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Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study

Damien B Irving, Jill L Cook, Mark A Young and Hylton B Menz

BMC Musculoskeletal Disorders 2007, 8:41

Background

Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal disorders of the foot, yet its aetiology is poorly understood. The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors.

Methods

Eighty participants with CPHP (33 males, 47 females, mean age 52.3 years, S.D. 11.7) were matched by age (+/- 2 years) and sex to 80 control participants (33 males, 47 females, mean age 51.9 years, S.D. 11.8). The two groups were then compared on body mass index (BMI), foot posture as measured by the Foot Posture Index (FPI), ankle dorsiflexion range of motion (ROM) as measured by the Dorsiflexion Lunge Test, occupational lower limb stress using the Occupational Rating Scale and calf endurance using the Standing Heel Rise Test.

Results

Univariate analysis demonstrated that the CPHP group had significantly greater BMI (29.8 +/- 5.4 kg/m2 vs. 27.5 +/- 4.9 kg/m2; P = 0.005), a more pronated foot posture (FPI score 2.4 +/- 3.3 vs. 1.1 +/- 2.3; P = 0.004) and greater ankle dorsiflexion ROM (45.1 +/- 7.1degrees vs. 40.5 +/- 6.6degrees; P < 0.001) than the control group. No difference was identified between the groups for calf endurance or time spent sitting, standing, walking on uneven ground, squatting, climbing or lifting. Multivariate logistic regression revealed that those with CPHP were more likely to be obese (BMI >= 30kg/m2) (OR 2.9, 95% CI 1.4 - 6.1, P = 0.004) and to have a pronated foot posture (FPI >= 4) (OR 3.7, 95% CI 1.6 - 8.7, P = 0.002).

Conclusions

Obesity and pronated foot posture are associated with CPHP and may be risk factors for the development of the condition. Decreased ankle dorsiflexion, calf endurance and occupational lower limb stress do not appear to play a role in CPHP.

BMC journals are open access, which means that anyone can download the full text for free.

Cheers,

Hylton

Related thread:
Plantar Fasciitis Discussions

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I know it is not fair or wise to generalize however, I am taking a step out here. With the obese having CPHP I look at the whole picture and often observe poor posture, weak and streched low abs, anterior tilt to pelvis, raised glut/cheeks/butt (your choice). Additionally genu recurvatum, internal femoral /tibial rotation, ankle plantarflexion, calcaneal eversion and more of a planus posture of the medial long arch.

I think the problems migrate form the pelvis down, and from the foot up. It would be interesting to study the variety of aches/maladies that accompany certain body types and see the postural relationships.

Motivating patients to make postural improvments that will have a variety of health improvments is a worthwhile challenge. Encouragment and hope are 2 of our greatest tools.

Sincerely

Freeman Churchill, Certified Pedorthist (Canada)
Halifax, Nova Scotia

The final PDF version of this paper is now available for free download at:

http://www.biomedcentral.com/1471-2474/8/41

Cheers,

Hylton

Hyton:

This was a nicely done paper and I enjoyed reading it. In reading through the paper and looking at the references section of the paper, I thought you might be interested to know about two very important scientific studies that discuss the close biomechanical relationship between Achilles tendon tensile force and plantar fascial tension. I use these references when I give my PowerPoint lecture on "The Ten Biomechanical Functions of the Plantar Fascia".

It is interesting to note that in the simulated cadaver walking study done by Erdemir et al with the Penn State dynamic gait simulator they found that plantar fascial tension was 0.96 times body weight. In other words, for 10 pounds of added body weight, they estimate that the plantar fascial tensile force increases by 9.6 pounds. It seems like this study would be a good reference to include on future papers on obesity and plantar heel pain.

Here are the PowerPoint slides from my lecture where I mention the studies:

Relationship Between Achilles Tendon Tension and Plantar Fascia Tension

-During the stance phase of walking gait, the tension in the Achilles tendon and tension in the plantar fascia are directly related to each other

-Erdemir et al found that the plantar fascia tensile force was directly proportional to the Achilles tendon tensile force in cadaver preparations in a dynamic gait simulator
Erdimir A, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA: Dynamic loading of the plantar aponeurosis in walking. JBJS, 86A:546-552, 2004.

-Carlson et al found that increasing the tension within the Achilles tendon caused an increase in plantar fascia tension at four different angles of MPJ dorsiflexion
Carlson RE, Fleming LL, Hutton WC: The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle. Foot Ankle Intl., 21:18-25, 2000.

Simulated cadaver walking study measured plantar fascial tension in 7 cadaver specimens using a 0.5 mm fiberoptic cable embedded with plantar fascia which was then calibrated in materials testing device
Erdimir A, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA: Dynamic loading of the plantar aponeurosis in walking. JBJS, 86A:546-552, 2004.

-Plantar fascial tension low at heel strike

-Plantar fascial tension gradually increased during midstance to peak at heel off at 0.96 times body weight

-Achilles tendon force was found to be effective predictor of plantar fascial tension (r=0.76)
Erdimir A, Hamel AJ, Fauth AR, Piazza SJ, Sharkey NA: Dynamic loading of the plantar aponeurosis in walking. JBJS, 86A:546-552, 2004.

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Sincerely,

Kevin

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Kevin A. Kirby, DPM
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Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

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