title: Depression, Anxiety, and Stress in People With and Without Plantar Heel Pain.
abstract: BACKGROUND
  Depression, anxiety, and stress are prevalent in patients with musculoskeletal pain, but the impact of these emotional states has not been evaluated in people with plantar heel pain. The aim of this study was to evaluate the association between depression, anxiety, and stress with plantar heel pain.
  
  
  METHODS
  Forty-five participants with plantar heel pain were matched by sex and age (±2 years) to 45 participants without plantar heel pain. Levels of depression, anxiety, and stress were measured using the Depression, Anxiety and Stress Scale (short version) in participants with and without plantar heel pain. Logistic regression was conducted to determine if levels of depression, anxiety, or stress were associated with having plantar heel pain.
  
  
  RESULTS
  Univariate analysis indicated that participants with plantar heel pain had greater levels of depression (mean difference = 4.4, 95% CI 2.3 to 6.5), anxiety (mean difference = 2.6, 95% CI 0.9 to 4.3), and stress (mean difference = 4.8, 95% CI 1.9 to 7.8). After adjusting for age, sex, BMI, and education, for every 1 unit increase in depression, anxiety, or stress (in the DASS subscales), the odds ratios for having plantar heel pain were increased by 1.3 (95% CI 1.1 to 1.6), 1.3 (95% CI 1.1 to 1.5), and 1.2 (95% CI 1.1 to 1.3), respectively.
  
  
  CONCLUSIONS
  Symptoms of depression, anxiety, and stress were independently associated with plantar heel pain. Larger prospective studies are necessary to evaluate the temporal association between these emotional states and plantar heel pain.
  
  
  METHODS
  Level III, cross sectional, observational.
authors.affiliation: Department of Community and Allied Health, La Trobe Rural Health School, College of Science Health and Engineering, La Trobe University, Bendigo, Victoria, Australia m.cotchett@latrobe.edu.au.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cotchett
authors.affiliation: Discipline of Podiatry, School of Allied Health, College of Science Health and Engineering, La Trobe University, Bundoora, Melbourne, Victoria, Australia.
authors.forename: Shannon E
authors.initials: SE
authors.lastname: Munteanu
authors.affiliation: Discipline of Podiatry, School of Allied Health, College of Science Health and Engineering, La Trobe University, Bundoora, Melbourne, Victoria, Australia.
authors.forename: Karl B
authors.initials: KB
authors.lastname: Landorf
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000209:etiology*; D036981:Fasciitis, Plantar / Q000150:complications / Q000523:psychology*; D005260:Female; D006365:Heel; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000209:etiology / Q000523:psychology*; D013315:Stress, Psychological / Q000209:etiology*
keywords: anxiety; depression; heel; pain; stress disorders