Article

Correlation of heel pain with body mass index and other characteristics of heel pain

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Abstract

A prospective, descriptive study was performed at Oakwood Healthcare medical clinics to determine the body mass index (BMI) of patients with heel pain and of a control group of patients presenting for other reasons. A questionnaire was used to obtain information in each of the patient groups and to determine characteristics of patients with plantar fascial heel pain. Standard weightbearing lateral radiographs were taken to determine overall foot structure. The typical patient was female, had heel pain for just over 1 year, with a sedentary to moderate activity level. Although height was comparable, patients with heel pain had a higher BMI (30.4 +/- 0.7) than those without heel pain (28.2 +/- 0.7, p = .04). The BMI appears to play a greater role in heel pain than does foot structure, as the authors found no structural commonalities that would explain these patients' pain. Control patients also reported a higher level of activity. Fifty-one percent exercised three or more times per week for more than 20 minutes each time, while less than half that (25.4%) of heel pain patients did so. While half of the heel pain patients had been treated by other providers prior to visiting our clinic, fewer than 25% of these patients had been instructed to lose weight by a physician. The authors feel that a BMI of 25 (the target for decreased cardiovascular risk) represents a reasonable goal for weight loss that may reduce heel pain.

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... In a large retrospective cohort study, Matheson et al (38) examined overuse injuries in 1407 older and younger athletes and found that 71.4% of the patients presenting with plantar fasciitis were >50 years old. Similar studies using the general population also favored a slightly increased risk with advanced age (39). ...
... Numerous studies have demonstrated a relationship between plantar fasciitis and an increased BMI or body weight (24,27,33,39,45,46). Although this correlation has been described in both athletic and nonathletic populations, a high BMI appears to confer the greatest risk in nonathletic individuals (46). ...
... Both high levels of activity and high levels of inactivity appear to be associated with the development of plantar fasciitis. The association of plantar heel pain with athletes and, in particular, runners has been discussed extensively in reported studies (18,25,28,30,31,39,47). Plantar fasciitis is also a common cause of heel pain in the active military (48). ...
Article
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Adult acquired inferior calcaneal heel pain is a common pathology seen in a foot and ankle practice. A literature review and expert panel discussion of the most common findings and treatment options are presented. Various diagnostic and treatment modalities are available to the practitioner. It is prudent to combine appropriate history and physical examination findings with patient-specific treatment modalities for optimum success. We present the most common diagnostic tools and treatment options, followed by a discussion of the appropriateness of each based on the published data and experience of the expert panel.
... Firstly, heel pain develops first and causes a decrease in activity levels resulting in weight gain. [7] Second, a high Body Mass Index (BMI) or obesity precedes foot pain that causes increase in load on the joints and structures of the feet resulting in heel pain. [8,9] A third and more recent hypothesis suggests that there may be a metabolic element with regard to body composition, generally increased adipose tissue and foot pain. ...
... Rano JA et al [7] used a questionnaire to obtain information in each of the patient groups and to determine characteristics of patients with plantar heel pain. They also took standard weight bearing lateral radiographs to determine overall foot structure. ...
... Somachi P [21] (1994) found the average BMI of the patients suffering from heel pain was 26.24 ± 3.42. Rano et al [7] (2001) in study found patients with heel pain had a higher BMI (30.4 ± 4) than those without heel pain. Daniel et al [22] (2003) found 80% of his patients suffering from heel pain have BMI > 25. ...
... A systematic review of 8 studies with a total of 3500 patients found a prevalence of 5.2 to 17.5% in active runners (4). PF can, however, occur as early as in childhood (5). ...
... Factors that lead to chronic overload and exertion of tension on the plantar fascia should always be considered when deciding on the appropriate treatment (e.g., weight loss in the case of high BMI) (5). A meta-analysis showed that use of insoles to relieve the medial segment of the longitudinal arch of the foot is associated with significant pain reduction and functional improvement (21). ...
... The general recommendations are regular stretching of the calf muscles and the plantar fascia by means of specific exercises, eccentric exercising or fascia training of the AJ, and weight loss (5). On biomechanical grounds, despite the lack of randomized controlled trials, it is beneficial to reduce the continuous tension on the insertion of the plantar fascia. ...
Article
Background: Plantar fasciitis (PF) is characterized by pain on weight-bearing in the medial plantar area of the heel, metatarsalgia (MTG) by pain on the plantar surface of the forefoot radiating into the toes. Reliable figures on lifetime prevalence in Germany are lacking. Methods: This review is based on pertinent publications retrieved from a selective search in PubMed, on guidelines from Germany and abroad, and on the authors' clinical experience. Results: Plantar fasciitis is generally diagnosed from the history and physical examination, without any ancillary studies. In 90-95% of cases, conservative treatment (e.g., stretching exercises, fascia training, ultrasound therapy, glucocorticoid injections, radiotherapy, shoe inserts, and shock-wave therapy) brings about total, or at least adequate, relief of pain within one year. Intractable pain is an indication for surgical treatment by plantar fasciotomy and/or calf muscle release. In metatarsalgia, a directed diagnostic work-up to find the cause is mandatory, including a search for excessive mechanical stress due to abnormal foot posture, neuropathic pain, rheumatoid arthritis, aseptic bony necrosis, or malignant disease; imaging studies and pedobarography are needed. For causally oriented treatment, a wide range of conservative and surgical measures can be considered. Conclusion: The reported results of treatments for plantar fasciitis and metatarsalgia are heterogeneous. The efficacy of the individual measures should be studied in randomized controlled trials.
... La fascitis plantar (FP) es la causa más frecuente de dolor en la zona inferior del talón, se estima que entre 11 y 15% de los adultos que acuden al médico por dolor en los pies 1 presentan datos clínicos compatibles con FP; entre los corredores de medio y gran fondo un 10% presentan sintomatología de FP, 2 el cuadro también es frecuente entre el personal militar; 3 en la población general se encuentra una mayor incidencia entre las personas de 40 a 60 años de edad, 4 con moderado predominio en el sexo femenino; la sintomatología es bilateral hasta en un 30% de los casos; 5 el sitio del dolor es localizado generalmente en la inserción proximal de la fascia plantar en la tuberosidad medial del calcáneo; histológicamente las biopsias en FP crónica muestran cambios inflamatorios inespecíficos de tipo degenerativo con o sin proliferación fibroblástica. 6,7 Existen factores de riesgo para presentar FP, algunos estudios mencionan a la obesidad, 8 ocupaciones que requieren la bipedestación por largo tiempo, la presencia de pro- nación del retropié y reducción de la dorsiflexión de tobillo; 9-12 dado que es frecuente en corredores, la FP puede ser originada por microtrauma de repetición, correspondiendo a lesión por abuso principalmente en presencia de pie cavo. 13 En general, el curso clínico en series con seguimiento a largo plazo indica que el pronóstico es favorable con resolución de los síntomas en más del 80% de los casos con seguimiento a 12 meses, 1 sin embargo hasta 5% de los pacientes llegan a tratarse con cirugía. ...
... 6 La mayoría de los estudios indican que la FPC está relacionada con alteraciones biomecánicas como: pie cavo (25% en esta serie) o pie plano (46% en nuestros casos); ambos con pronación de retropié (71% de la serie presentada) y contractura del tríceps sural, (89% en este estudio). Otros factores de riesgo asociados son: obesidad o sobrepeso, 8 (presentes en 75% de nuestros pacientes, con IMC > a 27); actividades de estrés repetitivo, edad > 40 años, marcha en superficies duras, ocupaciones que implican la bipedestación por tiempo prolongado, así como las características del zapato y el uso de tacón alto; se debe tomar en cuenta que a partir de los 40 años el cojinete graso plantar puede disminuir su grosor, siendo esto otro factor de riesgo. ...
Article
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Objective: To evaluate calf muscles and plantar fascia stretching exercises on patients with chronic fasciitis plantar (CFP) in a clinical essay, autocontrolled and prospective study. Material and methods: 28 patients with CFP of ≥ 6 months evolution. Measurements: MCI, posture, plantar sole graphic, extremities mobility arches, pain in AVS, analgesic use daily quantification and 12 months control outcomes. Intervention: Calf muscles and fascia plantar stretching exercises (10 movements of 20 seconds each by 6 weeks) on step platform. Results: age X and SD 55.4 years + 6.5; female sex 60.7% and male sex 39.3%; Findings: hallux valgus 60%, genu valgus and flatfoot 46%; pronation heel 71%; psoas major, iliacus, semimembranosus, semitendinosus, biceps femoris, gastrocnemius and soleus contractures. At 6th week: 43% asymptomatic patients; 50% with pain ≤ 3 correlated with analgesic diminish or not used. Outcomes at 12 months: 78.5% (n = 22) asymptomatic, two patients doing sporadic exercise; 3 patients were lost and 1 patient required surgery. Conclusions: Calf and fascia plantar stretching is an effective treatment of CFP.
