Predictors of response to foot orthoses and corticosteroid injection for 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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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 Foot Orthoses Versus Corticosteroid Injection for Plantar Heel Pain: The SOOTHE Randomized Clinical Trial

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2019.8807 ◽

2019 ◽

Vol 49 (7) ◽

pp. 491-500 ◽

Cited By ~ 9

Author(s):

Glen A. Whittaker ◽

Shannon E. Munteanu ◽

Hylton B. Menz ◽

James M. Gerrard ◽

Ayman Elzarka ◽

...

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Corticosteroid Injection ◽

Heel Pain ◽

Foot Orthoses ◽

Plantar Heel Pain

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

Clinical Rheumatology ◽

10.1007/s10067-014-2565-7 ◽

2014 ◽

Vol 34 (5) ◽

pp. 957-964 ◽

Cited By ~ 24

Author(s):

Matthew P. Cotchett ◽

Glen Whittaker ◽

Bircan Erbas

Keyword(s):

Heel Pain ◽

Foot Pain ◽

Psychological Variables ◽

Plantar Heel Pain ◽

Foot Function

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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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Clinical efficacy and cost-effectiveness of bespoke compared with over-the-counter foot orthoses for plantar heel pain

Journal of Foot and Ankle Research ◽

10.1186/1757-1146-3-s1-o22 ◽

2010 ◽

Vol 3 (S1) ◽

Author(s):

Katie Ring ◽

Simon Otter

Keyword(s):

Cost Effectiveness ◽

Clinical Efficacy ◽

Heel Pain ◽

Foot Orthoses ◽

Over The Counter ◽

Plantar Heel Pain

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Foot Health Status Questionnaire (FHSQ) in Spanish People with Type 2 Diabetes Mellitus: Preliminary Values Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17103643 ◽

2020 ◽

Vol 17 (10) ◽

pp. 3643

Author(s):

Francisco Javier Domínguez-Muñoz ◽

Miguel Angel Garcia-Gordillo ◽

Rodrigo Anibal Diaz-Torres ◽

Miguel Ángel Hernandez-Mocholi ◽

Santos Villafaina ◽

...

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Health Status ◽

Foot Pain ◽

Foot Health ◽

Foot Function ◽

Foot Health Status Questionnaire

Background and objectives: Type 2 Diabetes Mellitus (T2DM) is a chronic disease characterized by hyperglycemia. T2DM affects millions of people, and has a lot of complications such as impaired sensation in the feet. Moreover, it is important to know the health of the feet of people with T2DM. The aim of this study is to know the preliminary values of the Foot Health Status Questionnaire (FHSQ) in people with T2DM. Materials and Methods: A total of 87 patients with T2DM with an average age of 65.56 years, divided in 54 men and 33 women, participated in this cross-sectional study. The main outcome was the health of the foot as measured by the FHSQ questionnaire. This questionnaire collects data on eight dimensions: Foot Pain, Foot Function, Shoe, General Foot Health, General Health, Physical Activity, Social Capacity, and Vigor. Results: Patients with T2DM have lower values in Foot Pain; median values in General Foot Health and high values in Foot Function, Shoe, Physical Activity and Social Capacity. Some of these dimensions are affected by age, diabetes control, Body Mass Index (BMI), and years of diagnosis. Females with T2DM have more problems than males in the Shoe, General Foot Health, Physical Activity and Vigor dimensions. Conclusions: this research gives us preliminary values of the FHSQ in Spanish patients with T2DM and divided by gender, age, diabetes control, BMI, and years of diagnosis in people with T2DM.

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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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