Plantar fasciitis in HIV positive people

NewsBot · Mar 9, 2006

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This is an interesting piece of research:
Prevalence of rheumatic disease in HIV infected Thai patients.
J Med Assoc Thai. 2005 Dec;88(12):1775-81

OBJECTIVE: To determine the prevalence of rheumatic diseases in HIV-infected patients at Siriraj Hospital, Thailand.

MATERIAL AND METHOD: 178 patients who attended the HIV-Clinic at Siriraj Hospital between November 2002 and February 2003 were examined for the presence of rheumatic diseases. Diagnosis of HIV infection was performed by ELISA and confirmed by partial agglutination testing. HIV-infected patients were classified according to the Centers for Disease Control (CDC) 1993 revised classification system. Standard criteria were used to classify the rheumatic diseases.

RESULTS: 98 patients had rheumatic diseases. Seventy-seven patients were treated with antiretroviral drugs. Forty-nine patients had mechanical low back pain, twenty-four patients had arthralgia, nineteen patients had plantar fasciitis, eighteen patients had nonspecific myalgia, thirteen patients had fibromyalgia, and eleven patients had others. Arthralgia was associated significantly with Quadricept muscle wasting (p = 0.00001). Nonspecific myalgia was more likely to be associated with female (p = 0. 018) and less likely with use of antiretroviral therapy (p = 0.031).

CONCLUSION: Rheumatic diseases were commonly found in HIV-infected patients. Arthralgia associated with wasting Quadricep muscle. Nonspecific myalgia was predominant in female and without antiretroviral drug treatment
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NewsBot · Jun 3, 2008

Heel pain and HIV-associated lipodystrophy: a report of two cases.
Stupar M, Tibbles A.
JCCA J Can Chiropr Assoc. 2008 Jun;52(2):103-109.

Plantar fasciitis is diagnosed based on a pathognomonic clinical presentation and physical examination including plantar heel pain with the initial few steps after a period of inactivity. People living with HIV/AIDS, who are taking anti-retroviral medications, often have an associated redistribution of body fat (lipodystrophy). Lipoatrophy of the extremities may involve the heel fat-pad in this population and result in the signs and symptoms of plantar fasciitis. Two cases of plantar heel pain in HIV-associated lipodystrophy are presented to discuss the possible clinical association between the two conditions. Although conservative therapies have limited evidence, they are commonly used and have been seen, clinically, to result in a resolution of symptoms. In the presented cases, the individuals benefited from soft tissue therapy, modalities, activity modification and education on proper footwear. Clinicians should be aware that the association between these two conditions may be a significant cause of morbidity in a population of patients with HIV.
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NewsBot · Dec 18, 2013

Musculoskeletal and rheumatological disorders in HIV infection: Experience in a tertiary referral center.
Kole AK, Roy R, Kole DC.
Indian J Sex Transm Dis. 2013 Jul;34(2):107-12.

BACKGROUND:
Musculoskeletal involvement in human immunodeficiency virus (HIV) infected patients are important disease manifestations, responsible for increased morbidity and also decreased quality of life.
OBJECTIVES:
To study the spectrum of different musculoskeletal involvement in HIV infected patients and its impact on quality of life.
PATIENTS AND METHODS:
Three hundred (n = 300) HIV-1 reactive patients were evaluated in respect to different musculoskeletal involvement including the quality of life from January 2010 to January 2011.
RESULTS:
Male to female ratio was 11:1 with a mean age of 35 (±6.4) years and mean duration of the disease was 3 (±1.54) years. Majority of cases were truck drivers, motel workers, and jewelry workers. Musculoskeletal disorders were observed in a total of 190 cases (63.33%). The spectrum of musculoskeletal involvement was: Body ache in 140 (46.7%), arthralgia in 80 (26.7%), mechanical low back pain in 25 (8.3%), osteoporosis in 20 (6.7%), painful articular syndrome in 10 (3.3%), hypertrophic osteoarthropathy in two (0.7%), pyomyositis in two (0.7%), osteomyelitis in one (0.3%), and avascular bone necrosis in one patient (0.3%). Rheumatologic disorders associated were: Reactive arthritis in seven (2.3%), fibromyalgia in four (1.3%), septic arthritis in three (1%), acute gout in three (1%), spondyloarthropathy in two (0.7%), rheumatoid arthritis in two (0.7%), dermatomyositis in one (0.3%), and systemic lupus erythematosus (SLE) in one patient (0.3%). But HIV associated arthritis and diffuse infiltrative lymphocytosis syndrome (DILS) were not detected. Most of the patients had decreased quality of life.
CONCLUSIONS:
Musculoskeletal involvement was common in HIV patients causing increased morbidity, so early detection and timely intervention is essential to improve quality of life.
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NewsBot · Jun 6, 2018

