title: Musculoskeletal and activity-related factors associated with plantar heel pain.
abstract: BACKGROUND
  Despite the prevalence and impact of plantar heel pain, its etiology remains poorly understood, and there is no consensus regarding optimum management. The identification of musculoskeletal factors related to the presence of plantar heel pain could lead to the development of better targeted intervention strategies and potentially improve clinical outcomes. The aim of this study was to investigate relationships between a number of musculoskeletal and activity-related measures and plantar heel pain.
  
  
  METHODS
  In total, 202 people with plantar heel pain and 70 asymptomatic control participants were compared on a variety of musculoskeletal and activity-related measures, including body mass index (BMI), foot and ankle muscle strength, calf endurance, ankle and first metatarsophalangeal (MTP) joint range of motion, foot alignment, occupational standing time, exercise level, and generalized hypermobility. Following a comparison of groups for parity of age, analyses of covariance were performed to detect differences between the 2 groups for any of the variables measured.
  
  
  RESULTS
  The plantar heel pain group displayed a higher BMI, reduced ankle dorsiflexion range of motion, reduced ankle evertor and toe flexor strength, and an altered inversion/eversion strength ratio. There were no differences between groups for foot alignment, dorsiflexor or invertor strength, ankle inversion or eversion range of motion, first MTP joint extension range of motion, generalized hypermobility, occupational standing time, or exercise level.
  
  
  CONCLUSIONS
  Plantar heel pain is associated with higher BMI and reductions in some foot and ankle strength and flexibility measures. Although these factors could be either causal or consequential, they are all potentially modifiable and could be targeted in the management of plantar heel pain.
  
  
  METHODS
  Level III, comparative study.
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia justin.sullivan@sydney.edu.au.
authors.forename: Justin
authors.initials: J
authors.lastname: Sullivan
authors.affiliation: The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Joshua
authors.initials: J
authors.lastname: Burns
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Roger
authors.initials: R
authors.lastname: Adams
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Pappas
authors.affiliation: School of Science and Health, The University of Western Sydney, Sydney, New South Wales, Australia.
authors.forename: Jack
authors.initials: J
authors.lastname: Crosbie
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000502:physiology*; D015992:Body Mass Index; D005260:Female; D006365:Heel; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology; D008297:Male; D008683:Metatarsophalangeal Joint / Q000502:physiology; D008875:Middle Aged; D053580:Muscle Strength; D010146:Pain / Q000453:epidemiology*; D016059:Range of Motion, Articular; D012307:Risk Factors; D014034:Toes / Q000502:physiology
keywords: Strength; flexibility; foot alignment; obesity