Epidemiology of Posterior Heel Pain in the General Population: Cross‐Sectional Findings From the Clinical Assessment Study of the Foot

Abstract

ObjectiveTo identify the population prevalence of posterior heel pain (HP), related disability, and associated factors.MethodsA total of 9,334 adults ages ≥50 years were mailed a questionnaire. Participants reporting foot pain in the last month shaded the foot pain location on a manikin. The Manchester Foot Pain and Disability Index assessed disabling foot pain. Population prevalence of any, bilateral, and disabling posterior HP was estimated using weighted logistic regression accounting for nonresponse. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated between posterior HP and age, sex, neighborhood deprivation, occupational class (professional, intermediate, and manual), body mass index (BMI, kg/m2), physical activity, heel height, and diabetes mellitus.ResultsA total of 5,109 questionnaires were received (adjusted response 56%). Six hundred seventy‐five respondents (13%) reported posterior HP, of whom 382 had bilateral symptoms. A total of 398 (8%) reported disabling posterior HP. Posterior HP in either foot was associated with increasing BMI (25.0–29.9 [OR 1.58], 30.0–34.9 [OR 2.13], and ≥35.0 [OR 4.09]) and with manual occupations (OR 1.96, 95% CI 1.47–2.62). Bilateral posterior HP was associated with increasing BMI (25.0–29.9 [OR 1.79], 30.0–34.9 [OR 2.43], and ≥35.0 [OR 5.79]), diabetes mellitus (OR 1.48, 95% CI 1.07–2.05), and manual occupations (OR 2.21, 95% CI 1.48–3.30). Disabling posterior HP was associated with increasing BMI (25.0–29.9 [OR 1.44], 30.0–34.9 [OR 2.50], and ≥35.0 [OR 4.69]), age (≥75 years OR 1.41, 95% CI 1.01–1.96), manual occupations (OR 1.97, 95% CI 1.35–2.88), and diabetes mellitus (OR 1.56, 95% CI 1.04–1.95). High physical activity was negatively associated with posterior HP in either heel (OR 0.43, 95% CI 0.33–0.56), bilateral posterior HP (OR 0.35, 95% CI 0.25–0.49), and disabling posterior HP (OR 0.33, 95% CI 0.23–0.46).ConclusionPosterior HP is prevalent and associated with obesity, manual occupations, and physical inactivity. Prospective studies should assess the roles of obesity in causation and weight loss in treatment.

Identification of Clusters of Foot Pain Location in a Community Sample

“…Cluster 1 (forefoot, toe, and nail) had the highest proportion of older people, those with arthritis, and those with diabetes mellitus. Age , arthritis , and diabetes mellitus have all been shown to be associated with foot pain, and the age‐related increased prevalence of foot deformities, such as hallux valgus, may also partly explain this pattern . While Chatterton et al found an association between posterior heel pain and diabetes mellitus, which may be due to Achilles tendon involvement, the current study found an association between forefoot pain and diabetes mellitus.…”

“…Age , arthritis , and diabetes mellitus have all been shown to be associated with foot pain, and the age‐related increased prevalence of foot deformities, such as hallux valgus, may also partly explain this pattern . While Chatterton et al found an association between posterior heel pain and diabetes mellitus, which may be due to Achilles tendon involvement, the current study found an association between forefoot pain and diabetes mellitus. This group also had a higher proportion of participants classified as obese, thus indicating that factors other than the response of tendons to the presence of diabetes mellitus may be a factor in the location of foot pain.…”

“…Factors such as diabetes mellitus , body mass index (BMI) , depression , physical activity , arthritis , age , and sex have all been shown to be associated with foot pain in cross‐sectional studies; however, it is not known whether these factors contribute to a specific foot pain phenotype. Both smoking and alcohol consumption may also have an impact on foot pain.…”

High Prevalence of Achilles Tendon Enthesopathic Changes in Patients with Type 2 Diabetes Without Peripheral Neuropathy

“…25 On the other hand, obesity and diabetes have been identified as risk factors for posterior heel pain. 26 The risk of several rheumatic conditions is increased in patients with diabetes. 5 Tendons and ligaments, in particular, have been demonstrated to be a major target of diabetes-associated musculoskeletal damage, for example, in diffuse idiopathic skeletal hyperostosis.…”

An Anatomical Basis for the Myofascial Trigger Points of the Abductor Hallucis Muscle

“…e areas are concentrated in the region of the medial hindfoot and referred pain spreads throughout the medial aspect of the foot ( Figure 1). e main epidemiological studies found that 17.4% had foot pains [19], most of them in the region of the medial hindfoot [20,21]. e authors have sought anatomical approaches to support the theory of myofascial pain syndromes (MPSs) citing the presence of muscle trigger points and providing a pathophysiological explanation [6,18].…”