... Plantar fasciitis, has been reported in people from 7 to 85 years but is usually observed in the 40-60 year age group. It is more common in females 26 and in people with occupations that necessitates continual standing or walking, such as waiters, maids, and kitchen workers. 27 Our study also showed female predominance and most of our patients were home makers. ...
... These findings are consistent with earlier studies. 26,27 Our results in PRP group are comparable with Omar et al who found reduction in mean VAS score from 8.2±1.3 at baseline to 2.6±2.1 at 6 week (p ˂0.001). They also found highly significant improvement in Foot Health Status Questionnaire (FHSQ) (p <0.001). ...
Article
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BACKGROUND The study was undertaken to assess the effectiveness of autologous Platelet Rich Plasma (PRP) injection compared to local ultrasonic therapy for treatment of plantar fasciitis in terms of improvement in pain and function. MATERIALS AND METHODS This prospective, randomized, controlled study was conducted in Physical Medicine and Rehabilitation department of a tertiary care centre. 61 patients were randomly allocated in to either ultrasonic therapy (Group 1, n=30) or PRP group (Group 2, n=31). All patients were assessed for pain in Visual Analogue Scale (VAS) and for pain and function on Foot Ankle Disability Index (FADI) scale at baseline and three, six and twelve weeks after treatment. A p-value of less than 0.05 was considered significant. RESULTS Out of 61 subjects enrolled, 59 completed 12 weeks follow-up (29 in group 1, 30 in group 2). In both groups, statistically significant improvement was seen at three weeks on both VAS and FADI scales, but the observed improvement persisted upto 12 weeks follow-ups only in PRP treated group. There was no adverse event reported. CONCLUSION Local injection of autologous PRP proved to be a promising form of treatment. It is both safe and effective in relieving pain and improving function and superior to local ultrasonic therapy for treatment of plantar fasciitis.
... An obese designation is a BMI of over 30. Rano et al. (2001) suggest that decreasing an obese plantar heel pain patients BMI to a score of 25 or below (the same target for those with an identified cardiovascular risk) is a desirable goal. If the average height of a woman in England in 2012 was 164.5cm (Moody, 2013), for her to have a BMI of over 30 she would need to weigh approximately 82kg's. ...
... This is consistent with the present findings indicating an association between obesity and heel pain. In patients with early-onset plantar heel pain ( 6 months) with a high BMI, a weight loss program usually resulted in a response within 3 months with a success rate of 85% to 90% (33,34). One limitation of the present study was that the maximum pain reported by the subjects, especially in the morning, was evaluated. ...
Article
From March 2012 to February 2013, 37 patients experiencing plantar heel pain for ≥6 months despite treatment with physical therapy and other conservative treatment modalities were followed up. If neurogenic heel pain originating from the first branch of the lateral plantar nerve was present, with or without the medial calcaneal nerve, diagnostic nerve blocks to these nerves were performed for confirmation. If the pain was determined to be of neurogenic origin, radiofrequency neural ablation (RFNA) was applied to the corresponding sensory nerve endings. Pain was evaluated using the visual analog scale, and patients were followed for at least one year. A total of 41 feet from 37 patients (30 [81.1%] females, 7 [18.9%] males; mean age, 50.7 ± 1.6 years; mean body mass index, 30.6 ± 0.7 kg/m(2)) were included. The mean visual analog scale scores improved significantly from 1 to 6 to 12 months after the procedure relative to before the procedure, with 88% of all patients rating the treatment as either very successful or successful at 12 months postoperatively. RFNA applied to both the first branch of the lateral plantar nerve and the medial calcaneal nerve sensory branches (16 [39%] feet) and only the first branch of the lateral plantar nerve sensory branches (25 [61%] feet) showed similarly high levels of success. Of the 41 feet, 28 [68.3%] had received extracorporeal shockwave therapy, 35 [85.4%] had received steroid injections, and 22 [53.7%] had received both extracorporeal shockwave therapy and steroid injections before RFNA as an index procedure. All were unresponsive to these previous treatments. In contrast, almost all (88%) were treated successfully with RFNA. Despite a high incidence of neurologic variations, with a precise diagnosis and good application of the technique using the painful points, chronic plantar heel pain can be treated successfully with RFNA.
... The second line treatment includes orthotic devices, night splints, repeat corticosteroid or botulinum toxin injections, a course of physical therapy, and cast immobilization during activity [15,18,[20][21][22][23][24][25]. For most patients, clinical response after this line of treatment usually occurs within 2-3 months [26][27][28]. If the symptoms are still present within 1 year after the first and/or second line treatment, the patients should face the final line of treatment, which usually includes plantar fasciotomy, heel spur resection, nerve release, and other kinds of surgeries [12,29]. ...
Article
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Background: To explore the therapeutic effect and the biomechanical mechanism of 3D printing individualized heel cup in treating of plantar heel pain. Methods: The clinical effect was evaluated by plantar pressure analysis and pain assessment in participants. Its biomechanical mechanism of protecting the plantar heel was explored using finite element simulation. Results: The individualized heel cup could support and protect the osseous structure and soft tissue of plantar heel while walking and jogging, as well as significantly reduce the self-reported pain after being worn for 4 weeks. The nylon heel cup could alter the load concentration of the heel as well as decrease the load affected on plantar fascia and calcaneus bone. It also provided an obvious support for heel pad. Conclusion: To summarize, the 3D printed individualized heel cup can be used as an effective method for the treatment of plantar heel pain.
... The time required for full recovery depends on the risk factors, which have led to the occurrence of PF [27]. For example, an overweight patient may improve, and the symptoms resolve when the patient loses weight [28]. Therefore, risk factors should be considered when managing PF patients. ...
Article
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Background: Plantar fasciitis (PF) is one of the most common foot conditions. It has a negative impact on foot function and limits daily activities. Among all conservative interventions, foot orthosis is widely used for the management of PF. The aim of this study was to evaluate and compare the effectiveness of customised foot orthosis (CFO) and prefabricated foot orthosis (PFO) on pain and function in people with PF. Research Strategy: Medline, Embase, CINAHL Plus, AMED and SPORTDiscus databases were searched from 2008 (the date of the latest relevant systematic review) to July 2016. Study Selection: Original research trials that met these criteria were included: (1) published randomised controlled trials, (2) participants diagnosed with PF, (3) evaluation of the effectiveness of both CFO and PFO, (4) and pain and/or function as outcome measures. Data Extraction: PRISMA guidelines were employed to extract relevant data from trials that matched the inclusion criteria and two independent reviewers assessed the quality of studies. Results: A total of 631 studies were screened, and in the final process of selection, only two studies met the inclusion criteria. Both studies demonstrated that the use of foot orthosis in people with PF was associated with a greater improvement about pain and function. Also, both studies found that CFO produced similar effects compared to PFO, based on self-reported questionnaires results, such as visual analogue scale (VAS), foot function index (FFI) and 36-Item short form health survey (SF-36). One of the studies used an objective measurement tool to monitor participants' activities by using a body-worn sensor and found that CFO was over PFO regarding episodes of walking and sit-to-stand duration. However, Meta-analysis of FFI scores showed that CFO was not statistically greater than PFO on pain (SMD −0.09, 95% CI −0.41 to 0.24; P=0.60) and function (SMD −0.18, 95% CI −0.50 to 0.15; P=0.29). Conclusion: There is moderate evidence to show that CFO was as effective as PFO for treating PF in the short term, while the weak evidence showed that CFO was more effective than PFO. However, the long-term effect of both interventions remains unclear. Further well-structured studies with extended follow-up periods and the use of objective measurements are therefore recommended.
... İster fasiit ister fasiosis, PF'in temel patolojik mekanizması ne olursa olsun mekanik yüklenme şu anki en geçerli hipotezdir. Nitekim 2001 yılında yapılmış bir çalışmada PF'li hastalar, topuk ağrısı şikayeti olmayan kontrol grubu ile vücut kitle indeksi (VKİ) temel alınarak karşılaştırılmış ve plantar fasitli hastaların VKİ'lerinin plantar fasiit olmayanlara göre anlamlı şekilde fazla olduğunu saptanmıştır 17 . Yazarlar bu sonucu, vücut kitle indeksinin yüksek olmasının plantar fasiit gelişmesinde önemli rol oynadığı şeklinde yorumlamışlardır. ...
Article
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Aim: Plantar fasciitis (PF) is one of the most important causes of heel pain. Although the pathophysiology is not well understood, the current consideration is a degenerative process at the calcaneal insertion site of the plantar fascia. There are different conservative and surgical treatment methods. Etiology is multifactorial. In this study, it was aimed to investigate if there is a role of lower extremity venous insufficiency on the etiopathogenesis of PF. Material and Method: Sixty-seven patients (n=67) with diagnosis of PF (Group-1, male/female: 20/47) and fifty-two patients patients (n=52) with venous insufficiency (Group-2, male/female: 26/26) were examined in two different groups. Statistical analysis of the relationship between two groups was performed with Minitap-17 normality test and then paired samples t-test. Results: Among the doppler ultrasound examinations of sixtyseven patients in Group-1, no venous insufficiency was determined. Among the fifty-two patients in Group-2, only two patients were diagnosed as PF. Conclusion: It was found that there is no influence of lower extremity venous insufficiency on the etiopathology of PF.
