Psychological variables associated with foot function and foot pain in patients with plantar heel pain

Abstract Background Foot orthoses and corticosteroid injection are common interventions used for plantar heel pain, however few studies have investigated the variables that predict response to these interventions. Methods Baseline variables (age, weight, height, body mass index (BMI), sex, education, foot pain, foot function, fear-avoidance beliefs and feelings, foot posture, weightbearing ankle dorsiflexion, plantar fascia thickness, and treatment preference) from a randomised trial in which participants received either foot orthoses or corticosteroid injection were used to predict change in the Foot Health Status Questionnaire foot pain and foot function subscales, and first-step pain measured using a visual analogue scale. Multivariable linear regression models were generated for different dependent variables (i.e. foot pain, foot function and first-step pain), for each intervention (i.e. foot orthoses and corticosteroid injection), and at different timepoints (i.e. weeks 4 and 12). Results For foot orthoses at week 4, greater ankle dorsiflexion with the knee extended predicted reduction in foot pain (adjusted R2 = 0.16, p = 0.034), and lower fear-avoidance beliefs and feelings predicted improvement in foot function (adjusted R2 = 0.43, p = 0.001). At week 12, lower BMI predicted reduction in foot pain (adjusted R2 = 0.33, p < 0.001), improvement in foot function (adjusted R2 = 0.37, p < 0.001) and reduction in first-step pain (adjusted R2 0.19, p = 0.011). For corticosteroid injection at week 4, there were no significant predictors for change in foot pain or foot function. At week 12, less weightbearing hours predicted reduction in foot pain (adjusted R2 = 0.25, p = 0.004) and lower baseline foot pain predicted improvement in foot function (adjusted R2 = 0.38, p < 0.001). Conclusions People with plantar heel pain who use foot orthoses experience reduced foot pain if they have greater ankle dorsiflexion and lower BMI, while they experience improved foot function if they have lower fear-avoidance beliefs and lower BMI. People who receive a corticosteroid injection experience reduced foot pain if they weightbear for fewer hours, while they experience improved foot function if they have less baseline foot pain.

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Efficacy of electroacupuncture plus warm needling therapy for plantar heel pain: a randomised waitlist-controlled trial

Acupuncture in Medicine ◽

10.1177/0964528420946048 ◽

2020 ◽

pp. 096452842094604

Author(s):

Lai Fun Ho ◽

Yuanqi Guo ◽

Jessica Yuet-Ling Ching ◽

Kam Leung Chan ◽

Ping Him Tsang ◽

...

Keyword(s):

Treatment Group ◽

Controlled Trial ◽

Heel Pain ◽

Community Dwelling ◽

Control Group ◽

Therapeutic Effects ◽

Global Rating ◽

Plantar Heel Pain ◽

Foot Function ◽

Warm Needling

Objective: To investigate the therapeutic effects of electroacupuncture plus warm needling (EAWN) therapy on pain and foot function in adults with plantar heel pain (PHP). Methods: This prospective, randomised, parallel-group, waitlist-controlled trial was conducted at a Chinese medicine centre in Hong Kong between May 2018 and February 2019. Eighty eligible community-dwelling subjects with PHP (mean age 59.7 years; 85% female) were equally randomised to receive EAWN therapy or remain on a waitlist. The treatment group received six 30-min sessions of standardised EAWN therapy over 4 weeks; the control group received no treatment. The outcome measures were the visual analogue scale (VAS) score for first-step pain, foot function index (FFI) scores and global rating of change (GRC) scale scores. Assessments were made at baseline, week 2 and week 4 (primary endpoint). The treatment group underwent additional assessments at week 8. Outcomes were evaluated by intention-to-treat analysis. Results: Patients who received EAWN therapy exhibited greater improvements in the mean first-step pain VAS and all FFI scores than did those in the control group at weeks 2 and 4, with significant between-group differences (all P < 0.001). Compared with baseline, there were significant decreases in mean first-step pain VAS scores at weeks 2 and 4, and FFI scores at week 4, in the treatment group but not in the control group. The improvements in the treatment group continued until week 8. GRC scores at week 4 indicated improvement in all treated patients and only 22.5% of the control group patients ( P < 0.001). There were no study-related adverse events. Conclusion: EAWN therapy could be an effective treatment for PHP in middle-aged and older adults. Trial registration number: ChiCTR1800014906 (Chinese Clinical Trials Registry)

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Differentiating Sitting, Standing, and Walking Through Regional Plantar Pressure Characteristics

Journal of Biomechanical Engineering ◽

10.1115/1.4045049 ◽

2019 ◽

Vol 142 (4) ◽

Cited By ~ 2

Author(s):

Kohle Merry ◽

Megan MacPherson ◽

Evan Macdonald ◽

Michael Ryan ◽

Edward J. Park ◽

...

