systematic review of 4 studies [10]	Low quality
Heel spur	About 8.5 times the odds on X-ray [7]	Strong link; spurs are common without pain

Most research on the causes of plantar fasciitis cannot prove a cause. Of the 51 studies in the 2016 van Leeuwen meta-analysis, 46 were case-control and only 1 followed people forward in time, so most cannot show which came first [2]. The role of the foot itself is also debated: a 2003 case-control study found 23.3 times the odds of plantar fasciitis with a very tight calf, with a wide margin of error (4.3 to 124.4) [11], yet the 2016 van Leeuwen meta-analysis found a lack of evidence for clinical and mechanical measures of foot and ankle function [2].

Does being overweight cause plantar fasciitis?

Higher body weight is the most consistently reported link with plantar fasciitis, especially in people who are not athletes, but no study has proven that it is the cause. A 2016 meta-analysis of observational studies found about 3.7 times the odds with a BMI above 27 [2]. The NHS lists being overweight as a risk factor [1], the American Academy of Orthopaedic Surgeons says heel pain is often seen in overweight people [12], and the 2023 American Physical Therapy Association guideline lists higher body weight in people who are not athletes [13].

• A step-wise pattern: among 4,957 US adults in the 2009-2010 NHANES national survey, the odds of heel pain were 1.5 times as high with a BMI of 25 to 30, 2.1 times with 30 to 35 and 2.7 times with 35 or more, compared with a BMI below 25 [14].
• In active people: the evidence disagrees. A 2006 review found no link with BMI in athletes [15], while a 2021 meta-analysis in physically active people found BMI about 2.1 points higher in those with plantar fasciitis [16].
• Weight gain: almost all of the studies in the 2016 meta-analysis measured people at one point in time, so they cannot show whether weight or heel pain came first [2].

Does losing weight help plantar fasciitis?

Losing weight may help some people with plantar fasciitis, but in our PubMed searches on 30 October 2026 we found no randomised trial of it, and a 2012 systematic review called the evidence for weight loss and foot pain limited [17]. The NHS still advises trying to lose weight if you are overweight [1], and the 2023 American Physical Therapy Association guideline advises counselling on healthy body weight [13].

• After weight-loss surgery: in a 2018 US record review of 163 people with plantar fasciitis, mean BMI fell from 45 to 34.8 and 90% were recorded as having their symptoms settle. There was no comparison group [18].
• Weight may not act through load alone: in a 2018 Australian study of 45 candidates for weight-loss surgery (29 had surgery, 16 were on a waiting list), general foot pain fell after surgery, but the fall was not linked to changes in foot pressure. It was linked to an improvement in depressive symptoms [19].
• Weight-loss medicine: in a 2025 Chinese cohort, the 92 of 2,902 people with long-lasting heel pain who used semaglutide for diabetes or weight improved more than non-users. It was not randomised, and the authors call for a trial [20].

Does diabetes cause plantar fasciitis?

Type 2 diabetes is linked with plantar fasciitis, but it has not been shown to be a cause, and part of the link may come from shared factors such as body weight. In a 2019 five-year study of about 720,000 patients of one US health system, plantar fasciitis was recorded in 1.31% of people with type 2 diabetes, 0.92% with type 1 and 0.80% without diabetes, so it was recorded 64% more often in type 2 than without diabetes; the type 1 difference was not statistically significant. Women and people with higher BMI were also recorded more often [3].

• Shared risks: a 2020 review says people with diabetes are at risk partly because of common factors such as obesity and a sedentary lifestyle [21].
• A thicker fascia: in a 2025 Indian ultrasound study, the plantar fascia measured 3.4 mm in type 2 diabetes without heel pain, 5.6 mm in plantar fasciitis and 2.6 mm in healthy people. Reduced echo on ultrasound appeared in 90% of the plantar fasciitis group and 7% of the diabetes group, so the two changes are not the same [22].
• Weight again: in 51 people recently diagnosed with type 2 diabetes, plantar fascia thickness rose closely with BMI [23].
• A proposed mechanism, not a proven one: high blood sugar may thicken the fascia through sugar-bound proteins (advanced glycation end products) [3].

Read more on our type 2 diabetes page.

Is it plantar fasciitis or diabetic neuropathy?

Symptoms give the first clue to whether foot pain is plantar fasciitis or diabetic neuropathy. According to the NHS, plantar fasciitis typically hurts most with the first steps after rest and is felt around the heel and arch [1]. Tingling or loss of feeling suggests a nerve may be involved, and the NHS advises seeing a GP for this, or if you have diabetes and foot pain at all, because “foot problems can be more serious if you have diabetes” [1]. See our neuropathy page.

• Recovery: in a 2025 cohort of 220 people with long-lasting heel pain, rising scores for nerve-type symptoms went with poorer pain recovery over 12 months [24].
• Soaking: the US NIDDK says “do not soak your feet because your skin will get too dry” [25], and Diabetes UK also advises avoiding it [26]. If you have diabetes or numb feet, ask us before soaking.