... 4 Associated significant findings may include high body mass index (BMI), tightness of the Achilles tendon, pain upon palpation of the inferior heel and plantar fascia, and inappropriate shoe wear. 5 , 6 Tenderness can be produced over the medial calcaneal tuberosity and may increase on standing tip toe and dorsiflexion of toes. Americans annually and affects as much as 10% of the general population over the course of a lifetime. ...
Article
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Introduction Heel pain is a very common foot problem. The sufferer usually feels pain either under the heel (planter fasciitis) or just behind it (Achilles tendinitis), where the Achilles tendon connects to the heel bone. One of the reasons of heel pain may be due to Subtalar joint dysfunction that will affect the movement of calcaneus and thus potentially affect the tension in plantar fascia. There are no studies done to find the effectiveness of subtalar joint mobilization on heel pain. The aim of this study is to find out the effectiveness of subtalar joint mobilization on plantar heel pain. Methodology 14 subject both males and females were recruited in the study from KLES Dr. Prabhakar Kore Hospital & MRC, Belgaum. Participants were randomly allotted in 2 groups. Group A received Therapeutic Ultrasound and stretching and Group B received Subtalar joint mobilization with Therapeutic Ultrasound and stretching. The Outcome measures used are visual analogue scale (VAS) and functional ability level in terms of Foot Function Index (FFI). Readings were taken both pre and post treatment sessions, respectively. Results Fourteen subjects (mean [SD] age, 37.1(11.6) years in Group A and 39.1(15.08) in group B) satisfied the eligibility criteria, agreed to participate, and were allotted into the conventional (n =7) or mobilization group (n = 7). Significant difference was found between the differences of VAS between two groups with P-value (0.038). Significant difference was found in the Post value of foot function index between two groups P-value (0.002). Conclusion Manual therapy intervention i.e. Subtalar joint mobilization with stretching and ultrasound is more effective in improving Pain(VAS) and foot function index score in subjects with plantar heel pain. key words Plantar heel pain, Subtalar mobilization.
... It can be noted that many patients, regardless of a meaningful improved in function, still do not consider themselves recovered. A high BMI is a known risk factor for the development of PHP and has been found as a prognostic factor for * A patient was considered to have reached a minimal important improvement in FFI if their FFI total score at follow-up was at least 6.5 (the minimal important difference) lower than at baseline **A patient is defined as recovered if they answered 'the complaints have completely disappeared or they are strongly improved' ***A patient was considered to have reached a minimal important improvement in first step pain if their first step pain score follow-up was at least 1.9 (the minimal important difference) lower (improved) than at baseline In the patients treated with usual care only variables that gave a significant result in the patients treated with insoles were analyzed long lasting complaints in patients treated with insoles in a previous study [5,18,33]. In the present study there was no significant association between BMI and the total FFI score in the multivariable model. ...
Article
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Background Plantar heel pain (PHP) is a common cause of foot complaints, for which treatment with custom-made insoles is frequently applied. So far few studies have investigated patient characteristics that predict response to these treatments. The aim of this secondary exploratory analysis was twofold; firstly, to identify patient characteristics that predict prognosis in patients with PHP treated with insoles, and secondly to identify characteristics that might interact with treatment with insoles. Methods Data from a randomized trial in which participants received either custom insoles ( N = 70) or sham insoles ( N = 69) were used. At baseline, information was collected on demographics, foot symptoms, foot and ankle range of motion, navicular drop, presence of neuropathic pain, physical activity and other illnesses in the last 12 months. The primary outcome of this study was the Foot Function Index score (FFI) at 26 weeks. Multivariable linear regression models were generated to identify patients characteristics that predict the outcome for each type of intervention (i.e. insoles and GP-led usual care). Results We found two variables associated with a better function score at 26 weeks in patients treated with insoles, female sex (β − 9.59 95%CI -17.87; − 1.31) and a lower FFI score at baseline (β 0.56 95%CI 0.30; 0.82). Explorative analyses in patients treated with insoles showed no significant interaction effects between the type of insole (custom-made versus sham) and any of the potential predictive factors. Conclusion When communicating about the effect of insoles for PHP clinicians should take sex and the amount of pain and disability at first presentation into account. Women and people with better foot function scores at baseline (according to FFI) might respond better to treatment with insoles in terms of foot function. Trial registration Trial registration: NTR5346 .
... The role of BMI influence on the thickness of the Achilles tendon and plantar fascia has been well established in the literature. 4,[35][36][37][38][39] Abate et al. found that plantar fascia and Achilles tendon thickness is increased in the early stages of type 2 diabetes and that BMI is related more to the plantar fascia than to Achilles tendon thickness. As thickness and stiffness of the structures increases, the more severe the overall alteration of the foot loading pattern can be. ...
Article
Objective Hyperglycemia leads to increase advanced glycation end products (AGEs) in patients with type 1 and type 2 diabetes. Subsequently, formation of AGEs can cause increased plantar fascial thickness (PFT), an imaging feature of plantar fasciitis (PF). This study evaluates the prevalence of PF in a contemporary cohort of type 1 diabetes and type 2 diabetes patients managed according to current standards, compared to patients without diabetes. Research design and methods This is a five-year prevalence study in a large tertiary health system (approximately 535,000 patients/visits/year) with a single electronic medical record (EMR), applying a cohort discovery tool and database screen (Data Direct) with use of ICD-9 and ICD-10 codes. All patients with a PF diagnosis between 01/01/2011 and 01/01/2016 were included and divided into 3 groups: type 1 diabetes (7148 patients), type 2 diabetes (61,632 patients), and no diabetes (653,659 patients). Prevalence rates were calculated, accounting for other risk factors including BMI and gender using Fisher's exact test. Results The overall prevalence of PF in the entire study population was 0.85%. Prevalence rates were higher in patients with diabetes, particularly with type 2 diabetes (42% and 64% higher compared with patients with type 1 diabetes and no diabetes respectively). Individually, PF rates were 0.92% in type 1 diabetes and 1.31% in type 2 diabetes compared with 0.80% in patients with no diabetes (Type 1 vs. no diabetes p = 0.26; Type 2 vs. no diabetes p ≪ 0.0001; Type 1 vs. Type 2 diabetes p = 0.0054). Females in all groups had higher prevalence of PF than males (p ≪ 0.0001 for all), with those patients with diabetes having higher prevalence rates than those without diabetes. Patients with higher BMI levels (BMI ≥ 30 kg/m2) were also more likely to have PF in all categories except males with type 1 diabetes (p = 0.40). Conclusions In this large contemporary population managed in a tertiary health system, prevalence rates of PF were substantially higher in patients with diabetes compared with no diabetes, particularly in type 2 diabetes. Female gender and higher BMI were also associated with higher prevalence of PF in this cohort.
... Obesity has become a global pandemic and is recognized as a primary public health concern in many countries. In addition to contributing to conditions such as cardiovascular diseases and diabetes 1,2) , obesity is strongly related to lower extremity conditions such as ankle and foot pain [3][4][5] , which lower the quality of life (QoL) and increase the morbidity of obesity 6) . ...
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[Purpose] The purpose of this study was to examine the effects of increasing physical activity on foot structure and ankle muscle strength in adults with obesity and to verify whether the rate of change in foot structure is related to that in ankle muscle strength. [Subjects and Methods] Twenty-seven adults with obesity completed a 12-week program in which the intensity of physical activity performed was gradually increased. Physical activity was monitored using a three-axis accelerometer. Foot structure was assessed using a three-dimensional foot scanner, while ankle muscle strength was measured using a dynamometry. [Results] With the increasing physical activity, the participants’ feet became thinner (the rearfoot width, instep height, and girth decreased) and the arch became higher (the arch height index increased) and stiffer (the arch stiffness index increased); the ankle muscle strength also increased after the intervention. Additionally, the changes in the arch height index and arch stiffness index were not associated with changes in ankle muscle strength. [Conclusion] Increasing physical activity may be one possible approach to improve foot structure and function in individuals with obesity.
... (18,19) In the current study, males reported a little bit higher prevalence of plantar fasciitis (56.4 %). The current literature is inconsistent regarding the association between sex and plantar fasciitis, while some studies showed that men and women affected equally (20) .Some other studies showed an increased prevalence in men as was reported by Taunton et al. that found a significant sex difference within their study population, as 54% of those affected were males and 46% were females. (21) While others showed an increased prevalence in women as reported by Rano et al. (22) There are no theories within the current literature hypothesizing the reason for a difference in the prevalence of plantar fasciitis between the two sexes, whether it is due to a function of different hormones or structural differences caused by genetic variations, as is suggested by the increased incidence of anterior cruciate ligament tears in women compared with men. ...
Article
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Background: Plantar fasciitis is the most common cause of heel pain in adults seen in primary care. Extended standing and running frequently cause strain on the plantar fascia. Plantar fasciitis outcome is generally good, about 80 percent of people have no symptoms after one year. Objectives: To determine prevalence rate and risk factors of plantar fasciitis in primary health care settings. Methods: A cross-sectional study was conducted on 270 patients with heel pain attending five randomly selected primary health care centers. An interview questionnaire was structured to recognize the socio-demographic data, medical history of heel pain and independent risk factors for plantar fasciitis. Diagnosis was based on history and clinical examination. Results: The prevalence of plantar fasciitis among 270 patients was 57.8%. 88 (56.4 %) of them were males, 104 (66.7 %) were obese, 91 (58.3 %) were wearing inappropriate shoes and 140 (89.7 %) had sedentary lifestyle. Logistic regression showed that sedentary lifestyle is the most significant variable associated independently to plantar fasciitis (OR = 38.371; 95% CI: 5.411-272.110 p 0.000) Conclusion: Plantar fasciitis is very common in primary health care settings. Obesity, sedentary lifestyle, wearing inappropriate shoes, frequent running and long standing were shown to be risk factors.
... İster fasiit ister fasiosis, PF'in temel patolojik mekanizması ne olursa olsun mekanik yüklenme şu anki en geçerli hipotezdir. Nitekim 2001 yılında yapılmış bir çalışmada PF'li hastalar, topuk ağrısı şikayeti olmayan kontrol grubu ile vücut kitle indeksi (VKİ) temel alınarak karşılaştırılmış ve plantar fasitli hastaların VKİ'lerinin plantar fasiit olmayanlara göre anlamlı şekilde fazla olduğunu saptanmıştır 17 . Yazarlar bu sonucu, vücut kitle indeksinin yüksek olmasının plantar fasiit gelişmesinde önemli rol oynadığı şeklinde yorumlamışlardır. ...
... 1e4,28 It is also mentioned in the literature that sedentary lifestyle and obesity causes heel pain without causing obvious structural changes in the foot. 29 Similarly, in our study, no significant difference was found between the foot structures of both obese patients and sedentary patients compared to other patients. ...
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Objective: The aim of this study was to investigate the thickness of heel fat pad (THP) and to detect the relationship between the plantar fasciitis (PF) and age, occupation, BMI, longitudinal arch, the thickness of heel fat-pad in the patients with PF. Methods: A total of 50 patients (29 women and 21 men; mean age: 46.5 years (range: 22-70)) that were diagnosed with PF were included to this study. Patients' affected side were compared with the healthy opposite side with the angle of medial arch (AMA) and first metatarsophalangeal angle (FMTPA) on the foot radiograms, and THP and thickness of first metatarsal fat pad (TFMFP) using ultrasonography (USG) of both feet. Results: The mean AMAs of feet with pain and without pain were 122.56° and 120.60°, respectively. The mean FMTPAs of feet with pain and without pain were 14.72° and 14.40°, respectively. The mean THPs of feet with pain at the point of the medial calcaneal tubercle and the mean TFMFPs of the feet with pain at the point of the first metatarsal head were 19.45 mm and 6.75 mm, respectively. The mean THPs of feet without pain at the point of the medial calcaneal tubercle and the mean TFMFPs of the feet without pain at the point of the first metatarsal head were 19.94 mm and 6.75 mm, respectively. It was observed that the mean AMA in the heels with pain was significantly higher than that of the heel without pain (p < 0.05) and the mean THP in the heels with pain was significantly thinner than that of the heel without pain (p < 0.05). Conclusion: The results indicate that USG is an accurate and reliable imaging technique for the measurement of THP in the diagnosis of plantar fasciitis and the heel pad was thinner in the painful heels of patients with plantar fasciitis. Level of evidence: Level III, Diagnostic Study.
... A higher BMI has been shown to be associated with foot pain in general [61]. A BMI of > 30 kg/m 2 is associated with an increased risk of plantar heel pain [3], and a number of studies have reported higher BMI scores in people with plantar heel pain compared to asymptomatic control participants [27,35,38,62,63]. These findings strongly suggest an association between a high BMI and the presence of plantar heel pain. ...
Article
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Plantar heel pain is a common musculoskeletal foot disorder that can have a negative impact on activities of daily living and it is of multifactorial etiology. A variety of mechanical factors, which result in excessive load at the plantar fascia insertion, are thought to contribute to the onset of the condition. This review presents the evidence for associations between commonly assessed mechanical factors and plantar heel pain, which could guide management. Plantar heel pain is associated with a higher BMI in non-athletic groups, reduced dorsiflexion range of motion, as well as reduced strength in specific foot and ankle muscle groups. There is conflicting, or insufficient evidence regarding the importance of foot alignment and first metatarsophalangeal joint range of motion. Plantar heel pain appears to be common in runners, with limited evidence for greater risk being associated with higher mileage or previous injuries. Conflicting evidence exists regarding the relationship between work-related standing and plantar heel pain, however, longer standing duration may be associated with plantar heel pain in specific worker groups. The evidence presented has been generated through studies with cross-sectional designs, therefore it is not known whether any of these associated factors have a causative relationship with plantar heel pain. Longitudinal studies are needed to ascertain whether the strength and flexibility impairments associated with plantar heel pain are a cause or consequence of the condition, as well as to establish activity thresholds that increase risk. Intervention approaches should consider strategies that improve strength and flexibility, as well as those that influence plantar fascia loading such as body weight reduction, orthoses and management of athletic and occupational workload.
... It has been revealed that rate of injury in the ankle/foot area during running in females is higher than males (34.8% and 16.8%, respectively) [19]. In particular, overuse injuries of the foot which are common among both elite and recreational runners [20] and among them, plantar fasciitis, which is a common foot injury in runners, are reported [21] to have an increased prevalence in women compared to men. Other researchers [22] have also reported that the incidence of metatarsal stress fractures in women is more than 3.5 times that of men [19]. ...
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Purpose The pattern of gender differences in gait variability has not yet been well examined. The aim of the present study was therefore to investigate gender differences in the spatial–temporal variability between walking and running. Methods Twenty healthy recreational active individuals (ten males/ten females) were instructed to walk for 5 min at a constant speed of 4.0 km/h and then run for 5 min at 8.4 km/h on a treadmill. Walking and running kinematic data were collected during the 5 min. Results CV of duration [F (1,18) = 7.61, p < 0.01], CV of rate [F (1,18) = 7.56, p < 0.01], and CV of stance [F (1,18) = 33.49, p < 0.001] were significantly greater during running comparing to walking in both genders. Furthermore, CV of swing was significantly greater through running compared to walking only in women p < 0.05. Conclusion This study elucidates greater variability during running in females than males. The greater variability through running in females comparing to males might make them more prone to lower limb injury. These results may be useful in understanding the underlying mechanism contributing to differences in injury risk in males and females.
... 12,13,14,15 Rano et al found that the average age of the patients presenting to their facility with heel pain was almost 10 years higher than controls who presented for other reasons. 16 Matheson et al in their retrospective review of 1407 patients from an outpatient sports medicine clinic, found that younger athletes had a lower prevalence of plantar fasciitis (2.5%) than older athletes (6.6%). 17 The association of plantar fasciitis with increasing age is consistent with the histopathological findings of degenerative, rather than inflammatory changes within the plantar fascia. ...
... PF is probably the result of multiple etiological factors. Body mass index (BMI) > 30 kg/m 2 (the cutoff for grade-II obesity) had an odds ratio of 5.6 for PF compared to those with a BMI ≤ 25 kg/m 2 [21]. In our study population, the average BMI in both the groups was slightly more than 25 kg/m 2 , corresponding to the overweight category in BMI classification. ...
... The known risk factors are obesity, poor foot and ankle biomechanics, flat feet, prolonged standing, jumping, running and ill-fitting footwear. Plantar fasciitis can be isolated or associated with other systemic diseases like seronegative spondyloarthropathies [5][6][7][8][9]. ...