Keyword(s):

Plantar Pressure ◽

Repeated Measures ◽

Weight Bearing ◽

Heel Pain ◽

Average Pressure ◽

Sedentary Behaviors ◽

Plantar Heel Pain ◽

Measurement Tools ◽

Pressure Peak ◽

Foot Function

Abstract Prolonged static weight bearing (WBR) is thought to aggravate plantar heel pain and is common in the workplace, which may put employees at greater risk of developing plantar heel pain. However, objective measures of physical activity and sedentary behaviors in the workplace are lacking, making it difficult to establish or refute the connection between work exposure and plantar heel pain. Characterizing loading patterns during common workplace postures will enhance the understanding of foot function and inform the development of new measurement tools. Plantar pressure data during periods of sitting, standing, and walking were measured in ten healthy participants using the F-Scan in-shoe measurement system (Tekscan Inc, Boston, MA). Peak and average pressure, peak and average contact area, and average pressure differential were analyzed in ten different regions of the foot. A two-way repeated measures analysis of variance (ANOVA) assessed the posture by foot region interaction for each measurement parameter; significant effects of posture by foot region were identified for all five measurement parameters. Ten foot region by measurement parameter combinations were found to significantly differentiate all three postures simultaneously; seven used pressure measures to differentiate while three used area measures. The heel, lateral midfoot (LM), and medial and central forefoot (CFF) encompassed nine of ten areas capable of differentiating all postures simultaneously. This work demonstrates that plantar pressure is a viable means to characterize and differentiate three common workplace postures. The results of this study can inform the development of measurement tools for quantifying posture duration at work.

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Effect of a Toe-Walking Protocol in Plantar Heel Pain: A Proof of Concept

10.21203/rs.3.rs-965008/v1 ◽

2021 ◽

Author(s):

Dean Huffer ◽

Wayne Hing ◽

John Charles ◽

Richard Newton ◽

Mike Clair ◽

...

Keyword(s):

Plantar Fascia ◽

Primary Outcome Measure ◽

Heel Pain ◽

Cortical Inhibition ◽

Secondary Outcome ◽

Patient Reports ◽

Plantar Heel Pain ◽

Pain Disability ◽

Foot Function ◽

Toe Walking

Abstract Background: Plantar heel pain (PHP) is one of most common disorders of the foot treated in primary care. It affects athletic and sedentary populations, with patient reports of activity-limiting pain and reduced quality of life. Recently, atrophy of the forefoot plantar intrinsic musculature was identified in patients with PHP. Therefore, the purpose of this study was to assess whether loading the plantar fascia strengthens the intrinsic foot musculature (IFM) and decreases symptoms in subjects with PHP Methods: A within-subjects experimental design assessed foot function, foot pain, disability, and activity limitation in 12 subjects with PHP prior to and at the end of a six-week toe-walking program. The primary outcome measure was the Foot Function Index (FFI). IFM strength (both hallux flexion and lesser toe flexion) was measured as a secondary outcome. Results: After six weeks of treatment, the mean (SD) FFI score significantly decreased from 73.2 (32.4) to 43.3 (22.8) points (p = 0.010, ES=1.1). HHD measures: Both great toe flexion and lesser toes flexion strength measures demonstrated significant force increases from 21.8N to 29.6N (+7.8N) 95%CI [1.3, 14.4] (p=0.024, ES=1.0) and from 21.4N to 28.4N (+6.6N) 95%CI [1.8, 11.4] (p=0.010, ES=0.9), respectively. Conclusion: Results suggest that toe-walking may reduce PHP symptoms and increase IFM strength. There was no identified correlation between the IFM and FFI changes. Symptom reduction may be due to a reduction in cortical inhibition rather than IFM strength changes. Findings provide foundation for future larger and more controlled studies, to further validate the effectiveness of toe-walking in reducing symptoms of PHP patients. Trial registration: Bond University Ethics Committee (BUHREC Protocol No. 1908)

