O10. Prevalence and Associations of Posterior Heel Pain in the General Population: An Epidemiological Study

Abstract

Background: Foot pain is a common complaint in the general population, affecting 17-24% of adults. In clinical practice, pain in specific regions of the foot is commonly attributed to specific disorders. Posterior heel pain (PHP) is related largely to disorders of the Achilles' tendon and associated structures, and causes significant disability. This study aimed to identify the prevalence of PHP and related disability in the general population, and to identify factors associated with PHP. Methods: A postal questionnaire was mailed to all adults aged 50 years and older registered with four general practices, irrespective of consultation for foot pain. Participants reporting foot pain in the last month indicated pain location by shading on a foot manikin. Disabling foot pain was assessed using the Manchester Foot Pain and Disability Index. Respondents were asked if they had seen their general practitioner (GP), or a physiotherapist or podiatrist/chiropodist about their foot pain in the last 12 months. The prevalence of PHP was calculated. Adjusted odds ratios (ORs) and 95% CI were calculated for the associations of PHP and disabling PHP with age, sex, neighbourhood deprivation quartile (NDQ), occupational class, BMI and diabetes mellitus using logistic regression. Results: 5109 completed questionnaires were received (adjusted response 56%). 675 (13%) reported PHP in either heel, of whom 382 reported bilateral symptoms. Disabling PHP was reported by 398 (8%). Having any PHP was significantly associated with a higher BMI (BMI>35.0 OR 4.23; 95% CI 3.10, 5.78), manual occupations (OR 1.89; 95% CI 1.45, 2.47), and diabetes mellitus (OR 1.32; 95% CI 1.03, 1.69), but not age, gender or neighbourhood deprivation. Bilateral PHP was additionally associated with age >75 (OR 1.45; 95% CI 1.07, 1.97) and NDQ (most deprived OR 1.53; 95% CI 1.04, 2.25). Disabling PHP was significantly associated with age >75 (OR 12.39; 95% CI 3.71, 41.33), BMI>35.0 (OR 2.35; 95% CI 1.01, 5.47), lowest NDQ (OR 3.08; 95% CI 1.47, 6.46), and diabetes mellitus (OR 2.22; 95% CI 1.00, 4.90). Of those with any PHP, 241 (36%) had consulted their GP, 93 (14%) a physiotherapist, and 275 (41%) a podiatrist/chiropodist about their foot pain in the last 12 months. Conclusion: PHP and related disability are common in adults aged >50 years, and are associated with obesity, diabetes mellitus, NDQ, and occupational class. Bilateral and disabling PHP are also strongly associated with age. Only a minority of people with PHP seek advice from a healthcare professional. Weight loss may be a possible treatment for PHP, although prospective studies are needed to identify whether obesity is a causal factor for PHP.