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

Abstract

Plantar heel pain (PHP) is one of the most common foot pain conditions in adults. Several biological and psychological factors could be involved in chronic PHP in a complex matrix. However, reciprocal interactions between these factors are unknown. The aim of the present study was to use network analysis to quantify potential multivariate relationships between pain-related, function, clinical, mechanosensitivity, psychological, and health-related variables in individuals with PHP. Demographic (age, gender), pain-related (pain intensity), function, clinical (myofascial trigger points [TrPs]), mechanosensitivity (pressure pain thresholds), psychological (Beck Depression Inventory), and health-related variables (EQ-5D-5L) were collected in 81 PHP patients. Network connectivity analysis was conducted to quantify the adjusted correlations between the modeled variables and to assess their centrality indices. The connectivity network showed local associations between pain-related variables, foot function, and mechanosensitivity. Additionally, associations between quality of life, depression, and pain-related variables were found, while TrPs was associated with quality of life and mechanosensitivity. The node with the highest strength centrality was the worst pain intensity, while mechanosensitivity and worst pain intensity showed the highest closeness and betweenness centrality. This is the first study to apply network modeling to understand the connections between pain-related, function, clinical, mechanosensitivity, psychological, and health-related variables in PHP. The role of pain severity and mechanosensitivity is highlighted and supported by the network. Thus, this study reveals potential factors that could be the target in the management of PHP, promoting a comprehensive and effective therapeutic approach.

Long-term bilateral change in pain and sensitivity to high-frequency cutaneous electrical stimulation in healthy subjects depends on stimulus modality: a dermatomal examination

“…Health-related quality of life was assessed with the paper-based five-level version of EuroQol-5D (EQ-5D-5L), which assesses independent daily activities, mobility, self-care, perceived pain, and depression/anxiety impact domains. All responses, ranging from 1 (absence of problems) to 3 (severe problems), were converted into a single index number, which corresponds to the health state according to standardized values ranging from 0 (health state equivalent to death) to 1 (optimal health) ( 34 , 35 ). Additionally, this questionnaire also includes a visual analogue scale, where general health during the previous 24 h is rated on a scale from 0 (worse imaginable health) to 100 (best imaginable health) ( 35 ).…”

Impact of Plantar Fasciitis on Foot-Specific and Generic Health-Related Quality of Life in King Khalid University Hospital, Saudi Arabia

“…The pain caused by PF has been linked to changes in gait, deviations in stepping, and ultimately, internal rotation of the tibia and femur and alteration of overall foot function because walking is an integral part of daily routines [ 10 ]. Compared to healthy individuals, patients with PF have a much lower foot-specific and generic quality of life (QoL) and are more prone to experiencing symptoms of depression, anxiety, and stress [ 4 , 7 , 11 , 12 ]. Previous studies demonstrating the relationship between PF and QoL using the Foot Health Status Questionnaire (FHSQ) are scarce.…”

“…In communities, the prevalence of foot pain is estimated to be above 60%. Moreover, PF is considered the foremost source of foot pain in adults visiting an outpatient facility, with a prevalence of approximately 10% [4][5][6]. Its prevalence varies among community groups, with the highest prevalence in active runners and obese non-athlete patients; some sources indicate that up to 22% of runners may exhibit PF.…”

Effectiveness of Therapeutic Exercises Program on Pain and Functional Abilities among Patients with Plantar Fasciitis

“…Walking may help with the pain at first, but it can get worse during the day. Since walking is a necessary component of daily activities (Rhim et al, 2021;Ríos-León et al, 2022). PF results in significant functional disabilities, including discomfort and rigidity in the feet.…”