The relationship between plantar heel pain and heel plantar pressure.

Abstract

Aim Plantar fasciitis is a very common musculoskeletal condition in both the athletic and the non-athletic population. However, there is lack of evidence in research as to what the correct pathophysiology is. It has been debated whether increased medial heel plantar pressure is present in plantar fasciitis. The relationship between peak medial heel plantar pressure and medio-plantar heel pain in the Maltese population has been investigated in this study. Peak lateral heel plantar pressures and peak forefoot plantar pressures have also been investigated in order to identify any shift in pressure occurring from the painful region during gait. Research Design and Method The study consisted of a non-experimental subject design which was conducted in the Gait Analysis Laboratory at B'Kara Health Centre. A sample of 15 adult participants with medio-plantar heel pain caused by chronic plantar fasciitis who fit in the inclusion-exclusion criteria were selected using Purposive sampling. Another 15 healthy adult participants formed the control group, in order to identify any significant difference in medial heel plantar pressure between both groups. The two groups were matched for age (+/- 5years), gender and weight (+/- 5kg). Dynamic measurements of peak plantar pressures were taken, following the two-step gait initiation protocol, using the Tekscan HR Mat™ system. Peak medial heel plantar pressure, peak lateral heel plantar pressure and peak forefoot plantar pressure were recorded and compared between the two groups during statistical analysis of the data collected. Results No significant differences were found in peak plantar pressure measurements between participants with chronic plantar fasciitis and their controls. This was the case when assessing peak heel plantar pressure (p = 0.244), peak lateral heel plantar pressure (p = 0.867) and peak forefoot plantar pressure (p = 0.576). There was a significant difference in peak medial heel plantar pressure between the experimental and the control group (p = 0.015). Results show that not only is there no increase in pressure in symptomatic participants, but the pressure in symptomatic individuals was found to be less than asymptomatic individuals. The forefoot to rearfoot peak plantar pressure ratio (F/R ratio) was calculated in order to identify any compensatory shift in pressure from the rearfoot to the forefoot during gait. No significant difference between the FIR ratio of the experimental group and the FIR ratio of the control group (p = 0.242) was detected. Conclusion The findings in this study indicate that there is no relationship between peak medial heel plantar pressures and. chronic medio-plantar heel pain in plantar fasciitis. There is also no shift in pressure from the symptomatic medio-plantar heel region to the latero-plantar heel and forefoot region. As a result, pressure may not be playing a part in the pathophysiology of plantar fasciitis and the exact aetiology should be evaluated.