Factors associated with chronic plantar heel pain: a systematic review


      Chronic plantar heel pain (CPHP) is one of the most common soft tissue disorders of the foot, yet its aetiology is poorly understood. The purpose of this systematic review was to examine the association between CPHP and the various aetiological factors reported in the literature. Seven electronic databases and the reference lists of key articles were searched in August 2005. The resulting list of articles was assessed by two independent reviewers according to pre-determined selection criteria and a final list of articles for review was created. The methodological quality of the included articles was assessed and the evidence presented in each of the articles was descriptively analysed. From the 16 included articles, body mass index in a non-athletic population and the presence of calcaneal spur were the two factors found to have an association with CPHP. Increased weight in a non athletic population, increased age, decreased ankle dorsiflexion, decreased first metatarsophalangeal joint extension and prolonged standing all demonstrated some evidence of an association with CPHP. Evidence for static foot posture and dynamic foot motion was inconclusive and height, weight and BMI in an athletic population were not associated with CPHP. The findings of this review should be used to guide the focus of prospective cohort studies, the results of which would ultimately provide a list of risk factors for CPHP. Such a list is essential in the development of new and improved preventative and treatment strategies for CPHP.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Science and Medicine in Sport
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Rome K.
        Anthropometric and biomechanical risk factors in the development of plantar heel pain—a review of the literature.
        Phys Ther Rev. 1997; 2: 123-134
        • Rome K.
        Heel pain: diagnosis and management.
        Podiatry Now. 2005; 8: S1-S8
        • Riddle D.L.
        • Pulisic M.
        • Pidcoe P.
        • et al.
        Risk factors for plantar fasciitis: a matched case-control study.
        J Bone Joint Surg. 2003; 85: 872-877
        • Rome K.
        • Howe T.
        • Haslock I.
        Risk factors associated with the development of plantar heel pain in athletes.
        Foot. 2001; 11: 119-125
        • Hunt G.C.
        • Sneed T.
        • Hamann H.
        • et al.
        Biomechanical and histological considerations for development of plantar fasciitis and evaluation of arch taping as a treatment option to control associated plantar heel pain: a single-subject design.
        Foot. 2004; 14: 147-153
        • Crawford F.
        • Thomson C.
        Interventions for treating plantar heel pain.
        Cochrane Database Syst Rev. 2003; 3 (CD000416)
      1. Barrett P, Black M. In response to: anthropometric and biomechanical risk factors in the development of plantar heel pain—a review of the literature [Rome, Phys Ther Rev 1997;2:123–34]. Phys Ther Rev 1998;3(1):55–6.

        • Buchbinder R.
        Plantar fasciitis.
        N Engl J Med. 2004; 350: 2159-2166
        • Allen R.H.
        • Gross M.T.
        Toe flexors strength and passive extension range of motion of the first metatarsophalangeal joint in individuals with plantar fasciitis.
        J Orthop Sports Phys Ther. 2003; 33: 468-478
        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non randomised studies of health care interventions.
        J Epidemiol Commun Health. 1998; 52: 377-384
        • Cohen J.
        Statistical power analysis for the behavioural sciences.
        2nd ed. Earlbaum, Hillsdale, New Jersey1988
        • Menz H.B.
        Two feet, or one person? Problems associated with statistical analysis of paired data in foot and ankle medicine.
        Foot. 2004; 14: 2-5
        • Kibler W.B.
        • Goldberg C.
        • Chandler T.J.
        Functional biomechanical deficits in running athletes with plantar fasciitis.
        Am J Sports Med. 1991; 19: 66-71
        • Rome K.
        • Campbell R.
        • Flint A.
        • et al.
        Heel pad thickness—a contributing factor associated with plantar heel pain in young adults.
        Foot Ankle Int. 2002; 23: 142-147
        • Wearing S.C.
        • Smeathers J.E.
        • Yates B.
        • et al.
        Sagittal movement of the medial longitudinal arch is unchanged in plantar fasciitis.
        Med Sci Sports Exerc. 2004; 36: 1761-1767
        • Creighton D.S.
        • Olson V.L.
        Evaluation of range of motion of the first metatarsophalangeal joint in runners with plantar fasciitis.
        J Orthop Sports Phys Ther. 1987; 8: 357-361
        • Messier S.P.
        • Pittala K.A.
        Etiologic factors associated with selected running injuries.
        Med Sci Sports Exerc. 1988; 20: 501-505
        • Portney L.G.
        • Watkins M.P.
        Foundations of clinical research: applications to practice.
        2nd ed. Prentice Hall, Upper Saddle River, New Jersey2000
        • Ozdemir H.
        • Yilmaz E.
        • Murat A.
        • et al.
        Sonographic evaluation of plantar fasciitis and relation to body mass index.
        Eur J Radiol. 2005; 54: 443-447
        • Prichasuk S.
        • Subhadrabandhu T.
        The relationship of pes planus and calcaneal spur to plantar heel pain.
        Clin Orthop Relat Res. 1994; 306: 192-196
        • Rano J.A.
        • Fallat L.M.
        • Savoy-Moore R.T.
        Correlation of heel pain with body mass index and other characteristics of heel pain.
        J Foot Ankle Surg. 2001; 40: 351-356
        • Hill J.J.
        • Cutting P.J.
        Heel pain and body weight.
        Foot Ankle. 1989; 9: 254-256
        • Lapidus P.W.
        • Guidotti F.P.
        Painful heel: report of 323 patients with 364 painful heels.
        Clin Orthop Relat Res. 1965; 39: 178-186
        • Sadat-Ali M.
        Plantar fasciitis/calcaneal spur among security forces personnel.
        Military Med. 1998; 163: 56-57
        • Taunton J.E.
        • Ryan M.B.
        • Clement D.B.
        • et al.
        Plantar fasciitis: a retrospective analysis of 267 cases.
        Physl Ther Sport. 2002; 3: 57-65
        • Rome K.
        • Wall E.
        • Howe T.
        • et al.
        Generalised joint hypermobility: a poor predictor of plantar fasciitis in athletes.
        Br J Podiatr. 2001; 4: 45-48