Heel pain in female patients with early knee osteoarthritis

Background Multiple lower limb joint involvement is one of the most common and debilitating musculoskeletal conditions, while the complaints from both heel and knee pain are considered the most frequent. For that reason, in this cross-sectional study, the association between heel pain (HP) and early knee osteoarthritis (EKOA) was investigated; the most painful site and side of HP, the prevalence, and risk factors for disabling HP in patients with EKOA were identified. Results Bilateral HP (56%) and posterior HP (54%) were found to be the most prevalent complaints, and 66% of patients reported the HP to be non-disabling. There was a very high positive statistically significant correlation between the Manchester Foot Pain Disability Index (MFPDI) and both the Health Assessment Questionnaire (HAQ) and the total Western Ontario and McMaster University Osteoarthritis (WOMAC) score (p <= 0.001), while there was a high negative statistically significant correlation between MFPDI and quadriceps angle of the most affected knee (p = 0.002). A higher total WOMAC score (OR 1.077, 95% CI 1.014 to 1.145) significantly increases the risk of developing disabling HP, while wearing 2-3-cm heels during the past month was found to be protective against the development of disabling HP (odds ratio < 1). Conclusion Disabling HP was present in a third of patients with EKOA and HP, and it was associated with flat shoe wear as well as a high total WOMAC score. Also, it had a statistically significant correlation with varus knee mal-alignment. Furthermore, decreased functional ability in the presence of HP was found to lead to significant disability. Moreover, a striking finding in this study was the longer mean duration of HP compared to the duration of knee symptoms.