Despite delicate foot anatomy, your feet are able to take a pounding every day. Help them go the distance by identifying and correcting common foot problems, from corns and calluses to Athlete's foot and hammertoes.
The human foot has 42 muscles, 26 bones, 33 joints, and at least 50 ligaments and tendons made of strong fibrous tissues to keep all the moving parts together … plus 250,000 sweat glands. The foot is an evolutionary marvel, capable of handling hundreds of tons of force — your weight in motion — every day. The foot’s myriad parts, including the toes, heel, and ball, work in harmony to get you from one place to another. But the stress of carrying you around puts your feet at high risk of injury, more so than other parts of your body.
Many foot problems, including hammertoes, blisters, bunions, corns and calluses, heel spurs, claw and mallet toes, ingrown toenails, toenail fungus, and athlete’s foot, can develop due to neglect, ill-fitting shoes, and simple wear and tear. Your feet also can indicate if your body is under threat from a serious disease. Gout, for instance, will attack the foot joints first.
Foot Problems: Athlete's Foot
Caused by a fungus that likes warm, dark, and moist environments like the areas between the toes or on the bottoms of the feet, athlete’s foot can inflame the skin and cause a white, scaly rash with a red base. The athlete’s foot fungus also causes itching, burning, peeling, and sometimes a slight odor; the infection can also migrate to other body parts. You can avoid athlete’s foot (also called tinea pedis) by keeping your feet and toes clean and dry and by changing your shoes and socks regularly. Over-the-counter antifungal creams or sprays can be used to treat athlete’s foot. If these remedies do not work, however, you may need to see a podiatrist and ask about prescription-strength medication.
Foot Problems: Hammertoes
If your second, third, or fourth toe is crossed, bent in the middle of the toe joint, or just pointing at an odd angle, you may have what’s called a hammertoe. Hammertoes are often caused by ill-fitting shoes. Early on, wearing inserts or foot pads can help reposition your toe, but later it becomes fixed in the bent position. Pain then sets in and you may need surgery. Because hammertoes are bent, corns and calluses often form on them.
Foot Problems: Blisters
It’s this simple: If your shoes fit well, you won't have blisters. Soft pockets of raised skin filled with clear fluid, blisters are often painful and can make walking difficult. It’s important not to pick at them. Clean the area thoroughly, then sterilize a sewing needle and use it to open the part of the blister located nearest to the foot’s underside. Drain the blister, slather with antibiotic ointment, and cover with a bandage. Follow these same care steps if a blister breaks on its own.
Foot Problems: Bunions
A bunion is a crooked big-toe joint that sticks out at the base of the toe, forcing the big toe to turn in. Bunions have various causes, including congenital deformities, arthritis, trauma, and heredity. A bunion can be painful when confined in a shoe, and for many people, shoes that are too narrow in the toe may be to blame for the formation of bunions. Surgery is often recommended to treat bunions, after conservative treatment methods like over-the-counter pain relievers and footwear changes fail.
Foot Problems: Corns and Calluses
Corns and calluses form after repeated rubbing against a bony area of the foot or against a shoe. Corns appear on the tops and sides of your toes as well as between your toes. Calluses form on the bottom of the foot, especially under the heels or balls, and on the sides of toes. These compressed patches of dead skin cells can be hard and painful. To relieve the pain, you may want to try placing moleskin or padding around corns and calluses. Don’t try to cut or remove corns and calluses yourself — see a podiatrist for care.
Foot Problems: Plantar Fasciitis and Heel Spurs
It’s common for doctors to confuse heel spurs and plantar fasciitis when a patient comes to them with heel pain. Heel spurs are found in 70 percent of patients with plantar fasciitis, but these are two different conditions. Plantar fasciitis is a painful disorder in which the tissue that connects the ball of the foot to the heel – the fascia – becomes inflamed. Heel spurs are pieces of bone that grow at the heel bone base and often develop after you’ve had plantar fasciitis. The heel spurs themselves are not painful; it’s the inflammation and irritation caused by plantar fasciitis that can hurt. Heel spurs are often seen on X-rays of patients who do not have heel pain or plantar fasciitis.
Foot Problems: Claw Toes and Mallet Toes
Claw toe causes all toes except the big toe to curl downward at the middle of the joints and curl up at the joints where the toes and the foot meet. Calluses and corns may often form when someone has claw toes. While tight shoes can be blamed for claw toes, so can nerve damage to the feet (from diabetes or other conditions), which weakens foot muscles.
