Psychological Aspects

Related to the Duration and

Severity of Plantar Fasciitis

Joowon Joh, M.D., Jin-su Kim, M.D.*,

Kiwon Young, M.D.*

Dr. Choi's Orthopedic Surgery Clinic, Seoul, Korea

Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea*

AOFAS Annual Meeting 2015, Long Beach, California

Psychological Aspects

Related to the Duration and

Severity of Plantar Fasciitis

Joowon Joh, M.D.

My disclosure is in the Final AOFAS Mobile App.

I have no potential conflicts with this presentation.

No Conflict to Disclose

Introduction

Extensive research in the field of plantar fasciitis

• Anatomic variation (ex. reduced ankle dorsiflexion)

• Personal characteristics(ex. body weight)

• Life style(ex. work-related weight-bearing)

• Psychological aspects?

No studies measuring the

prevalence of psychological

profiles in plantar fasciitis

Pain

Genetics

Physiologic

Cellular Social culture

Psychological

Plantar fasciitis

• Affects as much as 10% of the population during the course of a lifetime

• Unknown etiology in approximately 85% of cases

- Crawford F. et al , Cochrane Review, 2004

- Riddle DL. et al , Foot Ankle Int25:311-317, 2004

The Purpose of this study

1. To obtain a psychological profile of individuals with plantar fasciitis

2. To examine the patients’ personal characteristics

3. To determine if there was a relationship between patients’s psychological and personal characteristics

Material and Methods(I)

Inclusion criteria for the study participants

• Diagnosis based on - pain in the area of the insertion of the plantar aponeurosis to the medial tubercle of the calcaneus - pain provoked when the patient took the first few steps in the morining - plantar fascia thickening, soft tissue edema on U/S

• Heel pain present ≥3 weeks duration

• No systemic arthritic condition

1:1 matching, with two controls(age & gender)

Study participants

60 patients(35 female,25 male)

received treatment on an outpatient basis

A control group

60 normal subjects(35 female, 25 male)

No history of plantar heel pain

Material and Methods(II)

Psychological assessment • The Symptom Checklist-90-Revised(SCL-90-R)

- The questionnaire comprised 90 items, measure ten psychological characteristics

Clinical assessment

• Age, sex, occupation, duration and severity of plantar heel pain(VAS)

Statistical analysis • Student t-test

• ANOVA

• Pearson correlation

• SPSS 12.0 for windows

Results(I)

Psychological profile:SCL-90-R Patients (N = 60)

Controls (N = 60)

Anxiety(ANX) 27.5±7.2 17.2±6.5

Depression(DEP) 37.6±8.8 21.3±10.4

General complaints(G-C) 14.9±4.3 10.2±5.0

Grudge(GRU) 13.5±4.1 12.9±3.7

Interpersonal sensitivity(INT) 21.8±4.8 15.6±4.1

Obsessive-compulsive disorder(O-C) 27.9±6.7 20.2±3.2

Paranoid thought(PAR) 13.3±3.1 13.6±4.3

Phobic anxiety(PHO) 9.8±2.2 10.1±3.0

Psychosis(PSY) 17.5±4.1 17.9±4.8

Somatization(SOM) 22.8±6.2 23.1±7.4

*

* ; P<0.05

*

*

*

*

*

Results(II)

0

5

10

15

20

25

30

35

40

45

ANX* DEP* G-C* GRU* INT* O-C* PAR* PHO* PSY* SOM*

Femal

Male

Analysis of SCL-90-R of patients by gender

SC

L -9

0-R

score

* ; P<0.05

0

5

10

15

20

25

30

35

40

45

ANX* DEP* G-C GRU INT O-C PAR PHO PSY SOM

Yes

No

Positive correlation between duration of illness and patients’ level of obsessive-compulsive behaviours(r=0.15), anxiety(r=0.33), general complaints(r=0.14), and depression(r=0.24)

Significant positive correlation between the severity of illness and SCL-90-R scores(r=0.34, P=0.002)

Analysis of SCL-90-R of patients by employed or not

* ; P<0.05

Discussion(I)

The awareness of psychological background of musculoskeletal pain(ex. back pain, fibromyalgia), long recognized in many literatures, has been little recognized in clinical practice for plantar fasciitis.

Psychological factors related to pain

: The higher the level of anxiety the higher the pain that is experienced.

: Fall into a pattern of lethargy as a form of “learned helplessness” : Observing an over-sensitive role model had a diminishing effect on pain threshold and pain tolerance.

Anxiety

- Merskey H. Raven press, 1978

Depression

- Silver RL. et al, Academic press, 1980

- Chapman CR. et al , a psychological approach to etiology

and treatment, 1981

Social modelling

Discussion(II)

Higher SCL-90-R score of anxiety, depression, interpersonal sensitivity, obsessive-compulsive disorder, somatization and general complaints in patients with plantar fasciitis

Females with plantar fasciitis scored higher on all dimensions of SCL-90-R.

Non-working patients were more depressed and had higher anxiety score.

Psychological stress exacerbate plantar fasciitis? or Patients develop psychiatric problems as a consequence of their condition?

SCL-90-R

Plantar fasciitis

patients

N=60

Control group

N=60

Psychological

comparison

Our study model

-Female subjects demonstrate enhanced responses to experimentally induced pain-

Unruh AM. Pain, 1996, 65:123-67

Conclusion

Our results demonstrated close relationships of psychological aspects in plantar fasciitis, highlighting the importance of recognizing psychological aspects in the development of treatment strategies.

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