Clinical, Metabolic, and Radiological Risk Factors in Individuals With Plantar Heel Pain From a South Indian Population: A Cross-Sectional Observational Study

Background One of the most common conditions seen in an orthopedic outpatient clinic is plantar heel pain (PHP). Studies analyzing various risk factors and their association with the development of PHP have been performed primarily in the Caucasian population, and no study has noted any association between the magnitude of various risk factors and their correlation to the severity of PHP. Hence, we performed a prospective cross-sectional observational study in a select South Indian population presenting with PHP to a tertiary care center. Methods All adult patients presenting to the orthopedic OPD between July 2019 and July 2020 were screened for unilateral PHP and were included after meeting the eligibility criteria. Age, sex, body mass index (BMI), random blood sugar (RBS), uric acid, thyroid-stimulating hormone (TSH), and vitamin D3 were measured as demographic and metabolic parameters. Heel pad thickness, calcaneal spurs, and plantar fascial thickness were noted radiographically. Clinically, the wall-toe distance by weight bear lunge test of each foot was noted, and the severity was measured by the foot functional index (FFI). Results Among the 40 participants, the mean age was 44 (±10.9) years. The average BMI was 30.1 (27.02-32.95). No significant association was noted between the biochemical parameters and the occurrence of PHP. The plantar fascial thickness (PFT) and heel pad thickness (HPT) were thicker than the asymptomatic foot by 1.01 (0.60 - 1.30) mm and 0.79 (0.4-1.7) mm, respectively, which was statistically significant (p<0.001). The heel cord length was found to be reduced by 0.86 (0.6-1) cms, which was statistically significant (p<0.001). The average FFI score was 123.07 (±15.57), and the FFI score percentage in individuals was 53.5% (±6.77). None of the above risk factors showed any significant correlation to the intensity of clinical symptoms measured by FFI (p>0.05). Conclusion Participants had a high BMI and a higher percentage of females. There was a significant increase in PFT and HPT thickness and a significant reduction in gastrocnemius flexibility when compared to the asymptomatic foot. There was no significant association between various clinical, metabolic, and radiological risk factors and the intensity of plantar fasciitis measured by FFI.