With mallet toes, the last joint of the toe bulges, and a painful corn will grow near the toenail. Generally the second toe is affected because it’s the longest. Injuries and arthritis are among the causes of mallet toe.
Foot Problems: Gout
Gout is a type of arthritis caused by a build-up of uric acid in joint tissues and joint fluid, which happens when the body is unable to keep uric acid levels in check. One of the first places for this build-up to occur is in the big toe joint — temperature-wise, the toes are the body’s coolest parts, and uric acid crystallizes with temperature changes. You’ll know a gout attack when it happens: The toe will get warm, red, and swollen and will be painful to even the slightest touch. The best way to prevent a gout attack is to learn to identify triggers, including high-purine foods, red meat, seafood, and alcohol. Applying ice, keeping hydrated, and staying bed may help, too.
Foot Problems: Ingrown Toenails
The right way to clip toenails — straight across — is key to foot health. If you don’t cut them properly, the corners or sides of the nail can dig into skin and become ingrown. Other causes of ingrown toenails include shoe pressure, a fungus infection, and even poor foot structure. When you cut your toenails, use larger toenail clippers and avoid cutting nails to short, as this can also cause ingrown toenails or infection.
Foot Problems: Toenail Fungus
Toenail fungus can give nails an unattractive, deformed appearance. It can alter the nail’s color and spread to other nails, even fingernails. Avoiding toenail fungus is difficult, especially if you walk through wet areas where people tend to go barefoot, such as locker rooms and swimming pools. People with chronic conditions, such as diabetes or immune deficiency diseases like HIV, are especially vulnerable and may want to keep their shoes on.
Showing posts with label heel spurs. Show all posts
Showing posts with label heel spurs. Show all posts
Sunday, December 18, 2011
Monday, October 31, 2011
The epidemiology of plantar fasciitis
Up to 10% of the population may present with heel pain over the course of their lives, which underscores the importance of practitioner familiarity with the diagnosis of plantar fasciitis and the associated risk factors, both intrinsic and extrinsic.
Plantar fasciitis is the most common cause of heel pain presenting to the outpatient clinic.1 Although thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the fascia, and may be more accurately termed plantar fasciosis.2 Plantar fasciitis is diagnosed on the basis of a history of pain on taking the first few steps in the morning, worsening pain with weightbearing, and pain and tenderness to palpation over the medial calcaneal tubercle.1-5 Patients may have decreased ankle dorsiflexion secondary to a tight Achilles tendon, which may lead to a compensatory pronation of the foot.4 Up to one third of patients with plantar fasciitis will present with bilateral symptoms.6
On examination, plantar fasciitis must be distinguished from other causes of plantar heel pain. For example, fat-pad atrophy occurs in elderly patients with pain in the central heel. These patients usually do not complain of pain upon first weight bearing in the morning.7 Tarsal tunnel syndrome is described as burning pain along the area of the posterior tibial nerve inferior to the medial malleolus. Finally, a calcaneal stress fracture is confirmed on examination with use of the squeeze test, tenderness on mediolateral compression of the calcaneus.7
Etiology
Plantar fasciitis is multifactorial in etiology. Intrinsic factors include age, excessive foot pronation, obesity and limited ankle dorsiflexion;1,6,8-12 extrinsic factors include occupational prolonged weightbearing, inappropriate shoe wear, and rapid increases in activity level.1,8,12 These factors combine to create a pathologic overload of the plantar fascia at the calcaneal insertion, causing microtears in the fascia that subsequently lead to perifascial edema and increasing heel pad thickness.2,13,14 As microtears within the fascia increase in size, they may coalesce to form a large symptomatic mass that causes the increase in heel pad thickness and can be identified during surgery. These changes in fascial thickening, particularly in the proximal portion of the plantar fascia extending to the calcaneal insertion, and edema of the adjacent fat pad and underlying soft tissues can typically be seen on magnetic resonance imaging studies.15 Inflexibility of the posterior structures of the foot, combined with weakness of the plantar flexors during pushoff, alters the normal biomechanics of the foot, creating an environment of decreased efficiency of force absorption and production.14 The decrease in force absorption contributes to the overload of the plantar fascia and increasing degenerative changes, which include collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia and matrix calcification.2 Plantar fasciitis can also be associated with various seronegative spondyloarthropathies, but in approximately 85% of cases there are no known systemic factors.1,15,16
