title: Pain Threshold Tests in Patients With Heel Pain Syndrome.
abstract: BACKGROUND
  Pressure pain threshold (PPT) is a useful tool for evaluating mechanical sensitivity in patients suffering from various musculoskeletal disorders. However, no previous study has investigated PPT in the heel of patients experiencing plantar heel pain syndrome (PHPS). The aim of this study was to compare PPT levels and topographic presentation of sensitivity in the heel of patients with PHPS and in healthy controls.
  
  
  METHODS
  The reliability of PPT testing in patients with PHPS was assessed for intra- and interrater recordings. The PPT levels of 40 feet in each group were then assessed on 5 predetermined sites in the heel using a standardized measurement protocol. Patient functional status (FS) as measured by the Foot & Ankle Computerized Adaptive Test was employed as an external reference.
  
  
  RESULTS
  Multivariate analysis of covariance revealed no group differences for PPTs at all sites (P = .406). Age (P = .099) or BMI (P = .510) did not affect PPT values, although there was an effect on gender (P = .006). The analysis revealed significant differences between sites (P < .001) demonstrating a diverse topographic distribution. In the PHPS group, PPT levels at the anterior/medial, posterior/medial and central sites were significantly lower than at the posterior/lateral and anterior/lateral sites (P < .05). For the control group, PPT levels at the anterior/medial site were significantly lower than all other sites (P < .001).
  
  
  CONCLUSIONS
  No significant differences were found between PPT of the PHPS patients and controls, therefore, PPT cannot be recommended as an assessment tool for these patients. The topographic distribution indicated low PPT levels at the anterior/medial area of the heel in patients with PHPS and controls.
  
  
  METHODS
  Level II, comparative study.
authors.affiliation: Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel Physical Therapy Service, Maccabi Healthcare Services, Shpeigel 3, Petach Tikva, Petach Tikva, Israel saban_b@mac.org.il.
authors.forename: Bernice
authors.initials: B
authors.lastname: Saban
authors.affiliation: Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Masharawi
mesh_terms: D005534:Foot Diseases / Q000503:physiopathology*; D006365:Heel / Q000503:physiopathology*; D006801:Humans; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold / Q000502:physiology*; D011312:Pressure; D015203:Reproducibility of Results; D013577:Syndrome
keywords: heel pain; plantar fasciitis; pressure pain threshold; topographic distribution