Article
IntroductionAutologous platelet rich plasma (PRP) local injection has been recently proposed as a treatment of plantar fasciitis. The autologous PRP does not have much side effects compared to steroid injections. So far PRP injections have shown promising results in various studies. This study assessed the efficacy of a single local injection of PRP in chronic unilateral plantar fasciitis through a prospective case series.MethodologyA hospital-based prospective case series of 30 unilateral plantar fasciitis patients with symptom duration of 6 months or more were included in the study. All patients included in the study were assessed clinically and by visual analogue score for heel pain, AHS component of AOFAS and FADI scores before injection and at 6 and 12 week follow-up. USG measurement of plantar fascia thickness was done at pre-injection and at 12 weeks follow-up. All patients were observed for 12 weeks.ResultsThe mean age was 39 years (range 20–55 years). The pre-injection VAS score for heel pain was 6.5 ± 1.1 which improved to 2.7 ± 0.5 and 1.8 ± 0.8 at 6 and 12 week respectively and difference was significant (p < 0.001). The baseline FADI and AHS component of AOFAS scores were 53.1 ± 9.0 and 72.2 ± 5.7 which improved to 65.5 ± 5.3 and 76.1 ± 4.5 at 6 weeks and, 77.9 ± 4.4 and 85.7 ± 4.6 at 12 weeks respectively which was significant (p < 0.001). The baseline mean plantar fascia thickness was 4.9 ± 0.3 mm which was significantly (p < 0.001) reduced to 3.9 ± 0.3 mm at 12 weeks post PRP injection. All pairwise comparisons by the post-hoc Wilcoxon signed rank test with p-value adjustment were also significant.Conclusion The short-term results of single dose PRP injections shows clinical and statistically significant improvements in VAS for heel pain, functional outcome scores and plantar fascia thickness measured by USG. This study concludes that local PRP injection is a viable management option for chronic plantar fasciitis.
... 4 No significant association was found in self-reported weight gain between patients with PF and control participants. 36 ...
Article
Question What (risk) factors are associated with plantar fasciopathy (PF)? Design Systematic review with meta-analyses. Participants Patients with PF. Factors All factors described in prospective, case–control or cross-sectional observational studies. Results 51 included studies (1 prospective, 46 case–control and 4 cross-sectional studies) evaluated a total of 104 variables. Pooling was possible for 12 variables. Higher body mass index (BMI) (BMI>27, OR 3.7 (95% CI 2.93 to 5.62)) in patients with PF was the only significant clinical association, and its effect was the strongest in the non-athletic subgroup. In people with PF compared to controls, pooled imaging data demonstrated a significantly thicker, hypoechogenic plantar fascia with increased vascular signal and perifascial fluid collection. In addition, people with PF were more likely to have a thicker loaded and unloaded heel fat pat, and bone findings, including a subcalcaneal spur and increased Tc-99 uptake. No significant difference was found in the extension of the first metatarsophalangeal joint. Conclusions We found a consistent clinical association between higher BMI and plantar fasciopathy. This association may differ between athletic and non-athletic subgroups. While consistent evidence supports a range of bone and soft tissue abnormalities, there is lack of evidence for the dogma of clinical and mechanical measures of foot and ankle function. Clinicians can use this information in shared decision-making.
... In particular, overuse injuries of the foot are common among both elite and recreational runners (Kindred, Trubey, & Simons, 2011). For example, among overuse injuries of the foot, plantar fasciitis, which is a common foot injury in runners, was shown by some studies (Davis, Severud, & Baxter, 1994;Rano, Fallat, & Savoy-Moore, 2001) to have an increased prevalence in females. Other previous research (Ohta-Fukushima, Mutoh, Takasugi, Iwata, & Ishii, 2002) also reported that the incidence of metatarsal stress fracture in overuse injury in females is more than 3.5 times that in males. ...
Article
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Females, as compared with males, have a higher proportion of injuries in the foot region. However, the reason for this gender difference regarding foot injuries remains unclear. This study aimed to investigate gender differences associated with rearfoot, midfoot, and forefoot kinematics during running. Twelve healthy males and 12 females ran on a treadmill. The running speed was set to speed which changes from walking to running. Three-dimensional kinematics of rearfoot, midfoot, and forefoot were collected and compared between males and females. Furthermore, spatiotemporal parameters (speed, cadence, and step length) were measured. In the rearfoot angle, females showed a significantly greater peak value of plantarflexion and range of motion in the sagittal plane as compared with males (effect size (ES) = 1.55 and ES = 1.12, respectively). In the midfoot angle, females showed a significantly greater peak value of dorsiflexion and range of motion in the sagittal plane as compared with males (ES = 1.49 and ES = 1.71, respectively). The forefoot peak angles and ranges of motion were not significantly different between the genders in all three planes. A previous study suggested that a gender-related difference in excessive motions of the lower extremities during running has been suggested as a contributing factor to running injuries. Therefore, the present investigation may provide insight into the reason for the high incidence of foot injuries in females.
... (18,19) In the current study, males reported a little bit higher prevalence of plantar fasciitis (56.4 %). The current literature is inconsistent regarding the association between sex and plantar fasciitis, while some studies showed that men and women affected equally (20) .Some other studies showed an increased prevalence in men as was reported by Taunton et al. that found a significant sex difference within their study population, as 54% of those affected were males and 46% were females. (21) While others showed an increased prevalence in women as reported by Rano et al. (22) There are no theories within the current literature hypothesizing the reason for a difference in the prevalence of plantar fasciitis between the two sexes, whether it is due to a function of different hormones or structural differences caused by genetic variations, as is suggested by the increased incidence of anterior cruciate ligament tears in women compared with men. ...
Article
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Background: Plantar fasciitis is the most common cause of heel pain in adults seen in primary care. Extended standing and running frequently cause strain on the plantar fascia. Plantar fasciitis outcome is generally good, about 80 percent of people have no symptoms after one year. Objectives: To determine prevalence rate and risk factors of plantar fasciitis in primary health care settings. Methods: A cross-sectional study was conducted on 270 patients with heel pain attending five randomly selected primary health care centers. An interview questionnaire was structured to recognize the socio-demographic data, medical history of heel pain and independent risk factors for plantar fasciitis. Diagnosis was based on history and clinical examination. Results: The prevalence of plantar fasciitis among 270 patients was 57.8%. 88 (56.4 %) of them were males, 104 (66.7 %) were obese, 91 (58.3 %) were wearing inappropriate shoes and 140 (89.7 %) had sedentary lifestyle. Logistic regression showed that sedentary lifestyle is the most significant variable associated independently to plantar fasciitis (OR = 38.371; 95% CI: 5.411– 272.110 p 0.000) Conclusion: Plantar fasciitis is very common in primary health care settings. Obesity, sedentary lifestyle, wearing inappropriate shoes, frequent running and long standing were shown to be risk factors.
Article
Plantar fasciitis, the most common cause of pain in the inferior heel, accounts for 11% to 15% of all foot symptoms requiring professional care among adults. The present study reports the results of a minimally invasive surgical treatment of chronic plantar fasciitis. All patients with plantar fasciitis who had undergone percutaneous latticed plantar fasciotomy at 3 clinical sites from March 2008 to March 2009 were included in the present study. The follow-up evaluations for this treatment were conducted using the Mayo clinical scoring system. We investigated 17 patients with recalcitrant chronic plantar fasciitis who had undergone this treatment within a follow-up period of ≥13 months. All procedures were performed in the clinic with the patient under local anesthesia. No wound infections or blood vessel or nerve damage occurred. At a mean follow-up period of 16.0 ± 2.29 (range 13 to 21) months, significant improvement was seen in the preoperative mean Mayo score (from 12.06 ± 2.54 to 89.76 ± 4.28, p < .001) and no patient had developed symptom recurrence. Also, none of the patients had developed complex regional pain syndrome. All patients were able to return to regular shoe wear by 3 weeks postoperatively. The technique of plantar fasciitis with percutaneous latticed plantar fasciotomy could be a promising treatment option for patients with recalcitrant chronic plantar fasciitis. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
Article
A comprehensive classification of talalgia (heel pain) is proposed including different talalgias caused by systemic or extraregional diseases and regional ones, inferior talalgia, medial talalgia, lateral talalgia and posterior talalgia. Talalgia is cause of foot pain eight times less frequent than metatarsal-gia elsewhere in our experience and a thought understanding of its multivariate etiology and pathogenesis is of utmost importance for any clinical dealing with foot disorders. This matrix, moreover, offers a tool for classifying all types of talalgia, by means of an alphanumeric system in a way useful for both analytical and clinical purpose.
Chapter
The human foot plays an important role in all weight-bearing tasks, as it provides the only direct source of contact between the body and the supporting surface. When walking, the foot contributes to shock absorption, adapts to irregular surfaces, and provides a rigid lever for forward propulsion (1). Any disruption to the precise timing of foot and ankle motion has the potential to decrease both the stability and efficiency of gait patterns.
Chapter
Overuse and traumatic distal lower extremity conditions are common among physically active individuals, and the incidence rate is an order of magnitude greater than that reported in the general population. With frequent impact and heavy load-bearing activity, military servicemembers have unique occupational demands that may further exacerbate inherent risks of leg, ankle, and foot injuries. A thorough endocrine, nutritional, and multisystem clinical work-up is warranted to evaluate certain overuse conditions. Furthermore, mechanical alignment and soft tissue integrity should always be scrutinized when considering a range of nonoperative or surgical treatment options. Modifications in training regimen, the use of external restraints or orthotics, and physical therapy with targeted neuromuscular, strength, and/or gait interventions may be effective preventative measures in selected patients with distal lower extremity injuries.