In runners, plantar fasciitis is primarily believed to be an overuse injury combined with training errors, training surfaces, biomechanical alignment and muscle dysfunction and inflexibility. For example, excessive pronation of the foot leads to increased tension on the plantar fascia during the stance phase of running.18 In athletes who are just beginning their training programs, the lower limb muscles may have yet to develop the necessary strength and flexibility, and shock absorption can be negatively affected.17
Epidemiology
Plantar fasciitis is an important public health disorder as it is the most common cause of heel pain in the outpatient setting.1 Ten percent of people in the United States may present with heel pain over the course of their lives, with 83% of these patients being active working adults between the ages of 25 and 65 years old.3,4 Two large national data sets of ambulatory care data (excluding visits to podiatrists or federal, military, or Veterans Administrations facilities) from the Centers for Disease Control and Prevention’s National Center for Health Statistics found that plantar fasciitis accounts for an average of one million patient visits per year to medical doctors.4 Sixty-two percent of these visits were made to general medicine clinics, while 31% of patients were evaluated by orthopaedic or general surgeons. Additionally, a recent survey of members of the American Podiatric Medical Association revealed that plantar fasciitis/heel pain was the most prevalent condition being treated in podiatric clinics.19 Within the current literature, prevalence rates of plantar fasciitis among a population of runners have been shown to be between 4% and 22%.20,21
Rano et al11 found that the average age of the patients presenting to their facility with heel pain was almost 10 years higher than controls who presented for other reasons. Matheson et al’s retrospective review of 1407 patients from an outpatient sports medicine clinic, found that younger athletes had a lower prevalence of plantar fasciitis (2.5%) than older athletes (6.6%).17 The association of plantar fasciitis with increasing age is consistent with the histopathological findings of degenerative, rather than inflammatory, changes within the plantar fascia.2 These degenerative findings support the hypothesis that plantar fasciitis is secondary to repetitive microtrauma caused by prolonged weightbearing activities.13 The constant overload inhibits the normal repair process, resulting in collagen degeneration, which causes both structural changes and perifascial edema.15,22 These changes in turn lead to a thicker heel pad, which has been shown to be associated with pain in individuals with plantar fasciitis.12,13 Increasing heel pad thickness leads to a loss of heel pad elasticity; both of these factors are associated with increasing age and increasing BMI.23 The decrease in elasticity of the fascia seen with increasing age is associated with a decrease in shock absorbing capabilities,23 which may be a result of the degenerative fascia’s inability to resist normal tensile loads.22 It is this decrease in shock absorbing capability that is believed to cause the pain associated with plantar fasciitis.
The current literature is inconsistent regarding the association between sex and plantar fasciitis, with some studies showing an increased prevalence in men,18,24 while others show an increased prevalence in women.11,25 In a retrospective case-control study of running athletes, Taunton et al found a significant sex difference within their study population, as 54% of those affected were male and 46% were female. In contrast, a prospective study including athletes of varying skill levels by Rano et al11 found a higher percentage of women in the heel pain group than in the control group (66.1% compared with 42.6%; p = 0.015). There are no theories within the current literature hypothesizing the reason for a difference in the prevalence of plantar fasciitis between the two sexes, whether it be a function of different hormones or structural differences caused by genetic variations, as is suggested by the increased incidence of anterior cruciate ligament tears in women compared with men.