Can high cholesterol or triglycerides cause plantar fasciitis?

No study has shown that high cholesterol or triglycerides cause plantar fasciitis, and in our PubMed searches on 30 October 2026 we found no trial of lowering blood fats for heel pain. Studies do find links, mostly with cholesterol, and they disagree on triglycerides.

• Cholesterol: in a 2022 study in Turkey, 22.7% of 238 people with plantar fasciitis had high total cholesterol, against 10.8% of 240 other orthopaedic patients [9].
• Triglycerides and LDL: in a 2025 Iranian study of 68 patients and 136 controls, total cholesterol, LDL (“bad”) cholesterol and triglycerides were all higher in plantar fasciitis, and an LDL above 130 mg/dL went with 3.3 times the odds of plantar fasciitis [4].
• A study that disagrees: in a 2026 Australian study with fasting blood from 197 people with long-lasting heel pain and 100 controls, no blood marker was linked with having heel pain. Cholesterol measures were linked with how severe the pain was; triglycerides were not [5].
• Clinic observation: at Cure4Pain, heel pain without a spur on X-ray is at times seen with raised triglycerides, and it often eases when they are brought down, in coordination with your existing consulting physician. No trial has tested this, and the 2026 Australian study found no link with triglycerides; further studies are needed.

Do uric acid, thyroid or vitamin D problems cause plantar fasciitis?

No study has shown that uric acid, thyroid or vitamin D problems cause plantar fasciitis, and the few small studies available disagree on vitamin D. In a 2023 study of 40 South Indian adults with heel pain, random blood sugar, uric acid, thyroid-stimulating hormone and vitamin D showed no significant link with heel pain; there was no separate healthy group [27]. In a 2022 Turkish study of 50 people with heel pain and a heel spur against 50 healthy volunteers, vitamin D and HDL cholesterol were lower, while LDL cholesterol, triglycerides and parathyroid hormone were higher; it cannot show which came first [28]. A sudden, red, swollen joint is a different matter: see our article on high uric acid and gout. Our article on deficiencies and joint pain covers nutrients more widely.

Can shoes or long hours standing cause plantar fasciitis?

Poor shoes and long hours of standing are linked with plantar fasciitis, but the studies are small and cannot prove cause. The NHS lists shoes with poor cushioning or support as a risk factor and advises against high heels, tight pointy shoes, flip-flops and backless slippers [1].

• Harder heels: in a 2023 study, 50 people with heel pain, matched with 25 without for age, sex and BMI, wore harder-heeled shoes and stood 3.4 hours more a day. Shoe style and heel height did not differ [6].
• High heels: in an online survey of 401 Saudi women, frequent high-heel use was linked with pain after standing, while general shoe type was not [29].
• In South Asia: of 101 patients in Pakistan, 83.2% wore shoes the authors rated as unsuitable, and these people had more severe pain; there was no comparison group [30]. In 50 non-athletic Indian patients, poorly cushioned shoes and BMI were linked with pain [31].
• Work: a 2015 systematic review found low-quality evidence for a link between plantar fasciitis and standing and walking on hard surfaces [10].

Do heel spurs cause plantar fasciitis?

The American Academy of Orthopaedic Surgeons states that “heel spurs do not cause plantar fasciitis pain”, and adds that most people with spurs have no heel pain [12]. Studies still find a strong link, so a spur often comes with the condition, but whether it contributes is unsettled.

• The link: a 2009 meta-analysis found about 8.5 times the odds of a spur on X-ray in people with long-lasting heel pain [7].
• Often painless: among 74 people with one painful heel, spurs appeared in 85.1% of painful feet and 71.6% of painless ones [32].
• Weight matters here too: in a 2023 study of 100 people who all had spurs, those with plantar fasciitis more often had a BMI above 30 (odds 2.7) [33].
• Where studies disagree: a Danish study of 174 people found that a spur did not change the long-term outlook [34], while two smaller studies linked larger spurs with more pain [35] [36].

What causes heel spurs?

The cause of heel spurs is not settled. The American Academy of Orthopaedic Surgeons describes a heel spur as a possible result of long-standing tension where the fascia meets the heel bone [12]. In a 2008 study of 216 older adults, however, spurs were linked with obesity (odds 7.9) and not with foot posture, which the authors read as a response to vertical pressure [37]. In a 2014 Irish study of 1,103 ankle X-rays, spurs were more common in women and older patients, and people with spurs were 4 times more likely to have diabetes [38].

What do guidelines advise?

Plantar fasciitis guidelines name body weight, shoes and time on the feet as risk factors. The 2023 American Physical Therapy Association guideline lists limited ankle bending, higher body weight in people who are not athletes, running and weight-bearing work as risk factors [13]. The 2024 Singapore guideline names obesity, worn-out shoes with poor support and jobs with prolonged standing, and suggests podiatrist review for orthoses when BMI is high [8]. A 2021 best practice guide in the British Journal of Sports Medicine advises taping, stretching and individual education, with footwear advice, as core treatment [39]. Neither the 2024 Singapore guideline nor the NHS page lists blood-fat or blood-sugar treatment among plantar fasciitis treatments [8] [1].

