A prospective study of the muscle strength and reaction time of the quadriceps, hamstring, and gastrocnemius muscles in patients with plantar fasciitis

Leg length discrepancy is not a risk factor for plantar fasciitis

PURPOSE

Plantar fasciitis (PF) is a main source of heel pain, and only about one-third of patients have bilateral symptomatic involvement, although age, body mass index (BMI), and physical activities are known risk factors. The high prevalence of unilateral involvement is poorly understood. We aimed to assess the potential association between PF and the leg length discrepancy (LLD) in unilateral PF.

METHODS

A transversal case-control study was conducted from January 2019 to December 2020, including 120 participants allocated to two groups matched by BMI and sex: cases (with a diagnosis of PF; 50 ± 13 years) and control (without foot pain; 40 ± 15 years). For both groups, a difference greater than 0.64 cm in the scanometry determined the criteria for the presence of LLD.

RESULTS

The multivariate logistic regression analysis showed an independent association of PF only with age (p < 0.001), and no association with LLD. We did not observe differences in the mean discrepancy (1.37 ± 0.83 cm in the PF group in comparison with 1.13 ± 0.37 cm in the control group, [p > 0.05]) or in the prevalence of LLD between groups (48% [n = 29] in the PF group compared with 42% [n = 25] in the control group, [p > 0.05]). In the PF group, 80% of the participants reported unilateral pain. We observed a higher prevalence of pain in the shorter limb (p < 0.05).

CONCLUSION

Age was the only factor associated with the diagnosis of PF when groups were matched by sex and BMI. LLD was not an independent factor associated with the diagnosis of PF. However, when PF is unilateral, the shorter limb is more affected with 70% of prevalence.

LEVEL OF EVIDENCE

Level III, case-control.

Muscle strength and foot pressure vary depending on the type of foot pain

This study compared muscle strength and foot pressure among patients with metatarsalgia, patients with plantar fasciitis, and healthy controls. A total of 31 patients with foot pain (14 metatarsalgia and 17 plantar fasciitis) and 29 healthy controls participated in the study. The strengths of the plantar flexor and hip muscles were measured using isokinetic and handheld dynamometers, respectively. Foot pressure parameters, including the pressure-time integral (PTI) and foot arch index (AI), were assessed using pedobarography. Compared with the healthy control group, plantar flexor strength was significantly reduced in the affected feet of the metatarsalgia and plantar fasciitis groups (F = 0.083, all p < 0.001); however, hip strength was significantly decreased only in the affected feet of the metatarsalgia group (F = 20.900, p < 0.001). Plantar flexor (p < 0.001) and hip (p = 0.004) strength were significantly lower in the metatarsalgia group than in the plantar fasciitis group. The PTI was lower in the forefeet of the affected feet in the metatarsalgia (p < 0.001) and plantar fasciitis (p = 0.004) groups. Foot AI (p < 0.001) was significantly reduced only in the metatarsalgia group. These results suggest the need to consider the evaluation of muscle strength and foot pressure in both feet for the diagnosis and treatment of foot pain.

The Incidence of Gastrocnemius Tightness Among Clinic Staff in a District Hospital's Clinic in the State of Kedah, Malaysia

Aim Musculus Gastrocnemius Tightness (MGT) has been linked with common foot and ankle pathologies. These symptoms sometimes are not severe enough for the patient to seek treatment. This study aims to determine the incidence rate of MGT among our clinical personnel and if there is any association between foot and ankle symptoms with MGT. Materials and methods This observational cross-sectional study involves clinical personnel from our Specialist Clinics at Hospital Kulim, Malaysia. We interviewed and assessed 85 volunteers of which, we measured the passive ankle dorsiflexion of the volunteers (the Silfverskiöld) test, to diagnose MGT. We then used the Manchester Oxford Foot Questionnaire (MOxFQ) is used to determine the functional outcome of our volunteers. Results Out of a total of 85 volunteers assessed, 12 (14%) volunteers were found to have gastrocnemius tightness. Among this cohort, 11 were symptomatic. Out of the 73 who did not have MGT, there were three symptomatic volunteers. There was a significant association between volunteers with foot and ankle symptoms with gastrocnemius tightness, compared to those without. There was a significant difference in the relationship between the MOxFQ scores in all components (walking, pain, and social) when comparing those with and those without MGT. Conclusion We conclude that there is a significant association between foot and ankle symptoms and MGT in our clinic sample population. However, these symptoms were not severe enough for these symptomatic volunteers to seek treatment. We should consider screening symptomatic staff and implementing stretching protocols.