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A Preliminary Study on the Effect of Computer-Aided Designed and Manufactured Orthoses on Chronic Plantar Heel Pain

Foot & Ankle Specialist ◽

10.1177/1938640017709906 ◽

2017 ◽

Vol 11 (2) ◽

pp. 112-116

Author(s):

Alfred Gatt ◽

Mark Grech ◽

Nachiappan Chockalingam ◽

Cynthia Formosa

Keyword(s):

Computer Aided Design ◽

Comparative Trial ◽

Heel Pain ◽

Painful Condition ◽

Plantar Heel Pain ◽

Pain Scores ◽

Computer Aided ◽

Cad Cam ◽

Foot Function ◽

Aided Design

Introduction. Chronic plantar heel pain (CPHP) is a significant, painful condition referring to a range of undifferentiated foot conditions that affect the heel of the foot. Method. Participants presenting with CPHP of more than 6 months’ duration were recruited on a first through the door basis. Computer-Aided Design and Computer-Aided Manufactured (CAD-CAM) orthoses were designed and constructed for each participant, then dispensed as per normal practice. Pre- and postintervention assessment of pain was performed at baseline and after 6 weeks of use, utilizing the pain subset of the Foot Function Index (FFI). Results. There was a significant reduction in the mean pain scores for all participants in all constructs of the FFI. Total FFI score was also significant ( P = .003). Conclusion. CAD-CAM orthoses have the potential to become a treatment modality of choice in CPHP since they have resulted in a significant improvement in heel pain after only 6 weeks’ use. Levels of Evidence: Therapeutic, Level IV: Prospective, comparative trial

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Evaluating the Clinical Effectiveness and Cost-effectiveness of Foot Orthoses in the Treatment of Plantar Heel Pain

Journal of the American Podiatric Medical Association ◽

10.7547/0940229 ◽

2004 ◽

Vol 94 (3) ◽

pp. 229-238 ◽

Cited By ~ 37

Author(s):

Keith Rome ◽

Joanne Gray ◽

Fiona Stewart ◽

Stephen Charles Hannant ◽

Des Callaghan ◽

...

Keyword(s):

Cost Effectiveness ◽

Health Status ◽

Health Service ◽

Clinical Effectiveness ◽

Heel Pain ◽

Foot Orthoses ◽

Foot Pain ◽

Foot Health ◽

Plantar Heel Pain ◽

Health Service Costs

This study evaluated the clinical effectiveness and cost-effectiveness of two different types of foot orthoses used to treat plantar heel pain. Forty-eight patients were randomly assigned to receive either a functional or an accommodative orthosis. General (EuroQol) and specific (Foot Health Status Questionnaire) health-status measures were used. Data were also collected using economic questionnaires relating to National Health Service costs for podia-try, other health-service costs, and patient costs. Data were measured at baseline and at 4- and 8-week intervals. Thirty-five patients completed the study. The results demonstrated a significant decrease in foot pain and a significant increase in foot function with the functional foot orthoses over the 8-week trial. The accommodative foot orthoses demonstrated a significant reduction in foot pain only at 4 weeks. The cost-effectiveness analysis demonstrated that functional orthoses, although initially more expensive, result in a better quality of life. Use of functional orthoses resulted in an increased cost of £17.99 ($32.74) per patient, leading to an incremental cost per quality-adjusted life year of £1,650 ($3,003) for functional orthoses. (J Am Podiatr Med Assoc 94(3): 229–238, 2004)

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Effectiveness of Trigger Point Dry Needling for Plantar Heel Pain: A Randomized Controlled Trial

Physical Therapy ◽

10.2522/ptj.20130255 ◽

2014 ◽

Vol 94 (8) ◽

pp. 1083-1094 ◽

Cited By ~ 63

Author(s):

Matthew P. Cotchett ◽

Shannon E. Munteanu ◽

Karl B. Landorf

Keyword(s):

