Altered Central Pain Processing in Patients With Chronic Plantar Heel Pain: A Critically Appraised Topic

Abstract

Clinical Scenario: Plantar heel pain is a common condition frequently associated with persistent symptoms and functional limitations affecting both the athletic and nonathletic populations. Common interventions target impairments at the foot and ankle and local drivers of symptoms. If symptoms are predominantly perpetuated by alterations in central pain processing, addressing peripheral impairments alone may not be sufficient. Clinical Question: Do individuals with chronic plantar heel pain demonstrate signs potentially associated with altered central pain processing? Summary of Key Findings: After searching 6 electronic databases (PubMed, CINAHL, Scopus, SportDiscus, Cochrane, and PEDro) and filtering titles based on predetermined inclusion and exclusion criteria, 4 case-control studies were included. All studies scored highly on the Newcastle-Ottawa Scale for quality assessment. Using pressure pain thresholds, each study found decreased pressure pain hypersensitivity locally and at a remote site compared to control groups, suggesting the presence, to some extent, of altered nociceptive pain processing. Clinical Bottom Line: In the studies reviewed, reported results suggest a possible presence of centrally mediated symptoms in persons with plantar heel pain. However, despite findings from these studies, limitations in appropriate matching based on body mass index and measures used suggest additional investigation is warranted. Strength of Recommendation: According to the Oxford Centre for Evidence-Based Medicine, there is evidence level C to suggest chronic plantar heel pain is associated with alterations in central pain processing.

Spannung lösen – Evidenz-Update Plantarfasziitis

“…Im Gegenteil, bei zu häufiger Anwendung und/oder in zu hoher Dosierung besteht die Gefahr für eine Ruptur der Plantarfaszie und/oder einer Atrophie des kalkanealen Fettpolsters und weiterem Weichteilgewebe. Expert*innen empfehlen daher maximal zwei bis drei Injektionen innerhalb eines Jahres, und zwar nur dann, wenn durch die vorherige Injektion eine Symptomverbesserung erkennbar ist 1 , 2 , 4 , 7 , 15 .…”

“…Sowohl lokal als auch entfernt von der schmerzhaften Region kann eine Schmerzhypersensitivität auftreten. Zudem können psychosoziale Auffälligkeiten vorliegen, weshalb eine rein mechanische Therapie zur Veränderung der Biomechanik des Fußes in diesem Fall nicht ausreichend wäre 14 , 15 .…”

Analyzing the Interaction between Clinical, Neurophysiological and Psychological Outcomes Underlying Chronic Plantar Heel Pain: A Network Analysis Study

“…Previous studies have identified several factors involved in a complex matrix behind the potential etiopathogenesis of PHP [ 8 , 12 , 13 , 14 , 15 , 16 , 17 ]. Among these factors, foot-level findings (e.g., limited ankle joint dorsiflexion) [ 8 ], presence of active trigger points (TrPs) [ 12 ], reduced muscle strength and endurance [ 8 ], and psychological factors [ 16 , 17 ] could be involved in PHP in a complex matrix.…”

“…Among these factors, foot-level findings (e.g., limited ankle joint dorsiflexion) [ 8 ], presence of active trigger points (TrPs) [ 12 ], reduced muscle strength and endurance [ 8 ], and psychological factors [ 16 , 17 ] could be involved in PHP in a complex matrix. In addition, emerging evidence also supports the presence of altered central nociceptive pain processing in people with PHP [ 13 , 14 ] related to pressure pain hyperalgesia [ 13 , 15 ]. Supporting these associations, some previous studies have reported different interactions between clinical, psychological, and neurophysiological variables in people with PHP [ 12 , 13 , 15 , 18 ].…”

“…Therefore, the aims of this study were: (1) to apply a network connectivity analysis including pain-related, function, clinical, mechanosensitivity, psychological, and health-related variables in individuals with PHP; and (2) to illustrate the potential of a network analysis for understanding underlying features of PHP and improving options for developing more targeted and effective treatment strategies. Based on the available literature [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 22 , 23 , 24 , 25 ], we hypothesized that pain intensity, foot function, number of trigger points, mechanosensitivity, depression, and quality of life will show multiple associations in individuals with PHP.…”