Relationship of Body Mass Index, Ankle Dorsiflexion, and Foot Pronation on Plantar Fascia Thickness in Healthy, Asymptomatic Subjects

Background: We sought to investigate the thickness of plantar fascia, measured by means of ultrasonographic evaluation in healthy, asymptomatic subjects, and its relationship to body mass index, ankle joint dorsiflexion range of motion, and foot pronation in static stance. Methods: One hundred two feet of 51 healthy volunteers were examined. Sonographic evaluation with a 10-MHz linear array transducer was performed 1 and 2 cm distal to its insertion. Physical examination was also performed to assess body mass index, ankle joint dorsiflexion, and degree of foot pronation in static stance. Both examinations were performed in a blinded manner. Results: Body mass index showed moderate correlation with plantar fascia thickness at the 1- and 2-cm locations. Ankle dorsiflexion range of motion showed no correlation at either location. Foot pronation showed an inverse correlation with plantar fascia thickness at the 2-cm location and no correlation at the 1-cm location. Conclusion: Body mass index and foot supination at the subtalar joint are related to increased thickness at the plantar fascia in healthy, asymptomatic subjects. Although the changes in thickness were small compared with those in patients with symptomatic plantar fasciitis, they could play a role in the mechanical properties of plantar fascia and in the development of plantar fasciitis. (J Am Podiatr Med Assoc 98(5): 379–385, 2008)

Download Full-text

The Effect of Dry Needling on Pain, Range of Motion of Ankle Joint, and Ultrasonographic Changes of Plantar Fascia in Patients With Plantar Fasciitis

Journal of Sport Rehabilitation ◽

10.1123/jsr.2021-0156 ◽

2021 ◽

pp. 1-6

Author(s):

Afsaneh Moosaei Saein ◽

Ziaeddin Safavi-Farokhi ◽

Atefeh Aminianfar ◽

Marzieh Mortezanejad

Keyword(s):

Range Of Motion ◽

Ankle Joint ◽

Visual Analog Scale ◽

Plantar Fasciitis ◽

Plantar Flexion ◽

Plantar Fascia ◽

Trigger Points ◽

Dry Needling ◽

Analog Scale ◽

Significant Difference

Context: Plantar fasciitis (PF) is a common and devastating disease. Despite different treatments, there is no clear evidence for the effect of these treatments on PF. One of the therapy methods used in physiotherapy is dry needling (DN). So the purpose of this study is to investigate the effect of DN on the pain and range of motion of the ankle joint and plantar fascia thickness in subjects with PF who are suffering from the trigger points of the gastrocnemius and soleus muscles. Methods: In this study, 20 volunteer females with PF were randomly assigned into DN treatment and control groups. Measurements were range of motion in dorsiflexion and plantar flexion, plantar fascia thickness, and visual analog scale measured before, immediately, and 1 month after the end of the intervention in both groups. Results: There were significant differences in the plantar fascia thickness and visual analog scale between the 2 groups. Plantar fascia thickness (P = .016) and visual analog scale (P = .03) significantly decreased in the treatment group. However, there was no significant difference in plantar flexion (P = .582) and dorsiflexion range of motion (P = .173) between groups. Conclusion: The result of this study showed that DN can reduce pain and plantar fascia thickness in women with PF who are suffering from trigger points of the gastrocnemius and soleus muscles. Level of evidence: Level 1, randomized controlled trial.

Download Full-text

Retrospective Analysis of Plantar Fascia by Ultrasound Imaging in Patients with Plantar Fasciitis

Journal of the American Podiatric Medical Association ◽

10.7547/16-083 ◽

2018 ◽

Vol 108 (5) ◽

pp. 349-354 ◽

Cited By ~ 2

Author(s):