Randomized Controlled Trial ◽

Adverse Events ◽

Trigger Point ◽

Controlled Trial ◽

Heel Pain ◽

Foot Pain ◽

Dry Needling ◽

Randomized Controlled ◽

Plantar Heel Pain ◽

End Point

Background Plantar heel pain can be managed with dry needling of myofascial trigger points; however, there is only poor-quality evidence supporting its use. Objective The purpose of this study was to evaluate the effectiveness of dry needling for plantar heel pain. Design The study was a parallel-group, participant-blinded, randomized controlled trial. Setting The study was conducted in a university health sciences clinic. Patients Study participants were 84 patients with plantar heel pain of at least 1 month's duration. Intervention Participants were randomly assigned to receive real or sham trigger point dry needling. The intervention consisted of 1 treatment per week for 6 weeks. Participants were followed for 12 weeks. Measurements Primary outcome measures included first-step pain, as measured with a visual analog scale (VAS), and foot pain, as measured with the pain subscale of the Foot Health Status Questionnaire (FHSQ). The primary end point for predicting the effectiveness of dry needling for plantar heel pain was 6 weeks. Results At the primary end point, significant effects favored real dry needling over sham dry needling for pain (adjusted mean difference: VAS first-step pain=−14.4 mm, 95% confidence interval [95% CI]=−23.5 to −5.2; FHSQ foot pain=10.0 points, 95% CI=1.0 to 19.1), although the between-group difference was lower than the minimal important difference. The number needed to treat at 6 weeks was 4 (95% CI=2 to 12). The frequency of minor transitory adverse events was significantly greater in the real dry needling group (70 real dry needling appointments [32%] compared with only 1 sham dry needling appointment [<1%]). Limitations It was not possible to blind the therapist. Conclusion Dry needling provided statistically significant reductions in plantar heel pain, but the magnitude of this effect should be considered against the frequency of minor transitory adverse events.

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Effect of a toe-walking protocol in plantar heel pain: A pilot study

10.21203/rs.3.rs-676307/v1 ◽

2021 ◽

Author(s):

Dean Huffer ◽

Wayne Hing ◽

John Charles ◽

Richard Newton ◽

Mike Clair ◽

...

Keyword(s):

Plantar Fascia ◽

Heel Pain ◽

Cortical Inhibition ◽

Patient Reports ◽

Plantar Heel Pain ◽

Walking Program ◽

Force Increase ◽

Within Subjects ◽

Foot Function ◽

Toe Walking

Abstract Introduction/Purpose: Plantar heel pain (PHP) is one of most common disorders of the foot treated in primary care. It affects athletic and sedentary populations, with patient reports of activity-limiting pain and reduced quality of life. Recently, atrophy of the forefoot plantar intrinsic musculature was identified in patients with PHP.Therefore, the purpose of this study was to assess whether loading the plantar fascia strengthens the intrinsic foot musculature (IFM) and decreases PHP sufferers’ symptoms.Methods: A within-subjects experimental design assessed Foot Function Index (FFI) and IFM strength via hand-held dynamometry (HHD) in 12 patients with PHP prior to and at the end of a six-week toe-walking program.Results: After six weeks of treatment, the mean (SD) FFI score significantly decreased from 73.2 (32.4) to 43.3 (22.8) points (p = 0.010, ES = 1.1). HHD measures: Both great toe flexion and lesser toes flexion strength measures demonstrated significant force increase of 7.8N 95%CI [1.3, 14.4] (p = 0.024, ES = 1.0) and 6.6N 95%CI [1.8, 11.4] (p = 0.010, ES = 0.9), respectively.Conclusion: Results suggest toe-walking reduces PHP symptoms and increases IFM strength. There was no identified correlation between the IFM and FFI changes. Symptom reduction may potentially be due to a reduction in cortical inhibition rather than IFM strength changes. Findings provide foundation for future studies, employing imaging, to further validate the effectiveness of toe-walking in reducing symptoms of PHP patients.Trial registration: PROSPERO 2016 CRD42016036302 Registered 10 March 2016, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016036302

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Active Muscle Trigger Points Are Associated with Pain and Related Disability in Patients with Plantar Heel Pain: A Case–Control Study

Pain Medicine ◽

10.1093/pm/pnz086 ◽

2019 ◽

Vol 21 (5) ◽

pp. 1032-1038 ◽

Cited By ~ 1

Author(s):