Increased body weight10 and increased body mass index (BMI)6,8,9,11 have been shown to be significant risk factors for plantar fasciitis, with a BMI of more than 30 kg/m2 having an odds ratio of 5.6 (95% confidence interval, 1.9 to 16.6; p < 0.01) compared with a BMI of less than 25 kg/m2. Frey and Zamora9 demonstrated a 1.4-fold increased probability of plantar fasciitis being diagnosed in an overweight or obese patient. Rome et al13 suggested that BMI is not related to plantar fasciitis pain in the athletic population, but other factors such as a low estrogen levels in female athletes leading to a reduction in the elasticity of collagen may predispose these patients to plantar fasciitis. Riddle et al8 hypothesized that reduced ankle dorsiflexion is the most important risk factor for the development of plantar fasciitis, as the greater the limitation in ankle dorsiflexion, the greater the amount of compensatory foot pronation and therefore the higher level of loading on the plantar fascia. A study by Scott et al26 found that older patients (mean age 80.2) had reduced ankle range of motion compared with younger patients (mean age 20.9). An exponential relationship between decreasing ankle dorsiflexion and the risk of developing plantar fasciitis has been found, with individuals who have 0o of dorsiflexion or less having an odds ratio of 23.3 (95% confidence interval, 4.3 to 124.4).8 Foot pronation alone, as measured by the Foot Posture Index,27 has also been shown to be significantly greater in patients with chronic plantar heel pain.6
In addition to these intrinsic factors, various extrinsic factors have been related to the development of plantar fasciitis. Several studies have shown an association between work-related prolonged weightbearing and plantar fasciitis.8,24,28,29 In their case series, Lapidus and Guidotti’s patient population included a predominance of occupations that necessitate continual standing or walking, such as waiters, maids, and kitchen workers. In addition, each heel strike during running causes compression of the heel pad up to 200% of body weight.30 Therefore, in individuals who may not have adequate muscle strength or flexibility, and therefore have decreased shock-absorbing capabilities, the initiation of a new training program can exacerbate overloading of the plantar fascia.30 Increases in tensile loading, seen with new increases in running intensity or frequency and changes in general footwear have been associated with overloads of the plantar fascia leading to microtears.14 In particular, firm footwear may exacerbate the developing plantar fasciitis in these patients.28 Additionally, plantar fasciitis has also been associated with young individuals engaging in sports involving jumping.15
In order to determine epidemiological risk factors and the current incidence of plantar fasciitis within a population of individuals with a high level of physical activity, Scher et al31 accessed a database from the United States Armed Forces. The United States Armed Forces represent a physically active population of ethnically diverse male and female service members with generally high occupational demands. They participate in daily, organized physical fitness training programs and are subject to the physical rigors of repeated combat deployments. The inability to meet these physical requirements secondary to a medical condition, such as plantar fasciitis, may necessitate a medical discharge from military service. In this population, the authors chose to look at various epidemiological risk factors in order to identify groups at high risk of developing plantar fasciitis. The authors used the Defense Medical Epidemiology Database, which compiles ICD-9 coding information for every patient encounter in a military treatment facility.
The overall incidence of plantar fasciitis in the military population was 10.55 per 1,000 person-years. Female sex; black race; junior enlisted, senior enlisted and senior officer rank groups; military service in the Army or Marines; and age greater than 24 years old were found to be significant risk factors for the development of incident plantar fasciitis when compared to male sex, white race, junior officers rank, service in the Air Force, and age 20 to 24, respectively. Female subjects, when compared with male subjects, had a significantly increased incidence rate ratio for plantar fasciitis of 1.95 (95% CI 1.93-1.98). These findings are based on incidence rates, but tend to correlate with prevalence data seen within the existing literature.
Summary
As 10% of the population may present with heel pain over the course of their lives, a familiarity with the diagnosis and risk factors for plantar fasciitis is important for both primary care and specialty practitioners. Obesity, decreased ankle dorsiflexion, a pronated foot, and increasing age are important intrinsic risk factors that have been associated with plantar fasciitis. The extrinsic risk factors include prolonged occupational weightbearing, increasing activity levels, and inappropriate shoe wear. With the knowledge of specific risk factors for the development of plantar fasciitis, the next step is to develop preventive measures, such as plantar-specific stretching programs and changes in footwear, to decrease the current incidence of this disorder.
by Capt. Danielle L. Scher, MD; Lt. Col. Philip J. Belmont, Jr., MD; and Maj. Brett D. Owens, MD
Plantar fasciitis is the most common cause of heel pain presenting to the outpatient clinic.1 Although thought of as an inflammatory process, plantar fasciitis is a disorder of degenerative changes in the fascia, and may be more accurately termed plantar fasciosis.2 Plantar fasciitis is diagnosed on the basis of a history of pain on taking the first few steps in the morning, worsening pain with weightbearing, and pain and tenderness to palpation over the medial calcaneal tubercle.1-5 Patients may have decreased ankle dorsiflexion secondary to a tight Achilles tendon, which may lead to a compensatory pronation of the foot.4 Up to one third of patients with plantar fasciitis will present with bilateral symptoms.6