How we look for causes beyond the foot at Cure4Pain

At Cure4Pain, we examine the foot and the whole picture together, starting with muscle testing and blood work.

• Muscle testing first: the calf, foot and leg muscles, because in our clinic the calves are often tighter and at times weaker.
• Blood work: we read a panel of about 100 markers, adding tests for your condition when clinically indicated, such as blood fats including triglycerides and blood sugar. The 2024 Singapore guideline says risk factors should be assessed and addressed, without naming these blood tests [8]. According to the US National Institutes of Health, less than 1% of the body’s magnesium is in the blood and serum levels do not accurately reflect total body magnesium [40], so we assess magnesium from the overall clinical picture.
• Heel pain with no spur: raised triglycerides addressed in coordination with your existing consulting physician, nutrient shortfalls corrected, with supplements by mouth first and injections only when specifically needed or advised, and regular Epsom salt foot soaks for comfort. A 2017 review concluded that claims for magnesium through the skin are scientifically unsupported [41]; no trial has tested soaks for heel pain, and we use them to support comfort.
• Diabetic neuropathy, poor circulation, or burning or tingling feet with known diabetes or high blood fats: we do not needle the foot. We first wait for blood sugar and HbA1c to come into a healthy range, which can take months, under clinical guidance from Dr Krushal Pabari and, where needed, your existing consulting diabetologist. Gentle myofascial release is used only after their approval and is rarely needed. If you have diabetes or numb feet, ask us before soaking.
• Medicines: Dr Krushal Pabari prescribes cholesterol medicines beyond statins where needed. Any change to diabetes, cholesterol or other medicines is made under clinical guidance from Team Cure4Pain, in coordination with your existing consulting physician; never stop or change them on your own.

This is our clinic practice; individual results vary, and further studies are needed. Treatment details are on our plantar fasciitis page, and weight and blood fats are covered on our metabolic syndrome page.

If you would like your heel pain looked at together with your weight, blood sugar and blood fats, you can book a consultation, online from anywhere or at our Mumbai clinic; muscle testing and needling need an in-person visit.

Frequently asked questions

What is the main cause of plantar fasciitis?

Plantar fasciitis comes from strain on the plantar fascia, and the NHS notes that it is not always clear why. Higher body weight has the most consistent link in studies; long standing and a tight calf are also linked in some studies, on weaker evidence. [1] [2] [11] [10]

Can being overweight cause plantar fasciitis?

Higher body weight is strongly linked with plantar fasciitis, especially in people who are not athletes, with about 3.7 times the odds at a BMI above 27 in a 2016 meta-analysis of observational studies. These studies cannot prove cause. [2]

Will losing weight help plantar fasciitis?

Losing weight may help, but we found no randomised trial of it in PubMed. In a 2018 US record review of people who had weight-loss surgery, 90% were recorded as having their symptoms settle, without a comparison group. The NHS advises trying to lose weight if you are overweight. [18] [1]

Does diabetes cause plantar fasciitis?

Type 2 diabetes is linked with plantar fasciitis, but a cause has not been shown. In a 2019 US records study of about 720,000 patients, plantar fasciitis was recorded 64% more often in type 2 diabetes than in people without diabetes. Body weight is a shared factor, and the type 1 difference was not statistically significant. [3] [21]

How do I tell plantar fasciitis from diabetic neuropathy?

Plantar fasciitis usually hurts most with the first steps after rest, under the heel and arch. Tingling or loss of feeling needs a doctor’s review, as does any foot pain if you have diabetes. [1]

Can high cholesterol cause plantar fasciitis?

No study has shown that high cholesterol causes plantar fasciitis. Small studies find higher cholesterol in people with plantar fasciitis, while a 2026 study of 297 people linked cholesterol with how severe the pain was, not with having heel pain. [9] [5]

Are high triglycerides linked with heel pain?

Studies disagree on whether high triglycerides are linked with heel pain: a 2025 study found higher triglycerides in plantar fasciitis and a 2026 study found no link. At Cure4Pain we at times see heel pain ease when raised triglycerides are brought down; this is a clinic observation, and further studies are needed. [4] [5]

Can shoes cause plantar fasciitis?

The NHS lists shoes with poor cushioning or support as a risk factor, and people with heel pain wore harder-heeled shoes in a 2023 matched study. No study proves that shoes alone cause plantar fasciitis. [1] [6]

Do heel spurs cause plantar fasciitis?

The American Academy of Orthopaedic Surgeons says heel spurs do not cause the pain, and most people with spurs have no heel pain. Spurs are still much more common in people with long-lasting heel pain. [12] [7]

Can I soak my feet in Epsom salt if I have diabetes?

If you have diabetes, ask us before soaking your feet in Epsom salt. The US NIDDK and Diabetes UK advise people with diabetes not to soak their feet, because of skin dryness and damage. [25] [26]

This article is for education and does not replace medical advice. Do not start, stop or change any medicine or supplement without medical guidance.

References

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