Entheseal involvement in asymptomatic human immunodeficiency virus infected patients: preliminary results of a clinical and ultrasonographic study.
Ciancio G et al
Clinical and Experimental Rheumatology [24 May 2018]

As a strong association between human immunodeficiency virus (HIV) infection and spondyloarthritis (SpA) has been hypothesised, our main objective was to explore by power Doppler ultrasonography (PDUS) the presence of subclinical enthesitis in asymptomatic HIV patients. The presence of subclinical synovitis was also evaluated.Consecutive asymptomatic HIV patients were studied and compared with asymptomatic HCV patients and healthy controls (HC). All subjects underwent a clinical and PDUS bilateral examination of the following entheses and joints: epicondyle, quadriceps, patellar, Achilles and plantar fascia; wrists, II and III metacarpo-phalangeal, knee and ankle.Twenty-nine HIV, 32 HCV and 25 HC were recruited; 1.032 entheses and 860 joints were examined. Clinical diagnosis of enthesitis was made in 10.3% HIV patients, 6.2% HCV patients (p=0.66) and none HC (p=0.24). PDUS enthesitis was found in 72.4% HIV, 28.1% HCV (p=0.0008) and 12% HC (p<0.0001). Clinical diagnosis of synovitis was made in 3.4% HIV patients, 9.3% HCV patients (p=0.61) and none HC (p=1). PDUS abnormalities were documented in 24.1% HIV patients, 71.8% HCV patients (p=0.0003) and none HC (p=0.0001). In detecting enthesitis and synovitis, PDUS was more sensitive than clinical examination both in HIV and HCV patients.Our preliminary study shows the high frequency of PDUS enthesitis in asymptomatic HIV patients, which highlights the close link between HIV and SpA. Further studies are desirable on a larger number of HIV patients to confirm these results. PDUS proved to be more sensitive than clinical examination in detecting subclinical involvement of entheses and joints.
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NewsBot · Feb 22, 2021

Does Plantar Lipoatrophy Affect Dynamic Balance In HIV Infected Persons?
Emeka G.Anyanwu Chioma L.Onuchukwu
Gait & Posture; Available online 17 February 2021

Highlights
•HIV infection is associated with significant gait and balance disorder
•Plantar lipoatrophy significantly impacts walking balance
•The velocity field diagram of human gait is an objective means of gait analysis
•Double support duration is a measure of dynamic balance
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Background
Chronic inflammation in HIV infection and antiretroviral therapy have been shown to cause balance disorders due to neuromusculoskeletal damage, sensorimotor deficits, failure of foot mechanoreceptors and/or plantar lipoatrophy. However, despite evidence of plantar lipoatrophy in HIV patients, there is a dearth of information on how this relates to walking balance. This study sought to investigate how plantar fat thickness affects dynamic balance in HIV infected persons.

Research Question
Can plantar lipoatrophy significantly affect walking balance in HIV infected persons?

Methods
This is a cross sectional study of 367 persons (106 HIV seronegative control subjects, 211 HIV seropositive subjects on antiretroviral therapy (HIV_ART) and 50 HIV ART naïve subjects (HIV_NonART)). Plantar fat thickness (PFT) was measured using diagnostic ultrasound. Subjects were asked to walk at 5 self-selected speeds, from very slow to very fast on a level 15-meter walkway. Average number of steps and time taken to complete the study distance were obtained, used to calculate gait parameters and plot the velocity field diagram for gait analysis.

Results
Findings from this study showed significant reduction in plantar fat thickness, velocity of travel, stride frequency and a significant increase in stride and double support duration (p < 0.01) in HIV-seropositive individuals compared to healthy controls but none were observed between HIV_ART and NonART groups.

Conclusion
HIV infection significantly affects dynamic balance and increases the risk of falls, fracture and mobility impairment in this patient population

Significance
This study will help clinicians to recognize plantar lipoatrophy as a significant cause of gait pathology in HIV infected persons and thus, make targeted interventions to minimize deformity and impairment, promote functional independence and improve quality of life.
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