Identification of Clusters of Foot Pain Location in a Community Sample

Abstract

Five clusters of foot pain according to pain location were identified, all with distinct age, sex, and comorbidity profiles. These findings may assist in the identification of individuals at risk for developing foot pain and in the development of targeted preventive strategies and treatments.

Identification of patterns of foot and ankle pain in the community: Cross‐sectional findings from the clinical assessment study of the foot

“…We found a significant association between female sex and bilateral widespread foot and ankle pain class, but no association was seen between age and any of the classes. This is contrary to the results found by the North West Adelaide Health Study (Gill et al, 2017) which found forefoot, toe and nail pain occurring in older men, rearfoot and heel pain affected a high proportion of young individuals, and ball and arch pain was seen in younger females. The differences may be explained by the older population in our study where more individuals might have osteoarthritis and other chronic conditions than the North West Adelaide Health Study (Gill et al, 2017), where study participants ranged between 20 to over 75 years of age and were more likely to be affected by a broader range of foot conditions.…”

“…These differences could be explained by their population being younger than ours (≥18 years compared to ≥50 years), and their use of the Framingham foot manikin (Hannan et al, 2006) which required participants to have pain on ‘most days’, whilst our study used the Garrow foot manikin (Garrow et al, 2004) in which study participants were asked to shade the foot regions where they experienced pain in the past month. In the current study, the foot manikin was divided into 14 foot and ankle pain regions (seven regions on each foot), whereas the Adelaide study (Gill et al, 2017) divided foot pain into seven areas that were recorded across both feet. Therefore, our analysis provides the added advantage of being able to compare patient characteristics of unilateral foot pain symptoms to those with bilateral foot and ankle pain, in addition to evaluating patient characteristics of different foot pain regions (forefoot, midfoot and/or hindfoot).…”

“…The North West Adelaide Health Study, which was a community‐based study undertaken in Adelaide, Australia identified five foot pain clusters using hierarchical cluster analysis: one with predominantly ball and arch pain (27%); one with rearfoot pain (21%); another with heel pain (13%), and two with predominantly forefoot, toe and nail pain (28% and 11%; Gill et al, 2017). The aforementioned study had a similarly large sample size compared to our study, although there were higher proportions of individuals in our study who reported foot and ankle pain (30% vs. 17%; Gill et al, 2017). We similarly identified individuals who were classed as predominantly forefoot and hindfoot groups, and found that forefoot pain was the most common presentation.…”

“…Many epidemiological studies have reported the occurrence of foot pain as a single entity without considering the location within the foot and ankle complex. Studies which have investigated the location of foot pain reported that toes and forefoot were the most frequently affected, whereas the heel and hindfoot were less commonly involved (Thomas et al, 2011; Gill et al, 2017). Foot and ankle pain are associated with older age, female sex (Parsons, Breen & Foster, 2007), obesity (Dufour et al, 2017), footwear (Dufour et al, 2009), hallux valgus (Menz, Roddy, Thomas, & Croft, 2011), osteoarthritis (Kalichman & Hernández‐Molina, 2014) and other comorbidities such as rheumatoid arthritis and diabetes (Jaakkola & Mann, 2004; Menz, Barr, & Brown, 2011).…”

“…To date, there have been few studies that have investigated whether foot pain occurs in distinct regions and whether these regions have distinctive characteristics, suggesting different foot pain phenotypes. A recent population‐based study of individuals aged 18 years and over identified five foot pain phenotypic presentations using hierarchical cluster analysis where one had predominantly arch and ball pain, one rearfoot pain, one heel pain and two had predominantly forefoot, toe and nail pain; all had distinct age, sex and comorbidity profiles (Gill et al, 2017).…”