Article
Background: Activity and footwear may be associated with plantar heel pain (PHP), however both factors have rarely been investigated. The aim of this study was to investigate activity and footwear characteristics in PHP while controlling for important confounders. Method: This cross-sectional observational study compared 50 participants with PHP to 25 participants without PHP who were matched for age, sex and body mass index. Activity was measured using the Stanford Activity Questionnaire, as well as the number of hours per day participants stood for, and whether they stood on hard floors. Footwear characteristics were measured using the footwear domain of the Foot Health Status Questionnaire (FHSQ), as well as the style of shoe, heel height, and the Shore A hardness value of the heel of the shoe most used. Results: Participants with PHP stood for more than twice as long as participants without PHP (mean difference 3.4 hours, p < 0.001, large effect size). Participants with PHP also reported greater difficulty accessing suitable footwear (FHSQ footwear domain mean difference (MD) 22 points, p = 0.002, large effect size (ES), and they wore harder-heeled shoes (Shore A MD 6.9 units, p = 0.019, medium ES). There were no significant differences for physical activity, whether they stood on hard floors, the style of shoe they wore, or heel height. Conclusions: Compared to people without PHP, people with PHP stand for more than twice the amount of time each day, have substantial difficulties accessing suitable footwear, and the primary shoes they wear are harder under the heel.
Article
Physicians and nurses in Taiwan have heavy workload and long working hours, which may contribute to plantar fasciitis. However, this issue is unclear, and therefore, we conducted this study to delineate it. We conducted a nationwide population-based study by identifying 26,024 physicians and 127,455 nurses and an identical number of subjects for comparison (general population) via the National Health Insurance Research Database. The risk of plantar fasciitis between 2006 and 2012 was compared between physicians and general population, between nurses and general population, and between physicians and nurses. We also compared the risk of plantar fasciitis among physician subgroups. Physicians and nurses had a period prevalence of plantar fasciitis of 8.14% and 13.11% during the 7-year period, respectively. The risk of plantar fasciitis was lower among physicians (odds ratio [OR]: 0.660; 95% confidence interval [CI]: 0.622–0.699) but higher among nurses (OR: 1.035; 95% CI: 1.011–1.059) compared with that in the general population. Nurses also had a higher risk than the physicians after adjusting for age and sex (adjusted odds ratio [AOR]: 1.541; 95% CI: 1.399–1.701). Physician subspecialties of orthopedics and physical medicine and rehabilitation showed a higher risk. Female physicians had a higher risk of plantar fasciitis than male physicians. This study showed that nurses, physician specialties of orthopedics and physical medicine and rehabilitation, and female physicians had a higher risk of plantar fasciitis. Improvement of the occupational environment and health promotion are suggested for these populations.
Article
Zusammenfassung Der plantare Fersenschmerz ist ein Überbegriff für zahlreiche Krankheitsbilder der Fersenregion und ein häufiger Konsultationsgrund in der orthopädischen Sprechstunde. Er umfasst eine Vielzahl von Pathologien unterschiedlicher Ätiologie. Die exakte Diagnose des plantaren Fersenschmerzes erfordert genaue anatomische, pathophysiologische sowie -morphologische Kenntnisse. Erschwert wird die Diagnosestellung nicht nur durch die engen anatomischen Beziehungen, sondern auch durch eine teilweise undifferenzierte Terminologie der Krankheitsbilder dieser Region. Die Plantarfasziitis stellt mit Abstand die häufigste Ursache für den plantaren Fersenschmerz dar, daneben können Nervenkompressionssyndrome, Stressfrakturen, Fibromatosen und Rupturen der plantaren Faszie ähnliche Beschwerden hervorrufen. Der differenzialdiagnostischen Betrachtung kommt eine besondere Bedeutung zu, da diese therapeutische Konsequenzen nach sich zieht. Im Folgenden sollen die Ursachen des plantaren Fersenschmerzes mit Schwerpunkt auf Diagnose und differenzialdiagnostische Abgrenzung dargestellt werden.
Article
Objective Treatment of chronic plantar fasciitis and release of the first calcaneal branch of the lateral plantar nerve (Baxter’s nerve).IndicationsChronic plantar fasciitis, compression of the first calcaneal branch of the lateral plantar nerve (Baxter’s nerve).ContraindicationsGeneral medical contraindications to surgical interventions, infection.Surgical techniqueLongitudinal incision at the medial heel. Exposure of the plantar fascia at its origin on the medial plantar calcaneus. Medial incision of the plantar fascia preserving the lateral portion. Resection of a heel spur, if present. Exposure of the abductor hallucis muscle. Incision of the superficial fascia of the muscle. Retraction of the muscle belly und incision of the deep portion of the fascia, decompression of the nerve.Postoperative managementTwo weeks partial weight bearing 20 kg in a healing shoe. Progressively weight bearing using a shoe with a stiff sole for another 4 weeks.ResultsA total of 32 feet of 27 patients with chronic plantar fasciitis and compression of the first branch of the lateral plantar nerve were treated with medial incision of the fascia and a nerve decompression. In 24 feet a calcaneal spur was resected. Mean follow-up was 25.6 months (12–35 months). Preoperative Manchester–Oxford Foot Questionnaire (MOXFQ) score was 52.5 (±9.0), postoperative MOXFQ score was 31.3 (±4.1). Six (18,8%) patients had same or more pain 6 weeks postoperatively.;8 (25%) patients stated minor complications like swelling, delayed wound healing, temporary hypoesthesia or pain while walking.
Chapter
Plantar fasciopathy is a common disorder of the foot characterized by pain along the medial aspect of the heel. It is a condition that is routinely encountered by a variety of healthcare practitioners, including primary care providers, orthopedists, and podiatrists. Plantar fasciopathy is a degenerative process of the broad, fibrous aponeurosis spanning the plantar structures of the foot. Risk factors for the development of plantar fasciopathy include pes cavus, pes planus, body habitus, abnormal biomechanics, and increased, prolonged mechanical load. Treatment of plantar fasciopathy includes correction of these risk factors, nonsteroidal anti-inflammatory drugs (NSAIDs), and judicious use of corticosteroid injections. Regenerative injection therapies, including platelet-rich plasma (PRP) and prolotherapy, have shown promise. Surgical treatment includes open fasciotomies, endoscopic fasciotomies, and microtenotomy. Surgery is rarely required and is reserved for cases that are refractory to nonoperative treatments.
Article
Purpose Plantar Fasciitis is a widely prevalent condition and is extremely disabling if it remains unresolved. Despite many available treatment modalities, the management of recalcitrant cases is still a dilemma. We conducted this study to evaluate and compare the role of two novel modalities: Intralesional PRP (Platelet Rich Plasma) injection and Extra Corporeal Shockwave Therapy (ESWT) for the management of this condition. Methods 60 patients with a clinical diagnosis of recalcitrant plantar fasciitis were randomized into 2 groups; PRP Group (n = 30) and ESWT Group (n = 30). In PRP group patients received 3 intralesional injections of PRP and in ESWT group 3 sessions of Extra Corporeal Shockwave Therapy were administered. The Primary outcome measures were Visual Analogue Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Roles and Maudsley Index and Heel Tenderness Index (HTI). The secondary outcome measures were complications. The patients were followed up for a period of 6 months and evaluated for various scores. Results At 6 months follow-up, significant results were found only on VAS score for both groups (p-value <0.05). However, both modalities resulted in significant clinical improvement with no complications reported. No statistically significant differences were reported between the two test groups. Conclusions Both autologous PRP and ESWT can become extremely useful modalities for management of recalcitrant cases of plantar fasciitis with no known adverse effects.
Thesis
Introduction: Plantar fasciitis is one of the most common disorders of foot soft-tissue and obesity is one of its major causes. In this study, we aimed to evaluate the relation between plantar fascia thickness and anthropometric findings in patients with plantar fasciitis. Materials and Methods: In the current study, we evaluated 80 patients (16 males and 64 females) who admitted to Orthopaedic Clinic of Urmia Imam Khomeini Hospital with plantar heel pain lasting for more than 1 month. Exclusion criteria included history of any systemic diseases and history of anti-inflammatory drug consumption within a month. Demographic characteristics of the patients were extracted and their weight, height, body mass index, and waist circumference were measured. According to body bass index, the patients were divided into obese (body mass index ≥30) and non-obese (body mass index <30) groups. Then, all the patients were referred to a radiologist for sonographic determination of the plantar fascia thickness. Finally, pain severity of the patients before and after corticosteroid injection and their foot function were assessed and their relation with anthropometric characteristics was analyzed. Results: Out of 80 patients, 44 were in obese and 36 were in non-obese groups. The mean age of the patients was 46.26 ± 11.41 years. The mean plantar fascia thickness of the whole patients, obese patinets and non-obese patients were 3.21 ± 0.40 mm, 3.49 ± 0.37 mm, and 2.98 ± 0.25 mm, respectively. The mean plantar fascia thickness in obese patients was significantly higher than non-obese patients (P<0.001). Plantar fascia thickness was significantly correlated with weight (P<0.001), body mass index (P<0.001), and waist circumference (P<0.001) but it had no significant association with age (P=0.533) and height (P=0.410). Following treatment, the mean visual analog scale during the day (P=0.049) and the mean morning visual analog scale (P=0.002) were significantly higher in obese patients compared with non-obese ones. Conclusion: Obesity may be one of the main reasons of the pain associated with plantar fasciitis. Recommendation to lose weight and its monitoring using body mass index may be helpful in reducing the pain in patients with plantar fasciitis and improving their function. Keywords: Plantar fascia thickness, Anthropometric findings, Plantar fasciitis, Sonography
Chapter
Plantar heel pain is a common disorder of the foot which involves multiple anatomic structures.