Michael Henry Slayton ◽

Richard C. Amodei ◽

Keegan B. Compton ◽

Luke D. Cicchinelli

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Plantar Fasciitis ◽

Plantar Fascia ◽

Control Group ◽

Ultrasound Images ◽

Acute Injuries ◽

Patient Database ◽

Thickness Measurements ◽

Unilateral Conditions

Background: We compared diagnostic ultrasound images of the plantar fascia with available patient histories for symptomatic patients previously diagnosed as having plantar fasciitis. Plantar fascia thickness and depth, the prevalence of perifascial hypoechoic lesions, and injury timelines in patients were reviewed. Methods: Images and histories for 126 symptomatic patients were collected from a patient database. We documented plantar fascia depth and thickness and the visualization of hypoechoic perifascial lesions. After image analysis, the obtained plantar fascia thickness measurements were compared with various patient attributes for possible relationships, including age, weight, and body mass index. In addition, plantar fascia thickness measurements were separated based on injury timeline as well as symptomatic/asymptomatic foot for patients with unilateral conditions to check for significant differences between subgroups. These were, in turn, compared with a control group of 71 individuals with no heel pain or diagnosis of plantar fasciitis. Results: Overall, mean ± SD symptomatic thickness (n = 148) was 6.53 ± 1.56 mm. Mean ± SD symptomatic depth (n = 136) was 13.36 ± 2.14 mm. For the control group, mean ± SD thickness was 3.20 ± 0.66 mm and depth was 10.30 ± 2.00 mm. Comparison of thickness based on injury timeline showed two significant differences: acute injuries (≤3 months) are significantly thicker than chronic injuries (>3 months), and only acute symptomatic thicknesses are significantly different from their asymptomatic thickness counterparts. Age, weight, and body mass index did not show significant correlations to thickness. Analysis of ultrasound images showed that 93% of symptomatic feet had hypoechoic lesions. Conclusions: Injury timeline and the presence of hypoechoic lesions may play important roles in patient discomfort, diagnosis, and treatment of plantar fasciitis.

Download Full-text

Sonographic Evaluation of Plantar Fasciitis and its Relation to Body Mass Index and Heel Pad Thickness

Nepalese Journal of Radiology ◽

10.3126/njr.v9i2.27427 ◽

2020 ◽

Vol 9 (2) ◽

pp. 32-39

Author(s):

Prashant Khatiwada ◽

Dinesh Chataut ◽

Kamal Subedi

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Plantar Fasciitis ◽

Plantar Fascia ◽

Skin Surface ◽

Control Group ◽

Heel Pad ◽

And Control ◽

Calcaneal Tuberosity ◽

Symptomatic Side

Introduction: To study the sonographic appearance of plantar fascia in clinically suspected cases of plantar fasciitis (PFs) using both quantitative and qualitative parameters, and to establish the correlation between plantar fasciitis, body mass index (BMI) and heel pad thickness (HPT). Methods: In this case controlled analytical study, we sonographically evaluated 100 patients with clinical plantar fasciitis (unilateral: 90, bilateral: 10 with mean age 46.9yrs) and control group of 60 (120 heels) healthy volunteers with mean age 45.3yrs. Plantar Fascia Thickness (PFT), HPT, hypoechogenity, biconvexity, perifascial fluid, intrafascial calcification and subcalcaneal spurs were evaluated sonographically. PFT was measured 5mm distal to the calcaneal insertion of plantar aponeurosis. The unloaded HPT was measured from the skin surface to the nearest calcaneal tuberosity. Results: Mean Plantar Fascia Thickness (PFT) and Heel Pad Thickness (HPT) are greater on the symptomatic side for patients with unilateral and bilateral PFs than on the asymptomatic side for patients with unilateral PFs, and also control subjects (PFT values are 4.41 ± 0.59, 4.63 ± 0.55, 2.83 ± 0.36, 2.62± 0.37 mm, and HPT values 17.64 ± 1.07, 17.28 ± 1.10, 16.91 ± 1.06, 16.73 ± 1.13 mm, respectively) (p <0.0001). Mean BMI values of the case and control groups are 26.14 ± 1.9 and 24.42 ± 0.89 Kg/m2, respectively (p <0.05). We found hypoechogenicity of plantar fascia in 80 cases (72.7%), calcaneal spur in 69 cases (62.7%), biconvexity in 11 cases (10%) and perifascial fluid in 16 cases (14.5%) within the plantar fasciitis group (110 symptomatic heels). Conclusion: Increased plantar fascia thickness, increased heel pad thickness and hypoechogenicity of plantar fascia are consistent sonographic findings in plantar fasciitis. Its occurrence has significant relation to high BMI.

