title: Epidemiology of posterior heel pain in the general population: cross-sectional findings from the clinical assessment study of the foot.
abstract: OBJECTIVE
  To identify the population prevalence of posterior heel pain (HP), related disability, and associated factors.
  
  
  METHODS
  A 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/m(2) ), physical activity, heel height, and diabetes mellitus.
  
  
  RESULTS
  A 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).
  
  
  CONCLUSIONS
  Posterior 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.
authors.affiliation: Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Chatterton
authors.affiliation: Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Muller
authors.affiliation: Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Roddy
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys / Q000379:methods; D006365:Heel / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis* / Q000453:epidemiology*; D010147:Pain Measurement / Q000379:methods*; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors