Background: Plantar fasciitis is one of the more common soft-tissue disorders of the foot, yet little is known about its etiology. The purpose of the present study was to use an epidemiological design to determine whether risk factors for plantar fasciitis could be identified. Specifically, we examined the risk factors of limited ankle dorsiflexion with the knee extended, obesity, and time spent weight-bearing.

Methods: We used a matched case-control design, with two controls for each patient. The matching criteria were age and gender. We identified fifty consecutive patients with unilateral plantar fasciitis who met the inclusion criteria. The data that were collected included height, weight, whether the subject spent the majority of the workday weight-bearing, and whether the subject was a jogger or runner. We used a reliable goniometric method to measure passive ankle dorsiflexion bilaterally. The main outcome measure was the adjusted odds ratio of plantar fasciitis associated with varying degrees of limitation of ankle dorsiflexion, different levels of body mass, and the subjects' reports on weight-bearing.

Results: Individuals with ≤0° of dorsiflexion had an odds ratio of 23.3 (95% confidence interval, 4.3 to 124.4) when compared with the referent group of individuals who had >10° of ankle dorsiflexion. Individuals who had a body-mass index of >30 kg/m 2 had an odds ratio of 5.6 (95% confidence interval, 1.9 to 16.6) when compared with the referent group of individuals who had a body-mass index of ≤25 kg/m 2. Individuals who reported that they spent the majority of their workday on their feet had an odds ratio of 3.6 (95% confidence interval, 1.3 to 10.1) when compared with the referent group of those who did not.

Conclusions: The risk of plantar fasciitis increases as the range of ankle dorsiflexion decreases. Individuals who spend the majority of their workday on their feet and those whose body-mass index is >30 kg/m 2 are also at increased risk for the development of plantar fasciitis. Reduced ankle dorsiflexion, obesity, and work-related weight-bearing appear to be independent risk factors for plantar fasciitis. Reduced ankle dorsiflexion appears to be the most important risk factor.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

Risk Factors for Plantar Fasciitis: A Matched Case-Control Study

Hallux valgus (HV) is a foot deformity commonly seen in medical practice, often accompanied by significant functional disability and foot pain. Despite frequent mention in a diverse body of literature, a precise estimate of the prevalence of HV is difficult to ascertain. The purpose of this systematic review was to investigate prevalence of HV in the overall population and evaluate the influence of age and gender. Electronic databases (Medline, Embase, and CINAHL) and reference lists of included papers were searched to June 2009 for papers on HV prevalence without language restriction. MeSH terms and keywords were used relating to HV or bunions, prevalence and various synonyms. Included studies were surveys reporting original data for prevalence of HV or bunions in healthy populations of any age group. Surveys reporting prevalence data grouped with other foot deformities and in specific disease groups (e.g. rheumatoid arthritis, diabetes) were excluded. Two independent investigators quality rated all included papers on the Epidemiological Appraisal Instrument. Data on raw prevalence, population studied and methodology were extracted. Prevalence proportions and the standard error were calculated, and meta-analysis was performed using a random effects model. A total of 78 papers reporting results of 76 surveys (total 496,957 participants) were included and grouped by study population for meta-analysis. Pooled prevalence estimates for HV were 23% in adults aged 18-65 years (CI: 16.3 to 29.6) and 35.7% in elderly people aged over 65 years (CI: 29.5 to 42.0). Prevalence increased with age and was higher in females [30% (CI: 22 to 38)] compared to males [13% (CI: 9 to 17)]. Potential sources of bias were sampling method, study quality and method of HV diagnosis. Notwithstanding the wide variation in estimates, it is evident that HV is prevalent; more so in females and with increasing age. Methodological quality issues need to be addressed in interpreting reports in the literature and in future research.

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Prevalence of hallux valgus in the general population: a systematic review and meta-analysis

Clinical practice. Plantar fasciitis.

Background:Plantar fasciitis is a relatively common disorder of the foot, yet little is known about its prevalence, what types of physicians see patients with the disorder, or how, on a national sc...

Volume of ambulatory care visits and patterns of care for patients diagnosed with plantar fasciitis: a national study of medical doctors.

Diagnosis of Bone and Joint Disorders

Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.

The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010

Foot and ankle specialists agree that flatfoot is a frequently encountered pathology in the adult population. For the purpose of this document, adult flatfoot is defined as a foot condition that persists or develops after skeletal maturity and is characterized by partial or complete loss (collapse) of the medial longitudinal arch. Adult flatfoot may present as an incidental finding or as a symptomatic condition with clinical consequences ranging from mild limitations to severe disability and pain causing major life impediments. Adult flatfoot encompasses a wide variety of pathologic etiologies that may include a benign process reflecting continuation of a congenital problem, trauma, or a condition associated with systemic pathology. The adult flatfoot is often a complex disorder with a diversity of symptoms and various degrees of deformity. Pathology and symptoms are caused by structural loading

Diagnosis and treatment of adult flatfoot.