Download Full-text

THE COMPARISON BETWEEN NORMAL, OVERWEIGHT, AND OBESE BODY MASS INDEX CATEGORIES WITH RISK OF HAVING PLANTAR FASCIITIS IN WOMEN ADULTS AT GIANYAR DISTRICT

Majalah Ilmiah Fisioterapi Indonesia ◽

10.24843/mifi.2018.v06.i02.p02 ◽

2018 ◽

Vol 6 (2) ◽

pp. 32

Author(s):

I Putu Adi Merta ◽

I Made Niko Winaya ◽

I Wayan Sugiritama

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Plantar Fasciitis ◽

Data Distribution ◽

Sampling Technique ◽

Plantar Fascia ◽

Chi Square ◽

Cross Sectional ◽

Group A ◽

Group B

Elevated body mass can increases plantar pressure, so that causing overstretch the plantar fascia and occurs inflammation. The aims of this study was to compare the risk of having plantar fasciitis in women with normal, overweight, and obese body mass index at Gianyar district. This study is a cross-sectional analytic study. Samples are selected using purposive sampling technique. The samples consists of 3 groups, which amounted to 25 people in each group. Group A was women with normal BMI, group B was women with overweight BMI, and group C was women with obese BMI. The result of pearson chi-square p = 0.022 (p ? 0.05) indicating that there is a significant data distribution difference. The relative risk for overweight-obese compared to normal BMI was RR=3.34 [95% CI 1.09 - 10.16]. Concluded that there is a difference proportion of risk having plantar fasciitis between normal BMI (4%), overweight BMI (10,7%), obesity BMI (16%) and overweight-obese BMI have 3,34 times greater risk of having plantar fasciitis than the normal BMI category. Keywords: Body Mass Index, overweight, obese, plantar fasciitis, women

Download Full-text

Risk Factors for Plantar Fasciitis in Physically Active Individuals: A Systematic Review and Meta-analysis

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120970976 ◽

2021 ◽

pp. 194173812097097

Author(s):

Karrie L. Hamstra-Wright ◽

Kellie C. Huxel Bliven ◽

R. Curtis Bay ◽

Burcu Aydemir

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Body Mass Index ◽

Risk Factor ◽

Range Of Motion ◽

Body Mass ◽

Plantar Fasciitis ◽

Observational Studies ◽

Meta Analysis ◽

Physically Active

Context: Plantar fasciitis (PF) is a common condition in active individuals. The lack of agreement on PF etiology makes treatment challenging and highlights the importance of understanding risk factors for preventive efforts. Objective: The purpose of this systematic review and meta-analysis was to determine what factors may put physically active individuals at risk of developing PF. Data Sources: CENTRAL, CINAHL, EMBASE, Gray Lit, LILACS, MEDLINE (PubMed), ProQuest, Scopus, SPORTDiscus, and Web of Science were searched through April 2018 and updated in April 2020. Study Selection: Studies were included if they were original research investigating PF risk factors, compared physically active individuals with and without PF, were written in English, and were accessible as full-length, peer-reviewed articles. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3, because of inconsistent definitions and blinding used in the included observational studies. Data Extraction: Data on sample characteristics, study design and duration, groups, PF diagnosis, and risk factors were extracted. The methodological quality of the studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement. When means and standard deviations of a particular risk factor were presented 2 or more times, that risk factor was included in the meta-analysis. Results: Sixteen studies were included in the systematic review and 11 risk factors in the meta-analysis. Increased plantarflexion range of motion (weighted mean difference [MD] = 7.04°; 95% CI, 5.88-8.19; P < 0.001), body mass index (MD = 2.13 kg/m2; 95% CI, 1.40-2.86; P < 0.001; I2 = 0.00%), and body mass (MD = 4.52 kg; 95% CI, 0.55-8.49; P = 0.026) were risk factors for PF. Conclusion: Interventions focused on addressing a greater degree of plantarflexion range of motion, body mass index, and body mass and their load on the force-absorbing plantar surface structures may be a good starting point in the prevention and treatment of active individuals with PF.