On examination, plantar fasciitis must be distinguished from other causes of plantar heel pain. For example, fat-pad atrophy occurs in elderly patients with pain in the central heel. These patients usually do not complain of pain upon first weight bearing in the morning.7 Tarsal tunnel syndrome is described as burning pain along the area of the posterior tibial nerve inferior to the medial malleolus. Finally, a calcaneal stress fracture is confirmed on examination with use of the squeeze test, tenderness on mediolateral compression of the calcaneus.7
Etiology
Plantar fasciitis is multifactorial in etiology. Intrinsic factors include age, excessive foot pronation, obesity and limited ankle dorsiflexion;1,6,8-12 extrinsic factors include occupational prolonged weightbearing, inappropriate shoe wear, and rapid increases in activity level.1,8,12 These factors combine to create a pathologic overload of the plantar fascia at the calcaneal insertion, causing microtears in the fascia that subsequently lead to perifascial edema and increasing heel pad thickness.2,13,14 As microtears within the fascia increase in size, they may coalesce to form a large symptomatic mass that causes the increase in heel pad thickness and can be identified during surgery. These changes in fascial thickening, particularly in the proximal portion of the plantar fascia extending to the calcaneal insertion, and edema of the adjacent fat pad and underlying soft tissues can typically be seen on magnetic resonance imaging studies.15 Inflexibility of the posterior structures of the foot, combined with weakness of the plantar flexors during pushoff, alters the normal biomechanics of the foot, creating an environment of decreased efficiency of force absorption and production.14 The decrease in force absorption contributes to the overload of the plantar fascia and increasing degenerative changes, which include collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia and matrix calcification.2 Plantar fasciitis can also be associated with various seronegative spondyloarthropathies, but in approximately 85% of cases there are no known systemic factors.1,15,16
In runners, plantar fasciitis is primarily believed to be an overuse injury combined with training errors, training surfaces, biomechanical alignment and muscle dysfunction and inflexibility. For example, excessive pronation of the foot leads to increased tension on the plantar fascia during the stance phase of running.18 In athletes who are just beginning their training programs, the lower limb muscles may have yet to develop the necessary strength and flexibility, and shock absorption can be negatively affected.17
Epidemiology
Plantar fasciitis is an important public health disorder as it is the most common cause of heel pain in the outpatient setting.1 Ten percent of people in the United States may present with heel pain over the course of their lives, with 83% of these patients being active working adults between the ages of 25 and 65 years old.3,4 Two large national data sets of ambulatory care data (excluding visits to podiatrists or federal, military, or Veterans Administrations facilities) from the Centers for Disease Control and Prevention’s National Center for Health Statistics found that plantar fasciitis accounts for an average of one million patient visits per year to medical doctors.4 Sixty-two percent of these visits were made to general medicine clinics, while 31% of patients were evaluated by orthopaedic or general surgeons. Additionally, a recent survey of members of the American Podiatric Medical Association revealed that plantar fasciitis/heel pain was the most prevalent condition being treated in podiatric clinics.19 Within the current literature, prevalence rates of plantar fasciitis among a population of runners have been shown to be between 4% and 22%.20,21
Rano et al11 found that the average age of the patients presenting to their facility with heel pain was almost 10 years higher than controls who presented for other reasons. Matheson et al’s retrospective review of 1407 patients from an outpatient sports medicine clinic, found that younger athletes had a lower prevalence of plantar fasciitis (2.5%) than older athletes (6.6%).17 The association of plantar fasciitis with increasing age is consistent with the histopathological findings of degenerative, rather than inflammatory, changes within the plantar fascia.2 These degenerative findings support the hypothesis that plantar fasciitis is secondary to repetitive microtrauma caused by prolonged weightbearing activities.13 The constant overload inhibits the normal repair process, resulting in collagen degeneration, which causes both structural changes and perifascial edema.15,22 These changes in turn lead to a thicker heel pad, which has been shown to be associated with pain in individuals with plantar fasciitis.12,13 Increasing heel pad thickness leads to a loss of heel pad elasticity; both of these factors are associated with increasing age and increasing BMI.23 The decrease in elasticity of the fascia seen with increasing age is associated with a decrease in shock absorbing capabilities,23 which may be a result of the degenerative fascia’s inability to resist normal tensile loads.22 It is this decrease in shock absorbing capability that is believed to cause the pain associated with plantar fasciitis.
The current literature is inconsistent regarding the association between sex and plantar fasciitis, with some studies showing an increased prevalence in men,18,24 while others show an increased prevalence in women.11,25 In a retrospective case-control study of running athletes, Taunton et al found a significant sex difference within their study population, as 54% of those affected were male and 46% were female. In contrast, a prospective study including athletes of varying skill levels by Rano et al11 found a higher percentage of women in the heel pain group than in the control group (66.1% compared with 42.6%; p = 0.015). There are no theories within the current literature hypothesizing the reason for a difference in the prevalence of plantar fasciitis between the two sexes, whether it be a function of different hormones or structural differences caused by genetic variations, as is suggested by the increased incidence of anterior cruciate ligament tears in women compared with men.
