Heel Pad Compressibility Index Research Articles

Clinico-radiological study of heel pain patients with special reference to heel pad thickness: A hospital based study

Background: Heel pain debilitates the quality of life. Causes of this pain are many but exact diagnosis is lacking in majority. Change of architecture and mechanical properties of plantar heel pad is considered a major cause. Materials and method: Prospective observational study with 194 cases of heel pain from 1st July 2006 to 1st November 2007. Acute heel pain following trauma, infection, tumour or other foot deformities were excluded. Standardised questionnaire, clinical examination and standard lateral wt. bearing & non-wt. bearing xrays view of foot projected at the calcaneum were taken to measure body weight loaded Heel Pad Thickness (LHPT) & unloaded Heel Pad Thickness (UHPT). Heel Pad Compressibility Index was measured by HPCI= (LHPT/UHPT). Results: 194 cases with heel pain were included in the study. 88 cases are male, 72 cases are female patients. (Ratio male: female = 1. 2: 1). Mean UHPT=20.7mm, LHPT=12.19mm, HPCI=0.58mm. HPCI tends to increase with increase in age (> 40 yrs age group). No significant difference in UHPT, LHPT, HPCI between males and female was noted. Conclusion: This is probably the first study in the North Eastern Region of India, which evaluated heel pain associated with heel pad thickness and compressibility index.

Sonographic Evaluation of the Plantar Heel in Asymptomatic Endurance Runners.

The primary purpose of this investigation was to determine the prevalence and spectrum of asymptomatic sonographically determined structural changes in the plantar fascia and plantar heel pad among experienced runners without a history of heel pain. Thirty-nine asymptomatic runners without a history of plantar heel pain were recruited. The following sonographic measures were recorded: power Doppler sonography in the plantar heel pad and plantar fascia, echo texture of the plantar heel pad, uncompressed heel pad thickness, compressed heel pad thickness, heel pad compressibility index, plantar fascia thickness, and plantar fascia echo texture. Doppler flow was shown in the plantar heel pads of 88% (68 of 77) of heels and 92% (36 of 39) of runners. Heel pad echo texture abnormalities were found in 86% (66 of 77) of heels and 97% (38 of 39) of runners. Mean values for right and left uncompressed heel pad thickness were 13.8 and 13.7 mm, respectively. The mean heel pad compressibility indices were 0.51 for the right heel and 0.53 for the left heel. Eight percent (6 of 77) of fat pads in 10% (4 of 39) of runners had abnormal compressibility indices. Doppler flow was present in the plantar fascia in 31% (24 of 77) of heels and 44% (17 of 39) of runners. The mean plantar fascia thicknesses were 3.78 mm for the right and 3.87 mm for the left. Forty-eight percent (37 of 77) of heels had an abnormal plantar fascia echo texture. At least 1 potentially abnormal sonographic finding was present in each heel of all asymptomatic runners in this study. Consequently, sonographic abnormalities in the plantar heel should be interpreted within the clinical context when evaluating runners.

INVESTIGATIONS ON IN VIVO HUMAN HEEL PAD THICKNESS

The human heel pad thickness is one of the intrinsic factors which must be taken into account when investigating the biomechanics of the heel pad [Rome, 1998; Uzel, 2006]. In fact, heel pad thickness has been reported to be an important factor in determining stresses observed in healthy as well as pathological feet [Rome, 1998; Uzel, 2006]. Furthermore, the heel pad compressibility index (HPCI), indicating the ability of the heel pad to be compressed, is also an important parameter.

Heel pad thickness and athletic activity in healthy young adults: A sonographic study

The aim of this study was to investigate the sonographic changes of heel fat pad thickness and compressibility index in healthy young adults in relation to level of athletic activity. One hundred ten young adults (55 women and 55 men) with a body mass index between 18.5 and 24.9 were divided into 3 groups according to their athletic activity level: group 1, sedentary (n = 50); group 2, athletic activity <7 hours/week (n = 30); and group 3, athletic activity >or=7 hours/week (n = 30). The loaded heel pad thickness (LHPT) and unloaded heel pad thickness (ULHPT) were measured via sonography, and the heel pad compressibility index (HPCI) was calculated. The mean values of ULHPT, LHPT, and HPCI in group 1 were similar to those of group 2 (p > 0.05) and group 3 (p > 0.05). The mean values of ULHPT, LHPT, and HPCI were similar in the left and right feet in the 3 groups (p > 0.05). There was no correlation between level of athletic activity and ULHPT, LHPT, or HPCI. The heel pad thickness and HPCI of individuals engaging in athletic activity up to an average of 11 hours/week were similar to those of sedentary individuals.

