It is widely accepted that psychological variables, including affective, cognitive and behavioural factors, are associated with self-reported pain and self-reported physical function in patients with musculoskeletal pain. However, the relationship between psychological variables and foot pain and foot function, in people with plantar heel pain (PHP), has received less attention. Therefore, the aim of this presentation was to present the results from a series of cross sectional studies that evaluated a range of psychological variables in people with PHP.
Three cross sectional studies were conducted separately at different time points. The first cross sectional study evaluated 84 people with PHP to determine the association between depression, anxiety and stress with foot pain and foot function. This was followed by a second study involving 45 people with PHP and 45 people without PHP to determine if symptoms of depression, anxiety or stress increased the likelihood of having PHP. A third cross sectional study evaluated the association between kinesiophobia and catastrophising with foot pain and foot function in 36 people with PHP. Hierarchical and logistic regression models were used to evaluate the data.
For participants with PHP, stress and depression scores were significantly associated with foot function but not foot pain. When the data was stratified by sex, stress and depression were significant predictors of foot pain and function in females. Symptoms of depression, anxiety and stress were found to increase the likelihood of having PHP. Finally, kinesiophobia and catastrophising were significantly associated with foot function, while catastrophising was associated with ‘first step’ pain in people with plantar heel pain.
Discussion and clinical relevance
In addition to addressing biological factors in the management of PHP, clinicians should consider the potential role of affective factors such as mood, and cognitive factors such as catastrophising and kinesiophobia which are equally important in the experience of pain in people with PHP. Podiatrists should contemplate the use of outcome measures to evaluate mood, anxiety, catastrophic thoughts and a fear of movement to help guide treatment that is viewed through a broader biopsychosocial model of health.