Article
Population: Strengths of associations are determined using multivariable logistic regression. It was estimated that 0.85% (95% CI: 0.77 - 0.92) of the sample reported diagnosed plantar fasciitis with pain in the last month. Higher prevalence of plantar fasciitis was seen in females (1.19%) [referent] versus males (0.47%), in those aged 45-64 (1.33%) versus those aged 18-44 (0.53%) [referent], and in the obese (1.48%) versus those with a body mass less than 25 (0.29%) [referent]. Prescription medications for pain were used by 41.04% of plantar fasciitis respondents, but only 6.31% attributed this use specifically to plantar fasciitis pain. NSAIDs (4.01%) and opioids (2.21%) were the most prevalent prescription drugs used specifically for plantar fasciitis pain. Almost 70% of individuals with plantar fasciitis used over-the-counter (OTC) analgesics for general pain management, with OTC NSAIDs being used by 49.47% and acetaminophen by 26.93% of respondents. Individuals diagnosed by medical specialists had twice the odds of using prescription drugs as those diagnosed by other providers (OR= 2.12; 95% CI: 1.01-4.46). Non-Hispanic blacks were more likely to use prescription pain medications specifically for plantar fasciitis pain than Non-Hispanic whites (OR = 3.02; 95% CI: 1.05-8.70). These findings will help inform healthcare providers and policy makers whether the current use of pharmaceutical treatments for plantar fasciitis reflect evidence-based treatment guidelines.
Article
Background:: Ultrasound is a widely used diagnostic tool for patients with plantar fasciitis. However, the lack of standardization during the measurement for plantar fascia thickness has made it challenging to understand the etiology of plantar fasciitis, as well as identify risk factors, such as gender. The purpose of this study was to investigate gender differences regarding plantar fascia thickness while controlling for metatarsophalangeal (MTP) joint position in the healthy and those with unilateral plantar fasciitis. Methods:: Forty participants (20 with unilateral plantar fasciitis and 20 controls) with plantar fascia thickness (mean age, 44.8 ± 12.2 years) participated in this study. The majority were females (n = 26, 65%). Plantar fascia thickness was measured via ultrasound 3 times at 3 different MTP joint positions: (1) at rest, (2) at 30 degrees of extension, and (3) at maximal extension. Results:: When comparing gender differences, the males in the plantar fasciitis group had a significantly thicker plantar fascia than the females ( P = .048, η2 = 2.35). However, no significant differences were observed between healthy males and females. The males with unilateral plantar fasciitis also had significantly thicker asymptomatic plantar fasciae collectively compared with controls ( P < .05), whereas females with unilateral plantar fasciitis had a similar but not significant change. Conclusion:: It appears that healthy males and females have similar plantar fascia thickness. However, as plantar fasciitis develops, males tend to develop thicker plantar fasciae than their female counterparts, which could have future treatment implications. Level of evidence:: Level III, case-control comparative study.
Article
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Background: Women, as compared with men, have a higher proportion of injuries in the ankle/foot region. However, the reason for this sex-related difference in foot injuries remains unclear. Recently, joint coordination and variability of coordination have been suggested to be a critical index for defining both the state of injury and the potential risk of injury. The purpose of this study was to investigate sex-related differences in coordination and variability among the foot joints during running. Methods: Twelve healthy men and 12 healthy women ran on a treadmill. A modified vector coding technique was used to identify coordination and variability among foot joints involving the shank, rearfoot, midfoot, and forefoot segments, and categorized into the following four coordination patterns: in-phase with proximal dominancy, in-phase with distal dominancy, anti-phase with proximal dominancy, and anti-phase with distal dominancy. Results: There were no differences in all spatiotemporal parameters and in the foot strike angle between men and women. Coordination of variability of the foot joints during running was similar between men and women, but the anti-phase with proximal dominancy in proportion of frontal rearfoot-shank vs. midfoot-rearfoot couple (men; 7.2%, women; 13.9%) and midfoot-rearfoot vs. forefoot-midfoot couple (men; 18.6%, women; 39.8%) in women was significantly increased compared to that in men. Other all coordination of the foot joints during running differed between men and women, and effect sizes of these parameters were all large. Conclusion: The results may be useful for understanding the underlying mechanism contributing to differences in injury risk in men and women, and may provide novel data on foot joint coordination and variability that could be used as reference data for both biomechanical and clinical running studies.
Article
Background Plantar fasciitis is the most common cause of plantar heel pain. Although most are self-limiting, recalcitrant conditions can be debilitating, significantly reducing patient’s quality of life. A myriad of surgical procedures are available for the treatment of recalcitrant plantar fasciitis (RPF) with little consensus on best practice. This purpose of this study was to assess the efficacy of radiofrequency coblation with and without gastrocnemius release on the surgical management of RPF. Methods Between June 2013 and June 2019, a total of 128 patients with RPF and tight gastrocnemius were treated surgically. Presence of tight gastrocnemius was assessed clinically by a positive Silfverskiold test. Group A (n = 73) consisted of patients who underwent radiofrequency coblation alone; group B (n = 55) consisted of patients who underwent radiofrequency coblation and endoscopic gastrocnemius recession. The primary outcome measure was visual analog scale (VAS) score. Secondary outcome measures included (1) American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score; (2) physical (PCS) and mental component summaries (MCS) of the 36-Item Short Form Health Survey; (3) overall assessment of improvement, expectation fulfilment, and satisfaction; and (4) complication rates. Results Both groups reported significant improvement in VAS, AOFAS, and PCS scores postoperatively at 6 and 24 months. Group B (radiofrequency coblation with gastrocnemius recession) was associated with better VAS at both 6 months (3.0 ± 2.9 vs 1.7 ± 2.6, P < .05) and 24 months postoperatively (1.9 ± 3.1 vs 0.8 ± 2.0, P < .05) compared with group A (radiofrequency coblation without gastrocnemius recession). At 24 months postoperatively, no differences were found in AOFAS, PCS, MCS scores, expectation fulfilment, or overall satisfaction. No wound complications were reported in either group. One patient (group B) has persistent symptoms consistent with tarsal tunnel syndrome. Conclusion In this retrospective cohort comparative study, treatment of RPF with radiofrequency coblation alone was associated with slightly inferior results than radiofrequency coblation combined with endoscopic gastrocnemius recession in terms of pain relief without an increase in complication rates. However, at 2 years, we did not find a significant difference in other measures of outcome. Level of Evidence Level III, retrospective cohort study.
Article
Chronic plantar fasciitis is a common cause of foot pain, with conservative treatment providing relief for most patients. However, because of the common occurrence of this pathology, this leaves many patients dissatisfied. The purpose of the present study was to determine the effectiveness of extracorporeal shock wave therapy (ESWT) to treat chronic plantar fasciitis (PF) in a largely active duty population. A review of 82 patients (115 heels) who had undergone ESWT for chronic PF was performed. Outcome data were obtained by patient telephone interviews. All ESWT was conducted at 24 kV for 2000 shocks. Of the 82 patients (115 heels), 76 (93%; 111 heels) agreed to participate. Their mean age was 42 ± 10 years, with 41 males (54%) and 35 females (46%). The mean follow-up period was 42 ± 22 months. Of the patients, 73.6% were active duty military personnel. The mean preoperative pain score of 7.8 ± 2 had improved to 2.5 ± 2 at the last follow-up visit (p <.0001). Active duty patients reported a mean improvement in pain of 4.8 ± 3 compared with 6.8 ± 3 in non-active duty patients (p = .005). Of the 76 patients, 75 (98%) underwent 1 ESWT session, and 1 (2%) requiring 2 sessions. Overall, 74% of patients rated the outcome of their procedure as either good or excellent, with 87% stating that ESWT was successful. Ten patients (18%) left the military because of continued foot pain, with 76% able to return to running. For patients with chronic PF, these results support the use of ESWT to relieve pain in >85% of patients, with a preponderance for better pain relief in patients who are not active duty military personnel.
Article
The link between increased body weight and hindfoot complaints is largely based on correlation to single foot pathology. We retrospectively reviewed 6879 patients with tibialis posterior tendonitis (TPT), plantar fasciitis (PF), or both. Among patients with either TPT or PF, 1 in 11 (9%) had both. We then compared age, gender, and body mass index among these groups. Patients with both diagnoses were neither statistically older nor more obese than patients with single diagnoses. However, they were statistically more female. Given the overall high prevalence of obesity in the study population, we feel these data support the link between obesity and multiple foot pathology. Prognostic Level IV: Case series. © 2015 The Author(s).
