title: Relationship between foot pain, muscle strength and size: a systematic review.
abstract: BACKGROUND
  Foot pain is common and disabling and thought to be associated with muscle weakness. Understanding the relationship between pain and weakness may help identify effective treatment targets.
  
  
  OBJECTIVE
  To conduct a systematic review to evaluate the relationship between foot pain and foot muscle weakness, or muscle size as a proxy for weakness.
  
  
  METHODS
  Electronic databases and reference lists were searched for all years to April 2015.
  
  
  METHODS
  Full-text articles were retrieved based on the question 'Does the study evaluate an association between foot pain and foot muscle weakness or size?'
  
  
  METHODS
  Two reviewers independently screened eligible studies, extracted data and completed a methodological rating.
  
  
  RESULTS
  Eight studies were identified evaluating the relationship between foot pain and foot muscle strength (n=6) or size (n=2). Four studies reported a significant relationship between pain and toe flexor force. One study reported a significant relationship between heel pain and reduced forefoot muscle size. One study reported an inconsistent association depending on measurement technique. One study reported no association between pain and hindfoot muscle size. One study reported no association between low to moderate pain and toe flexion force.
  
  
  CONCLUSIONS
  Due to data heterogeneity, no data were pooled for meta-analysis.
  
  
  CONCLUSIONS
  There is evidence of a significant association between foot pain and muscle weakness when foot pain is of high intensity and primarily measured by toe flexion force. However there is inconsistent evidence that lower intensity foot pain is associated with other measures of foot muscle weakness or size. Systematic Research Registry ID reviewregistry166.
authors.affiliation: Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, NSW, Australia. Electronic address: latey@tpg.com.au.
authors.forename: Penelope J
authors.initials: PJ
authors.lastname: Latey
authors.affiliation: Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, NSW, Australia; Paediatric Gait Analysis Service of New South Wales, The Children's Hospital at Westmead, Sydney, NSW, Australia. Electronic address: joshua.burns@sydney.edu.au.
authors.forename: Joshua
authors.initials: J
authors.lastname: Burns
authors.affiliation: Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, NSW, Australia. Electronic address: claire.hiller@sydney.edu.au.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Hiller
authors.affiliation: Arthritis and Musculoskeletal Research Group, Faculty of Health Sciences, The University of Sydney, NSW, Australia. Electronic address: jean.nightingale@sydney.edu.au.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Nightingale
mesh_terms: D005528:Foot / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement; D012720:Severity of Illness Index
keywords: Foot; Muscle size; Muscle strength; Pain; Skeletal muscle weakness; Systematic review