Increased body weight10 and increased body mass index (BMI)6,8,9,11 have been shown to be significant risk factors for plantar fasciitis, with a BMI of more than 30 kg/m2 having an odds ratio of 5.6 (95% confidence interval, 1.9 to 16.6; p < 0.01) compared with a BMI of less than 25 kg/m2. Frey and Zamora9 demonstrated a 1.4-fold increased probability of plantar fasciitis being diagnosed in an overweight or obese patient. Rome et al13 suggested that BMI is not related to plantar fasciitis pain in the athletic population, but other factors such as a low estrogen levels in female athletes leading to a reduction in the elasticity of collagen may predispose these patients to plantar fasciitis. Riddle et al8 hypothesized that reduced ankle dorsiflexion is the most important risk factor for the development of plantar fasciitis, as the greater the limitation in ankle dorsiflexion, the greater the amount of compensatory foot pronation and therefore the higher level of loading on the plantar fascia. A study by Scott et al26 found that older patients (mean age 80.2) had reduced ankle range of motion compared with younger patients (mean age 20.9). An exponential relationship between decreasing ankle dorsiflexion and the risk of developing plantar fasciitis has been found, with individuals who have 0o of dorsiflexion or less having an odds ratio of 23.3 (95% confidence interval, 4.3 to 124.4).8 Foot pronation alone, as measured by the Foot Posture Index,27 has also been shown to be significantly greater in patients with chronic plantar heel pain.6
In addition to these intrinsic factors, various extrinsic factors have been related to the development of plantar fasciitis. Several studies have shown an association between work-related prolonged weightbearing and plantar fasciitis.8,24,28,29 In their case series, Lapidus and Guidotti’s patient population included a predominance of occupations that necessitate continual standing or walking, such as waiters, maids, and kitchen workers. In addition, each heel strike during running causes compression of the heel pad up to 200% of body weight.30 Therefore, in individuals who may not have adequate muscle strength or flexibility, and therefore have decreased shock-absorbing capabilities, the initiation of a new training program can exacerbate overloading of the plantar fascia.30 Increases in tensile loading, seen with new increases in running intensity or frequency and changes in general footwear have been associated with overloads of the plantar fascia leading to microtears.14 In particular, firm footwear may exacerbate the developing plantar fasciitis in these patients.28 Additionally, plantar fasciitis has also been associated with young individuals engaging in sports involving jumping.15
In order to determine epidemiological risk factors and the current incidence of plantar fasciitis within a population of individuals with a high level of physical activity, Scher et al31 accessed a database from the United States Armed Forces. The United States Armed Forces represent a physically active population of ethnically diverse male and female service members with generally high occupational demands. They participate in daily, organized physical fitness training programs and are subject to the physical rigors of repeated combat deployments. The inability to meet these physical requirements secondary to a medical condition, such as plantar fasciitis, may necessitate a medical discharge from military service. In this population, the authors chose to look at various epidemiological risk factors in order to identify groups at high risk of developing plantar fasciitis. The authors used the Defense Medical Epidemiology Database, which compiles ICD-9 coding information for every patient encounter in a military treatment facility.
The overall incidence of plantar fasciitis in the military population was 10.55 per 1,000 person-years. Female sex; black race; junior enlisted, senior enlisted and senior officer rank groups; military service in the Army or Marines; and age greater than 24 years old were found to be significant risk factors for the development of incident plantar fasciitis when compared to male sex, white race, junior officers rank, service in the Air Force, and age 20 to 24, respectively. Female subjects, when compared with male subjects, had a significantly increased incidence rate ratio for plantar fasciitis of 1.95 (95% CI 1.93-1.98). These findings are based on incidence rates, but tend to correlate with prevalence data seen within the existing literature.
Summary
As 10% of the population may present with heel pain over the course of their lives, a familiarity with the diagnosis and risk factors for plantar fasciitis is important for both primary care and specialty practitioners. Obesity, decreased ankle dorsiflexion, a pronated foot, and increasing age are important intrinsic risk factors that have been associated with plantar fasciitis. The extrinsic risk factors include prolonged occupational weightbearing, increasing activity levels, and inappropriate shoe wear. With the knowledge of specific risk factors for the development of plantar fasciitis, the next step is to develop preventive measures, such as plantar-specific stretching programs and changes in footwear, to decrease the current incidence of this disorder.
by Capt. Danielle L. Scher, MD; Lt. Col. Philip J. Belmont, Jr., MD; and Maj. Brett D. Owens, MD
Subscribe to:
Posts (Atom)
