The effects of plantar fasciitis and pain on plantar pressure distribution of recreational runners
Introduction
Plantar fasciitis is a common musculoskeletal disorder (Crawford et al., 2001), which affects 25% of athletes (Clement et al., 1981) and 10% of sedentary individuals (Kaya, 1996, Kibler et al., 1991, Rome et al., 2001) and is the third most frequent injury in runners (Taunton et al., 2002a). Commonly referred to calcaneus spur or plantar heel pain, plantar fasciitis is characterized by localized pain on the plantar fascia insertion, which is exacerbated in the mornings after getting up or after long rest periods (Kwong et al., 1988, Tisdel et al., 1999).
Despite its high prevalence, knowledge about its pathogenesis is still limited (Wearing et al., 2006). It is reported that chronical inflammation is a secondary mechanism, which induces degenerative changes of the aponeurotic tissues (Wearing et al., 2006), however, its etiology is still controversial and various intrinsic and extrinsic factors are cited in the literature (Rome et al., 2001, Wearing et al., 2006). Amongst all of the factors, mechanical overload and excessive stretching of the plantar fascia are often associated with its development (Bedi and Love, 1998, Kaya, 1996, Kibler et al., 1991, Wearing et al., 2007, Young et al., 2001). According to Kibler et al., 1991, Bedi and Love, 1998, increases in plantar overloads of the feet promote stretching stresses on the plantar aponeurosis, which cause microtraumas and subsequent degenerative changes of the connective tissues, leading to the development of plantar fasciitis.
Previous biomechanical studies on plantar fasciitis targeted gait evaluation in non-athletes individuals (Bedi and Love, 1998, Kelly et al., 1995, Liddle et al., 2000, Wearing et al., 2003, Wearing et al., 2007), even though plantar fasciitis incidence is much higher in runners (Taunton et al., 2002a, Taunton et al., 2002b). To our knowledge, there is only one study that addressed runners population with history of plantar fasciitis aimed at investigating plantar loads during running.
Most of the previous gait studies observed that the pain stimulus at the feet of individuals with plantar fasciitis promotes changes in the pattern the foot rollover process causing a load reduction in the rearfoot and a load increase in other plantar regions such as the midfoot (Wearing et al., 2007), forefoot (Bedi and Love, 1998) and fingers (Wearing et al., 2003), possibly due to the protective mechanism of pain. Other studies, however, found no changes in load distribution over the plantar surface in individuals with plantar fasciitis (Kelly et al., 1995, Liddle et al., 2000). According to Wearing et al. (2007), the symptomatic feet make some adaptations during gait to reduce the load on the rearfoot that is in pain and proposed two explanations to this fact. First, it is not possible to infer whether this increased loads in other regions of the plantar surface, as described by some authors (Bedi and Love, 1998, Wearing et al., 2007), are actually contributing to the development of plantar fasciitis by inducing the stretching of the fascia. Secondly, the presence of pain in the rearfoot would promote protective mechanisms, which could reduce the plantar load in this area (Wearing et al., 2007). Based upon these explanations, the majority of the clinical interventions use rearfoot insoles to reduce the pain symptoms, however, recent studies demonstrated that they cannot prevent long-term recurrences (Landorf et al., 2006, Landorf et al., 2007).
The only biomechanical study that evaluated running showed that history of plantar fasciitis in female's runners was associated with greater vertical ground reaction force load rates compared to controls. These authors reported the importance of evaluating the influence of the pain symptom in the acute phase of plantar fasciitis during running in future studies (Pohl et al., 2009).
According to the results of the biomechanical studies of plantar fasciitis during gait, it is possible that the load distribution over the foot surface in runners with plantar fasciitis would be different in the presence of pain symptom during running, but the literature is still scarce about this matter. Taking into consideration that recreational running provides significant impact on the rearfoot area and that these mechanical stimuli are generally repeated over 625 times per km (Frederick, 1986), it is important to better understand how the rearfoot and other adjacent areas receive loads during running, especially in the presence of pain.
Therefore, the aim of this study was to evaluate and compare the plantar pressure distributions during running of recreational runners with symptom or previous history of plantar fasciitis and runners without the disease. The hypotheses were that the group with symptomatic plantar fasciitis would receive higher loads on the forefoot and that the group with history of plantar fasciitis would show higher loads on the rearfoot in comparison with the control group.
Section snippets
Subjects
One hundred and five recreational adult runners of both genders and ages ranging from 20 to 55 years (Liddle et al., 2000, Wearing et al., 2003) participated in the study. For inclusion in this study, the runners have to run at least 20 km weekly for at least one year, experienced in long distance competitions, had to have regular rear foot strike pattern, had to be free of musculoskeletal injury in the last 6 months, and have a maximum leg length discrepancy of 1 cm.
The runners were recruited from
Results
The groups were similar regarding their demographic and anthropometric characteristics (Table 1). The runners with plantar fasciitis had a mean time since the onset of pain of 7(2) months and pain level of 5.1(2.1) cm.
As shown in Table 2, no interactions were found between groups and plantar areas for any of the investigated variables: Peak of pressure (F = 1.23; P = 0.253), contact area (F = 2.75; P = 0.068), contact time (F = 0.55; P = 0.876), and pressure-time integral (F = 1.25; P = 0.245).
Discussion
The aim of the present study was to evaluate and compare the patterns of the plantar pressure distributions in runners with symptom or history of plantar fasciitis and a control group during running. The results demonstrated that the presence or absence of pain associated with plantar fasciitis did not change plantar pressure distributions during running.
Lieberman et al. (2010) discussed that the impact of the heel during running is quickly transferred to the rest of the body and would
Conclusions
Plantar fasciitis or the symptom of pain related to the disease do not change the pressure plantar distribution patterns during running that is not different from the pattern performed by runners without the fasciitis condition. The plantar load distributed over the plantar surface may not be related to the development of the plantar fasciitis.
Acknowledments
The authors thank to the Brazilian Government Funding Agency (CAPES-Coordenação de Aperfeiçoamento de Pessoal de Ensino Superior) for the scholarship awarded to Ribeiro.
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