Ricardo Ortega-Santiago ◽

Marta Ríos-León ◽

Patricia Martín-Casas ◽

César Fernández-de-las-Peñas ◽

Gustavo Plaza-Manzano

Keyword(s):

Case Control Study ◽

Trigger Points ◽

Case Control ◽

Heel Pain ◽

Referred Pain ◽

Healthy Controls ◽

Foot Pain ◽

Foot Health ◽

Plantar Heel Pain ◽

Control Study

Abstract Objective Pain experienced by patients with plantar heel pain has been associated with fascia thickness. It is possible that referred muscle pain may also be related to symptoms experienced by these patients. Our aim was to systematically investigate if the referred pain elicited by trigger points in the leg and foot musculature reproduces the symptoms in individuals with plantar heel pain and to determine the association of trigger points (TrPs) with pain and related disability. Methods A case–control study was conducted. Thirty-five individuals with unilateral chronic plantar heel pain and 35 matched comparable healthy controls participated. An assessor blinded to the subject’s condition explored TrPs in the flexor hallucis brevis, adductor hallucis, quadratus plantae, and internal gastrocnemius. Pain and related disability were assessed with a numerical pain rating scale (0–10), the Foot Function Index, and the Foot Health Status Questionnaire. Results The number of TrPs for each patient with plantar heel pain was 4 ± 3 (2.5 ± 2 active TrPs, 1.5 ± 1.8 latent TrPs). Healthy controls only had latent TrPs (mean = 1 ± 1). Active TrPs in the quadratus plantae (N = 20, 62.5%), and flexor hallucis brevis (N = 19, 59%) were the most prevalent in patients with plantar heel pain. A greater number of active, but not latent, TrPs was associated with higher foot pain variables (0.413 < rs < 0.561, P < 0.01), higher impact of foot pain (0.350 < rs < 0.473, P < 0.05) and worse related disability (–0.447 < rs < –0.35456, P < 0.05). Conclusions The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in patients with plantar heel pain. A greater number of active TrPs was associated with higher pain and related disability in patients with plantar heel pain.

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Foot function and strength of patients with diabetes grouped by ulcer risk classification (IWGDF)

Diabetology & Metabolic Syndrome ◽

10.1186/s13098-019-0487-x ◽

2019 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Jane S. S. P. Ferreira ◽

João P. Panighel ◽

Érica Q. Silva ◽

Renan L. Monteiro ◽

Ronaldo H. Cruvinel Júnior ◽

...

Keyword(s):

Treatment Strategies ◽

Foot Deformities ◽

Diabetic Patients ◽

Foot Pain ◽

Foot Health ◽

Significant Difference ◽

Patients With Diabetes ◽

Foot Function ◽

Group 2 ◽

Stratification System

Abstract Background The stratification system from the International Working Group on the Diabetic Foot (IWGDF) was used to classify the participants as to the ulcer risk. However, it is not yet known what the classification groups’ individual deficits are regarding sensitivity, function, and musculoskeletal properties and mechanics. This makes it difficult to design proper ulcer prevention strategies for patients. Thus, this study aimed to investigate the foot function, foot strength and health of people with diabetes mellitus (DM)—with or without DPN—while considering the different ulcer risk classifications determined by the IWGDF. Methods The subject pool comprised 72 people with DM, with and without DPN. The patients were divided into three groups: Group 0 (G0), which comprised diabetic patients without DPN; Group 1 (G1), which comprised patients with DPN; and Group 2 (G2), which comprised patients with DPN who had foot deformities. The health and foot function of the subjects’ feet were assessed using a foot health status questionnaire (FHSQ-BR) that investigated four domains: foot pain, foot function, footwear, and general foot health. The patients’ foot strength was evaluated using the maximum force under each subject’s hallux and toes on a pressure platform (emed q-100, Novel, Munich, Germany). Results Moderate differences were found between G0 and G1 and G2 for the foot pain, foot function, general foot health, and footwear. There was also a small but significant difference between G0 and G2 in regards to hallux strength. Conclusion Foot health, foot function and strength levels of people with DM and DPN classified by the ulcer risk are different and this must be taken into account when evaluating and developing treatment strategies for these patients.

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