Comparison of ultrasonography and radiography in assessment of the heel pad compressibility index of patients with plantar heel pain syndrome. Measurement of the fat pad in plantar heel pain syndrome

Aims. – The shock absorption of the heel fat pad is assessed by heel-pad compressibility index measuring the thickness of the heel pad on the lateral radiographs unloaded and loaded by body-weight. Ultrasonography is an easily applicable method without radiation and magnification inherent in radiographs. There are no reports comparing these measurements by diagnostic ultrasonography and direct radiography in healthy individuals and in different clinical entities. The efficacy of ultrasonography in assessment of heel-pad compressibility index in patients with plantar heel pain syndrome was investigated comparing it with direct radiography. Methods. – The loaded and unloaded heel-pad thicknesses by ultrasonography and direct radiography were measured in 69 feet of 42 patients with plantar heel pain syndrome and their results were compared. Results. – In direct radiographs, the mean unloaded heel-pad thickness was 20 ± 2 mm and ranged from 14 to 26 mm. Heel-pad compressibility index was 0.62 ± 0.09. There was a strong positive correlation between the measurements of the unloaded thickness ( r = 0.84, P < 0.001) and also between the measurements of the loaded thickness ( r = 0.88, P < 0.001) done using ultrasonography and direct radiography. The difference between the results of measurements in two modalities did not exceed ± 1 mm in 50% and ± 2 mm in 81% in unloaded position and ± 1 mm in 62% and ± 2 mm in 82% in loaded position. Conclusion. – Measuring unloaded and loaded heel pad thickness by ultrasonography is reliable in the adult feet with heel pain. The preference of ultrasonography is reasonable in the studies involving the heel fat pad.

The relationship of the heel pad compressibility and plantar pressure distribution.

Loss of heel pad elasticity has been suggested as one of the possible explanations of heel pain. This study aimed to determine the effect of heel pad thickness and its compressibility to heel pressure distribution, in 47 (94 feet) normal subjects and 59 (94 feet) patients with heel pain, using radiological measurements and EMED-SF (Novel, Munich) plantar pressure distribution measurement system. Both heels of the patients and control group were radiographed with and without weight bearing. The ratio of the heel pad thickness in loading to unloading position was defined as "the heel pad compressibility index." The plantar peak pressure of the heel was measured at heel strike phase of the gait cycle. The compressibility index for control and patient groups were found to be 0.60 and 0.69, respectively. The peak pressure under the heel pad was recorded to be 28.4 N/cm2 for patients and 31.7 N/cm2 for control group. No significant difference was found for heel pad compressibility index and heel pad pressures between patient and control groups (p > 0.05). This study revealed that there is no relationship between heel pad compressibility and pressure distribution of the heel pad both in control and patient group. We feel the flexibility of the heel pad does not have any influence on heel pain syndromes.

The relationship of heel pad elasticity and plantar heel pain.

Loss of heel pad elasticity has been suggested as one of the possible explanations of plantar heel pain. This hypothesis is evaluated by this blinded observer prospective study, using an age and weight matched control population. Hindfoot lateral radiographs of 73 patients with plantar heel pain, 29 of whom had bilateral involvement (102 feet), and who ranged in age from 20 to 60 years, were studied and compared with 120 healthy subjects (240 feet). Heel pad thickness and heel pad compressibility index were not significantly different in patients with plantar heel pain than in healthy subjects matched for age and weight. In patients with unilateral heel pain, heel pad thickness and heel pad compressibility index on the painful side were not significantly different from the opposite painless side. The contribution of the heel pad elasticity measured as a visual compressibility index for plantar heel pain is a matter of debate.

The Heel-Pad Compressibility

Heel-pad thickness and compressibility were studied in the feet of 400 normal subjects by loaded and unloaded lateral radiographs. The normal unloaded heel-pad thickness was 18.70 +/- 2.46 mm. The thickness was greater in men than in women and increased with age. The heel-pad compressibility index was 0.53 +/- 0.09. The compressibility increased with age, but there was no significant difference with gender. An increase in body weight led to an increase in heel-pad thickness and loss of elasticity.