Download Full-text

Detection of Normal Plantar Fascia Thickness in Adults via the Ultrasonographic Method

Journal of the American Podiatric Medical Association ◽

10.7547/8750-7315-105.1.8 ◽

2015 ◽

Vol 105 (1) ◽

pp. 8-13 ◽

Cited By ~ 10

Author(s):

Kadir Abul ◽

Devrim Ozer ◽

Secil Sezgin Sakizlioglu ◽

Abdul Fettah Buyuk ◽

Mehmet Akif Kaygusuz

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Plantar Fasciitis ◽

Plantar Fascia ◽

Heel Pain ◽

Common Cause ◽

Significant Difference ◽

The Mean ◽

The Right ◽

Thickness Measurements

Background Heel pain is a prevalent concern in orthopedic clinics, and there are numerous pathologic abnormalities that can cause heel pain. Plantar fasciitis is the most common cause of heel pain, and the plantar fascia thickens in this process. It has been found that thickening to greater than 4 mm in ultrasonographic measurements can be accepted as meaningful in diagnoses. Herein, we aimed to measure normal plantar fascia thickness in adults using ultrasonography. Methods We used ultrasonography to measure the plantar fascia thickness of 156 healthy adults in both feet between April 1, 2011, and June 30, 2011. These adults had no previous heel pain. The 156 participants comprised 88 women (56.4%) and 68 men (43.6%) (mean age, 37.9 years; range, 18–65 years). The weight, height, and body mass index of the participants were recorded, and statistical analyses were conducted. Results The mean ± SD (range) plantar fascia thickness measurements for subgroups of the sample were as follows: 3.284 ± 0.56 mm (2.4–5.1 mm) for male right feet, 3.3 ± 0.55 mm (2.5–5.0 mm) for male left feet, 2.842 ± 0.42 mm (1.8–4.1 mm) for female right feet, and 2.8 ± 0.44 mm (1.8–4.3 mm) for female left feet. The overall mean ± SD (range) thickness for the right foot was 3.035 ± 0.53 mm (1.8–5.1 mm) and for the left foot was 3.053 ± 0.54 mm (1.8–5.0 mm). There was a statistically significant and positive correlation between plantar fascia thickness and participant age, weight, height, and body mass index. Conclusions The plantar fascia thickness of adults without heel pain was measured to be less than 4 mm in most participants (~92%). There was no statistically significant difference between the thickness of the right and left foot plantar fascia.

Download Full-text

Sever’s Disease

Journal of the American Podiatric Medical Association ◽

10.7547/1010133 ◽

2011 ◽

Vol 101 (2) ◽

pp. 133-145 ◽

Cited By ~ 7

Author(s):

Rolf W. Scharfbillig ◽

Sara Jones ◽

Sheila Scutter

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Ankle Joint ◽

Body Mass ◽

Odds Ratio ◽

Total Activity ◽

Activity Levels ◽

Ankle Joint Dorsiflexion ◽

Foot Posture ◽

Calcaneal Apophysitis

Background: Sever’s disease, also known as calcaneal apophysitis, is thought to be an inflammation of the apophysis of the heel, which is open in childhood. This condition has been commented on and looked at in a retrospective manner but has not been examined systematically. We assembled the most commonly cited theoretical causative models identified from the literature and tested them to determine whether any were risk factors. Methods: Children with Sever’s disease were compared with a similarly aged nonsymptomatic population to determine whether identifiable risk factors exist for the onset of Sever’s disease. Areas raised in the literature and, hence, compared were biomechanical foot malalignment, as measured by Root et al–type foot measurements and the Foot Posture Index; ankle joint dorsiflexion, measured with a modified apparatus; body mass index; and total activity and types of sport played. Results: Statistically significant but small odds ratios were found in forefoot to rearfoot determination and left ankle joint dorsiflexion. Conclusions: This study suggests that there is no evidence to support that weight and activity levels are risk factors for Sever’s disease. The statistically significant but clinically negligible odds ratio (0.93) on the left side for decreased ankle joint dorsiflexion and statistically significant and clinically stronger odds ratio bilaterally for forefoot to rearfoot malalignment suggest that biomechanical malalignment is an area for further investigation. (J Am Podiatr Med Assoc 101(2): 133–145, 2011)

Download Full-text

Evaluation of the Association Between Plantar Fasciitis and Hallux Valgus

Journal of the American Podiatric Medical Association ◽

10.7547/17-150 ◽

2019 ◽

Vol 110 (2) ◽

Author(s):

Adem Cobden ◽

Yalkin Camurcu ◽

Hakan Sofu ◽

Hanifi Ucpunar ◽

Serda Duman ◽

...

