Determinants of footwear difficulties in people with plantar heel pain.

Justin Sullivan,Evangelos Pappas,Jack Crosbie,Roger Adams,Joshua Burns

doi:10.1186/s13047-015-0102-9

Abstract

BackgroundPlantar heel pain is a common foot disorder aggravated by weight-bearing activity. Despite considerable focus on therapeutic interventions such as orthoses, there has been limited investigation of footwear-related issues in people with plantar heel pain. The aim of this study was to investigate whether people with plantar heel pain experience footwear-related difficulties compared to asymptomatic individuals, as well as identifying factors associated with footwear comfort, fit and choice.MethodsThe footwear domain of the Foot Health Status Questionnaire (FHSQ) was assessed in 192 people with plantar heel pain and 69 asymptomatic controls. The plantar heel pain group was also assessed on a variety of measures including: foot posture, foot strength and flexibility, pedobarography and pain level. A univariate analysis of covariance, with age as the covariate, was used to compare the heel pain and control groups on the FHSQ footwear domain score. A multiple regression model was then constructed to investigate factors associated with footwear scores among participants with plantar heel pain.ResultsWhen compared to asymptomatic participants, people with plantar heel pain reported lower FHSQ footwear domain scores (mean difference −24.4; p < 0.001; 95 % CI: −32.0 to −17.0). In the participants with heel pain, footwear scores were associated with maximum force beneath the postero-lateral heel during barefoot walking, toe flexor strength and gender.ConclusionsPeople with plantar heel pain experience difficulty with footwear comfort, fit and choice. Reduced heel loading during barefoot walking, toe flexor weakness and female gender are all independently associated with reports of footwear difficulties in people with heel pain. Increased focus, in both clinical and research settings, is needed to address footwear-related issues in people with plantar heel pain.

Highlights

Plantar heel pain is a common foot disorder aggravated by weight-bearing activity
Participants were excluded from either group if they had undergone foot surgery, or had any of the following conditions: systemic arthritis, neurological conditions, lumbar radiculopathy, neurological or vascular compromise of the foot related to diabetes, peripheral neuropathies or any coexisting painful musculoskeletal condition of the lower limb
The following variables were immediately discarded from the analysis due to nonsignificant correlation with the Foot Health Status Questionnaire (FHSQ) footwear domain score: height, weight, BMI, symptom duration, Foot Posture Index, dorsiflexion range of motion, first metatarsophalangeal extension range of motion, inversion and eversion range of motion, peak pressure in all regions of the foot, pressure–time integrals in the heel, midfoot and lateral forefoot, maximum force under the forefoot and the medial heel and force-time integral at the forefoot

Summary

Introduction

Despite considerable focus on therapeutic interventions such as orthoses, there has been limited investigation of footwear-related issues in people with plantar heel pain. The aim of this study was to investigate whether people with plantar heel pain experience footwear-related difficulties compared to asymptomatic individuals, as well as identifying factors associated with footwear comfort, fit and choice. Plantar heel pain is a common musculoskeletal condition that negatively impacts on both work and leisure activities [1]. It is the most common foot condition treated by physical therapists [2] and accounted for approximately one million physician consultations per year in the United States of America between 1995 and 2000 [3]. The mechanical nature of plantar heel pain [15] may implicate footwear as either a potential

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