Lower Extremity Muscle Performance and Foot Pressure in Patients Who Have Plantar Fasciitis with and without Flat Foot Posture

Abnormal foot posture and poor muscle performance are potential causes of plantar fasciitis (PF). However, no study has compared the differences between lower extremity muscle performance and foot pressure in patients who have PF with and without abnormal foot postures. This study aimed to compare the differences in lower extremity muscle performance, such as in the hip, quadriceps, hamstring, and plantar flexor, and foot pressure in patients who have PF with and without flat foot postures. Seventy patients with plantar heel pain were enrolled (37 flat feet and 33 without flat feet). The hip muscle strength was measured using a handheld digital dynamometer. The strength and reaction time of the quadriceps, hamstring, and plantar flexor muscles were evaluated using an isokinetic device. Foot pressure parameters were assessed using pedobarography. The strength of the plantar flexor muscles was significantly lower (p = 0.008), while the reaction time of the plantar flexor muscles was significantly faster (p = 0.007) for the involved feet of PF patients with flat feet than in those without flat feet. This study confirmed the differences in muscle performance between patients who have PF with different foot postures. Therefore, clinicians and therapists should plan treatment considering the differences in these characteristics for the management of these patients.

Is There a Relationship Between Foot Reaction Time and Ankle Frontal Plane Torque in Female Soccer Athletes? A Pilot Study

The purpose of this study was to determine if a relationship existed between foot reaction time and ankle frontal plane peak torque in female soccer athletes. A one-shot case study design was selected for this investigation. Seventeen female college athletes volunteered to participate. Right and left foot reaction time measurements were assessed using 3×4 switch mats interfaced with a precise timing counter. Participants stood in front of the mat with eyes closed and responded to the auditory stimulus by touching the mat as fast as possible with their foot. Two trials were conducted per foot, and the best time was used to determine the reaction time score per foot. An isokinetic dynamometer assessed inversion and eversion peak torque for both right and left ankle joint at 120°/sec. Left peak torque eversion and right foot reaction time demonstrated a significant negative moderate relationship (r = -0.530; p value = 0.03). Left ankle peak torque eversion does have a significant moderate negative relationship to reaction time of the right foot; therefore, evasive dribbling movements which requires inversion and eversion torque could directly affect foot reaction time, resulting in improved dribbling performance for soccer athletes.

Relationships between Plantar Pressure Distribution and Rearfoot Alignment in the Taiwanese College Athletes with Plantar Fasciopathy during Static Standing and Walking

BACKGROUND

Plantar fasciopathy (PF) is usually related to changes in foot arch, foot shape and rearfoot posture. However, little research has been implemented by using large-scale datasets, and even less has been conducted centering on plantar pressure distributions (PPDs) of different genders of PF athletes. This study aimed to investigate the relationships among the arch index (AI), the PPDs and the rearfoot postural alignment in hundreds of college athletes with PF during static standing and walking.

METHODS

Cross-sectional study of 100 male and 102 female athletes with PF was undertaken. The PF athletes' pain assessment and self-reported health status were examined for evaluating their musculoskeletal painful areas.

RESULTS

The PF athletes' PPDs mainly concentrated on inner feet in static standing, and transferred to lateral forefeet during the midstance phase of walking. The males' PPDs from the static standing to the midstance phase of walking mainly transferred to anterolateral feet. The females' PPDs mainly transferred to posterolateral feet. The PF athletes' static rearfoot alignment matched the valgus posture pattern. The medial band of plantar fascia and calcaneus were the common musculoskeletal pain areas.

CONCLUSIONS

Characteristics of higher plantar loads beneath medial feet associated with rearfoot valgus in bipedal static stance could be the traceable features for PF-related foot diagrams. Higher plantar loads mainly exerted on the lateral forefoot during the midstance phase of walking, and specifically concentrated on outer feet during the transition from static to dynamic state. Pain profiles seem to echo PPDs, which could function as the traceable beginning for the possible link among pronated low-arched feet, PF, metatarsalgia, calcanitis and Achilles tendinitis.