Heel pain: Biomechanical and sensory differences

NewsBot · Oct 4, 2006

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Sensory and Biomechanical Characterization of Two Painful Syndromes in the Heel.
J Pain. 2006 Sep 30;
Saggini R, Bellomo RG, Affaitati G, Lapenna D, Giamberardino MA

This study evaluated sensory and biomechanical assets in 2 heel pain conditions with similar symptoms, entrapment syndrome of the nerve to abductor digiti quinti and myofascial syndrome of abductor hallucis. Thirty-three patients with unilateral heel pain and 20 asymptomatic subjects underwent pressure pain threshold measurement in the painful area in site A (medial process of calcaneal tuberosity, trigger point site of abductor hallucis) and site B (1 cm posteriorly to site A, where the nerve to abductor digiti quinti becomes most superficial) and contralaterally; electroneurography of posterior tibial nerve; evaluation of ground-foot reaction on a dynamic platform. Eighteen patients had electric shock-type pain (entrapment syndrome, Group 1), 15 had cramp-like pain (myofascial syndrome, Group 2). Pain thresholds on the affected side versus contralaterally were significantly lower in site B in Group 1 and in site A in Group 2 (P < .001). Nerve conduction velocity was slightly reduced in Group 1 (P = .05). Ground-foot reaction was significantly altered on the affected side in all patients versus asymptomatic subjects; a significant difference between the 2 sides was found for peak of force (F1) in Group 1 and for all parameters except temporal phase of peak of force (TF3) (P = .05) for Group 2 (P < .0001). The different sensory and biomechanical patterns of the 2 examined syndromes help the differential diagnosis and consequent therapeutic approach.

PERSPECTIVE: This study shows different sensory and biomechanical patterns in 2 algogenic conditions of the heel with similar pain location. These distinct patterns reflect different pathophysiologic mechanisms in the 2 cases, which has a potential significant impact on treatment.
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NewsBot · Nov 11, 2006

Medial calcaneal neuropathy is associated with plantar fasciitis.
Clin Neurophysiol. 2006 Nov 7;
Chang CW, Wang YC, Hou WH, Lee XX, Chang KF

OBJECTIVE: To demonstrate a method of sensory nerve conduction study (NCS) for the medial calcaneal nerve (MCN) and confirm the medial calcaneal neuropathy in patients with plantar fasciitis (PF).

METHODS: Twenty-six patients with clinical and ultrasonographic diagnosis of PF participated in the present study. An antidromic method for sensory NCS of MCN was performed in each patient and in 30 controls. The conduction latency, sensory nerve conduction velocity (SNCV) and amplitude of the sensory nerve action potential (SNAP) were measured and the correlation of the SNCV of MCN with both body weight and body mass index (BMI) was studied.

RESULTS: The mean conduction latency obtained in the MCN was greater in the PF patients than in the normal controls. Mean SNCV and SNAP amplitude of the MCN were significantly less in the PF patients than in the normal controls. Body weight and BMI were greater in PF patients than in controls. Six patients were identified as having a medial calcaneal neuropathy by using the criteria of the lowest normal values of the NCS of MCN from the normal controls.

CONCLUSIONS: Medial calcaneal neuropathy is associated with PF. The present method of sensory NCS is useful and objective in the diagnosis of the medial calcaneal neuropathy.

SIGNIFICANCE: Medial calcaneal neuropathy was confirmed by the sensory NCS of MCN and shown to be associated with PF
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NewsBot · Mar 25, 2021

Sensorimotor deficits in distance runners with medial plantar pain
Colton Funk et al
Source

Context: Medial plantar pain is a complex and multifactorial condition experienced by some
distance runners, which makes etiological differentiation and diagnosis challenging.
Objective: To assess plantar sensation, pain perception and sensitivity, intrinsic foot strength,
and foot morphology before and after a 9.7 km run in long-distance runners with and without
medial plantar pain.
Design: Descriptive laboratory study
Setting: Laboratory.
Patients: Seven distance runners with medial plantar pain (four males, three females; aged
22.3±3.7 years; BMI 22.3±3.5 kg/m2 9 ) and seven matched healthy controls (four males, three
females; aged 20.3±1.0 years; BMI 22.0±1.7 kg/m2 10 ) were recruited from a public university.
Intervention(s): Participants ran a six-mile course in their own footwear at a self-selected pace.
Main Outcome Measures: Pain visual analogue scale (VAS), pressure pain thresholds (PPT),
plantar sensation, foot morphology, weight-bearing dorsiflexion (WBDF), forefoot joint
mobility, toe flexion, intrinsic foot muscle strength, and a seated neural provocation test were
analyzed pre-and post-run utilizing mixed model group by time ANOVAs, post hoc effect size
point estimates, and 95% confidence intervals.
Results: A significant group by time interaction was observed for PPT at the mid-arch (Control:
pre: 83.0±27.4N, post: 79.5±22.6N; Symptomatic: pre: 90.5±31.9N, post: 70.1±32.7 N; p=.03)
and posterior tibialis (PT) (Control: pre: 75.7±19.5 N, post: 65.7±14.2N; Symptomatic: pre:
75.8±20.4 N, post: 51.1±11.9 N; p=.05) sites. PPT in the posterior tibialis significantly decreased
in the symptomatic group following the run (ES=1.5, 95% CI: 0.3, 2.7). Both groups
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demonstrated significantly decreased plantar sensation thresholds at the base of the 5 22 th metatarsal
(p=.04), PPT at the calcaneal tuberosity (p=.001), and increased TMT extension (p=.01) and
WBDF (p=.01) following the run.
Conclusions: The etiology of medial plantar pain observed in our sample was likely attributed to
central sensitization and running-induced sensory changes. Clinicians should include
sensorimotor testing when managing patients with medial plantar pain.
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