Keyword(s):

Body Mass Index ◽

Hallux Valgus ◽

Body Mass ◽

Plantar Fasciitis ◽

Metatarsophalangeal Joint ◽

Plantar Fascia ◽

Radiographic Examination ◽

Heel Spur ◽

First Metatarsophalangeal Joint ◽

Factors Associated

Background The windlass mechanism, first described by John Hicks in 1954, defines the anatomical and biomechanical relationship between the hallux and the plantar fascia. Hallux valgus (HV) and plantar fasciitis are the most common foot disorders, and, to date, no study has evaluated the relationship between these disorders. The purpose of this study was to determine the incidence of and factors associated with plantar fasciitis in patients with HV deformity. Methods In this prospective observational study, 486 patients with HV were divided into three groups according to stage of HV deformity. Patient sex, age, and body mass index were recorded. Presence of accompanying plantar fasciitis and heel spur was investigated by physical and radiographic examination. First metatarsophalangeal joint dorsiflexion of the affected side was measured. Patients with or without plantar fasciitis were also compared to evaluate factors associated with plantar fasciitis. Results Mean age and body mass index of the patients were significantly different among the three HV groups. The incidence of plantar fasciitis and heel spur significantly increased in correlation with the severity of HV deformity. Increased age and HV stage and decreased first metatarsophalangeal joint dorsiflexion were significantly associated with presence of plantar fasciitis in HV. Conclusions In this study, the incidence of plantar fasciitis was significantly increased in correlation with the severity of HV deformity. Significant association was found between plantar fasciitis and HV, which are anatomically and biomechanically related to each other by the windlass mechanism.

Download Full-text

The Effects of Body Mass Index on Softball Pitchers’ Hip and Shoulder Range of Motion

Sports Medicine International Open ◽

10.1055/a-1244-1621 ◽

2020 ◽

Vol 05 (01) ◽

pp. E8-E13

Author(s):

Kenzie B. Friesen ◽

Adam W. Anz ◽

Jeffrey R. Dugas ◽

James R. Andrews ◽

Gretchen D. Oliver

Keyword(s):

Body Mass Index ◽

Body Composition ◽

Range Of Motion ◽

Body Mass ◽

Mean Difference ◽

Additional Stress ◽

Maximal Velocity ◽

Strength And Conditioning ◽

Shoulder Range Of Motion ◽

Shoulder Range

AbstractCurrently it is hypothesized that increased body mass index may contribute to overuse injuries. Thus, if hip or shoulder range of motion is affected by body mass index, pitchers may be placing additional stress on joints as they seek to pitch at maximal velocity. The purpose of this study was to examine if range of motion at the hips and shoulders were related to body mass index classification. A sample of 147 female softball pitchers (17.0±4.2 years; 167.6±11.8 cm; 70.6±17.5 kg; body mass index=24.8±4.7 kg/m2) participated. Bilateral hip and shoulder range of motion were assessed. Multivariate analysis of variance results indicated body mass index [Wilks’ Λ=0.742, F=1.722, p=0.014, η2=0.095] significantly affected range of motion of the shoulder and hip. Post hoc results indicated the underweight group had significantly more range of motion than the obese group in hip internal range of motion on both the throwing side (mean difference=12.39, p=0.005) and glove side (mean difference=11.98, p=0.004). Although body composition is not overly emphasized among softball pitchers, the current study reveals excess weight may inhibit proper mechanics. Coaches, athletic trainers, strength and conditioning personnel, and athletes should acknowledge the role that body composition can play in affecting pitch outcomes.

Download Full-text