Article
Of 116 patients with pain in the plantar portion of the heel, nineteen proved on follow-up to have systemic disease as the etiology. Of these treated with phenylbutazone, 71 per cent showed good results and a similar percentage benefited equally from injections of cortisone derivatives. Only two patients required surgical procedures, and these were successful in both.
Article
A new, minimally traumatic endoscopic approach to plantar fasciotomy has been developed by the authors. This technique can be performed comfortably under a local anesthetic. Patients are immediately weightbearing and all returned to regular type shoes on the 3rd postoperative day. An earlier return to regular activity and work, with less pain and patient discomfort was found, as compared with traditional heel spur surgery techniques.
Article
Plantar fasciitis is a common orthopedic syndrome among athletes and nonathletes. The etiology of the pain is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. The majority of patients will respond to conservative measures. Surgical treatment is reserved for those patients who do not respond. A complete plantar fascia release is performed through a medial longitudinal incision. Prominent heel spurs and degenerated areas in the plantar fascia are resected. Of 27 surgically treated cases followed from one to three years, satisfactory results were obtained in 24 cases. Histologically, localized fibrosis or granulomatous changes or both were noted in several cases.
Article
The symptom of heel pain from heel spur syndrome has both a cause (abnormal pronation) and an effect (inflammation at the heel spur area). I believe that heel spur syndrome cause and effect can best be treated mechanically by a two-stage approach. This two-stage approach uses a different orthotic for each stage. The first stage is to prescribe an orthotic to alleviate the cause through control of abnormal pronation by posting or wedging, and also to alleviate the effect by local accommodation and shock absorption of the inflamed area. The second stage of mechanical treatment is begun after the effect (local inflammation) has subsided. This second stage consists of treatment with a rigid functional orthotic to treat only the cause. This orthotic is more durable and controlling and will therefore maintain the patient and prevent abnormal pronation from occurring. Thus, the cause of pain at the heel spur area will be eliminated. Orthotics can be a great adjunct to treatment of heel spur syndrome. But, as is the case with any other method you use to treat your patients, orthotics are only as good as the theories on which you base them. There are a variety of excellent materials and computerized methods being used today for fabrication of orthotic devices, but they are only as effective as the knowledge on which you base them. If you do not understand the etiology of the mechanical problem and do not observe what treatment is successful and the reasons behind this success, the orthotic you prescribe is not going to have a high level of success, regardless of new materials or technology. You will be like the laboratory technician who can fabricate an orthotic, but cannot predict, with any level of confidence, whether it will alleviate the mechanical problem.
Article
The clinical syndrome of plantar fasciitis is characterized by pain inflammation caused by strain or tearing of the plantar aponeurosis at its attachment to the medical calcaneal tubercle. Plantar fasciitis is commonly associated with heel spur formation, but heel spurs are also found with no symptomology. The most significant finding in plantar fasciitis and heel spur syndrome is point tenderness at the insertion of the fascia to the anterior edge of the medial calcaneal tuberosity. History typically reveals pain on rising in the morning which subsides during the day but returns after periods of nonweight-bearing. The plantar aponeurosis functions to maintain the medial longitudinal arch of the foot and assists in absorbing forces in the midtarsal joints. Abnormal biomechanical factors can influence the stresses on the plantar fascia. Factors include a cavus foot type, excessive foot pronation, and ankle equinus. Plantar fasciitis usually presents unilaterally; however, bilateral involvement can occur and should cause the clinician to suspect the probability of systemic disease. The systemic diseases include seronegative arthridities, rheumatoid arthritis, gout, and Paget's disease. Other etiologies for subcalcaneal pain include calcaneal stress fractures, apophysitis, and nerve entrapment. Conservative therapy yields a high success rate in the treatment of heel spur syndrome and plantar fasciitis. Treatment consists of padding, strapping, orthotics, nonsteroidal anti-inflammatory drugs, and local synthetic steroid injections. If chronic heel pain is not responsive to these treatment regimens, then surgical intervention is considered.
Article
Body weight has been implicated as a factor in plantar heel pain. In this study, a statistically significant correlation between heel pain and increased body weight is documented in a series of consecutive plantar heel pain patients.
The author describes the role of the nerve to the abductor digiti quinti muscle and presents a preliminary report of a direct surgical approach for decompression.
Article
An excessive amount and/or a prolonged duration of pronation is the most common mechanical cause of structural strain resulting in plantar fasciitis. Temporary relief of pain can be achieved by customary antiinflammatory drugs or therapy; long-term relief is achieved by adequate remedy of the aggravating pronation factors. A semirigid, custom-molded orthosis reduces excessive plantar fascial strain by supporting the first metatarsal bone and by controlling calcaneal position when in conjunction with a firm posterior counter shoe. A clinical environment with physician and orthotist together allows ideal evaluation and treatment of patients.
Article
Plantar fasciitis is a common cause of pain, particularly in runners and certain other athletic groups. This syndrome must be distinguished from certain other conditions, such as the tarsal tunnel syndrome and achillodynia. Conservative therapy including rest, orthotics, heel cups, anti-inflammatory agents, and icing reduce symptoms in most patients. A few athletes may need surgery to continue running. The authors released the plantar fascia and excised areas of mucinoid degeneration in 15 athletes. Fourteen returned to full athletic activity.
Article
The relation between body weight and overall mortality remains controversial despite considerable investigation. We examined the association between body-mass index (defined as the weight in kilograms divided by the square of the height in meters) and both overall mortality and mortality from specific causes in a cohort of 115,195 U.S. women enrolled in the prospective Nurses' Health Study. These women were 30 to 55 years of age and free of known cardiovascular disease and cancer in 1976. During 16 years of follow-up, we documented 4726 deaths, of which 881 were from cardiovascular disease, 2586 from cancer, and 1259 from other causes. In analyses adjusted only for age, we observed a J-shaped relation between body-mass index and overall mortality. When women who had never smoked were examined separately, no increase in risk was observed among the leaner women, and a more direct relation between weight and mortality emerged (P for trend < 0.001). In multivariate analyses of women who had never smoked and had recently had stable weight, in which the first four years of follow-up were excluded, the relative risks of death from all causes for increasing categories of body-mass index were as follows: body-mass index < 19.0 (the reference category), relative risk = 1.0; 19.0 to 21.9, relative risk = 1.2; 22.0 to 24.9, relative risk = 1.2; 25.0 to 26.9, relative risk = 1.3; 27.0 to 28.9, relative risk = 1.6; 29.0 to 31.9, relative risk = 2.1; and > or = 32.0, relative risk = 2.2 (P for trend < 0.001). Among women with a body-mass index of 32.0 or higher who had never smoked, the relative risk of death from cardiovascular disease was 4.1 (95 percent confidence interval, 2.1 to 7.7), and that of death from cancer was 2.1 (95 percent confidence interval, 1.4 to 3.2), as compared with the risk among women with a body-mass index below 19.0. A weight gain of 10 kg (22 lb) or more since the age of 18 was associated with increased mortality in middle adulthood. Body weight and mortality from all causes were directly related among these middle-aged women. Lean women did not have excess mortality. The lowest mortality rate was observed among women who weighed at least 15 percent less than the U.S. average for women of similar age and among those whose weight had been stable since early adulthood.
Article
Obesity, android fat distribution, and other anthropometric measures have been associated with coronary heart disease in long-term prospective studies. However, fluctuations in weight due to age-related hormonal changes and changes in lifestyle practices may bias relative risk estimates over a long follow-up period. The authors prospectively studied the association between body mass index (BMI) (kg/m2), waist-to-hip ratio, and height as independent predictors of incident coronary heart disease in a 3-year prospective study among 29,122 US men aged 40-75 years in 1986. The authors documented 420 incident coronary events during the follow-up period. Body mass index, waist-to-hip ratio, short stature, and weight gain since age 21 were associated with an increased risk of coronary heart disease. Among men younger than 65, after adjusting for other coronary risk factors, the relative risk was 1.72 (95% confidence interval (CI) 1.10-2.69) for men with BMI of 25-28.9, 2.61 (95% CI 1.54-4.42) for BMI of 29.0-32.9, and 3.44 (95% CI 1.67-7.09) for obese men with BMI > or = 33 compared with lean men with BMI < 23.0. Among men > or = 65 years of age, the association between BMI and risk of coronary heart disease was much weaker. However, in this age group, the waist-to-hip ratio was a much stronger predictor of risk (relative risk = 2.76, 95% CI 1.22-6.23 between extreme quintiles). These results suggest that for younger men, obesity, independent of fat distribution, is a strong risk factor for coronary heart disease. For older men, measures of fat distribution may be better than body mass index at predicting risk of coronary disease.
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