Foot and ankle specialists acknowledge that flatfoot deformity is a frequently encountered pathology in the pediatric population. Flattening of the medial arch is a universal finding in flatfoot and it is common in both pediatric and adult populations. Pediatric flatfoot comprises a group of conditions occurring in infants, children, and adolescents (1) that are distinguished by anatomy and etiologic factors (2, 3–8). Flatfoot may exist as an isolated pathology or as part of a larger clinical entity (4). These entities include generalized ligamentous laxity, neurologic and muscular abnormalities, genetic conditions and syndromes, and collagen disorders. Pediatric flatfoot can be divided into flexible and rigid categories. Flexible flatfoot is characterized by a normal arch during nonweightbearing and a flattening of the arch on stance (Fig 1). Flexible flatfoot may be asymptomatic or

/pdf/diagnosis-and-treatment-of-pediatric-flatfoot-4e2svru213.pdf

Diagnosis and treatment of pediatric flatfoot.

Mechanical heel pain is one of the most frequent conditions presented to foot and ankle specialists. Plantar heel pain is responsible for the majority of mechanical heel pain cases. Plantar heel pain is defined as insertional heel pain of the plantar fascia with or without a heel spur (Fig. 1). The most common cause cited for plantar heel pain is biomechanical abnormalities that lead to pathologic stress to the plantar soft tissues (1–7). Localized nerve entrapment of the medial calcaneal or muscular branch off the lateral plantar nerve may be a contributing factor (8–11). Patients usually present with isolated plantar heel pain upon initiation of weightbearing, either in the morning upon arising or after sitting for a period of rest. The pain tends to decrease after a few minutes, then returns as the day proceeds and time on the feet increases. Associated significant findings may include high body mass index, tightness of the Achilles tendon, pain upon palpation of the inferior heel, and inappropriate shoe wear (12–14). Many patients will have attempted self-remedies before seeking medical advice. A careful history is important, including time(s) of day when pain occurs, current shoe wear, activity level both at work and at leisure, and history of trauma. An appropriate physical examination of the lower extremity includes range of motion of the ankle with special attention to decreased range of motion of dorsiflexion of the ankle, palpation of the inferior medial aspect of the heel, palpation of the medial aspect of the heel, the occurrence of bilateral symptoms, and angle and base of gait evaluation. Following physical evaluation, appropriate radiographs may be considered. Radiographic identification of a plantar heel spur indicates that the condition has been present for at least 6–12 months, whether having been symptomatic or not (Fig. 2). As a rule, the longer the duration of heel pain symptoms, the longer the period to final resolution of the condition. Initial treatment options may include nonsteroidal antiinflammatory drugs (NSAIDs), padding and strapping of the foot, and corticosteroid injections for appropriate patients. Patient-directed treatments seem to be as important in resolving symptoms. They include regular stretching of the calf muscles, avoidance of flat shoes and barefoot walking, use of cryotherapy directly to the affected part, over-the-counter arch supports and heel cushions, and limitation of extended physical activities. Patients usually have a clinical response within 6 weeks of initiation of treatment. If improvement is noted, the initial therapy program is continued until symptoms are resolved. If no improvement is noted, the patient should be referred to a podiatric foot and ankle surgeon. The second phase of treatment for the referred patient includes continuation of the initial treatment options with considerations for additional therapy: the use of custom orthotic devices, especially in the biomechanically malaligned patient, the use of night splints to

The diagnosis and treatment of heel pain

Radiographic angular measurements are commonly used in decision making in adult foot and ankle surgery. Unfortunately, there are few controlled studies available to substantiate comprehensive radiographic values in the adult foot. The purpose of this study was to determine the values of a variety of radiographic measurements of the adult foot in a standardized population. A total of 100 participants, 50 men and 50 women (200 feet), were evaluated. Individuals with a history of foot/ankle pain, previous foot/ankle operation or fracture, or a history of systemic disease were excluded from the study. Bilateral weight-bearing digital anterior-posterior and lateral radiographs were taken using a standardized method. In all, 21 measurements were made in the anterior-posterior view and 9 in the lateral view for a total of 6000 measurements. Some traditional measurement techniques of selected angles were found to be not consistently reproducible and alternative consistently reproducible techniques are described. Results are given in table form for maximum, minimum, average, median, and SD. Left and right foot maximum, minimum, and average differences were determined. Differences were also briefly explored for age and sex.

James L. Thomas

Papers

The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010

Diagnosis and treatment of adult flatfoot.

Diagnosis and treatment of pediatric flatfoot.

The diagnosis and treatment of heel pain

Radiographic values of the adult foot in a standardized population.