The association of demographic, psychological, social and activity factors with foot health in people with plantar heel pain

Background: Plantar Heel Pain (PHP) can be a debilitating musculoskeletal condition from which only 50% recover within a year due to poor understanding of the mechanisms explaining severity and predicting outcomes specific to PHP. Objective: To explore associations between biopsychosocial variables and the severity of people with PHP. Secondly, to determine what combination of self-reported factors distinguishes people with PHP from other foot pain (OFP). Methods: We collected data from 235 participants, including 135 (%57) PHP (age 44 +/- 12 years, 66% female) and 99 OFP (%43) (age 38 +/- 11 years, 57% female) using 5 demographic, 13 biomedical, 8 psychological, 3 social and 8 activity-related factors. These were tested in linear and logistic regression models. Results: Quality of life (QoL) (beta = 0.35; p < 0.001), education (beta = -0.22; p = 0.003), gender (beta = -0.20; p = 0.007), morning pain duration (beta = -0.18; p = 0.01) and disease duration (beta = -0.15; p = 0.040) were significantly associated with severity of PHP. The second model, without QoL, showed that having sensitisation (beta = -0.18; p = 0.002) and a higher level of morning pain (beta = -0.20; p = 0.01) are associated with severity. The logistic regression results revealed that people with PHP tend to have a systemic disease (OR = 3.34; 1.53-7.76), express more kinesiophobia (OR = 1.02; 1.01-1.14), are less likely to have previous injuries (OR = 0.40; 0.19-0.81), worse morning pain (OR = 1.02; 1.01-1.03) and standing pain (OR = 2.60; 1.39-4.87) compared to people with OFP. Conclusions: People with PHP have higher associated levels of a range of psychological, social and activity related factors than people with OFP. The findings highlight the importance of considering psychosocial assessments alongside physical examination.