Introduction
Methods
Study population
Measures
Questionnaire battery
Clinical examination & ultrasound assessment
Biomechanical assessment
Validity, reliability and feasibility of procedures
Validity
Questionnaire validity
Clinical and biomechanical validity
Reliability
Feasibility
Calculation of sample size
Data analysis
Demographics | Plantar Heel Pain (n = 12) | Other Foot Problems (n = 12) | Healthy Controls (n = 12) |
---|---|---|---|
Gender (female:male) | 6:6 | 6:6 | 7:5 |
Age, years (mean ± SD) | 41 ± 16* | 38 ± 13 | 28 ± 2.7 |
BMI, kg/m2 (mean ± SD) | 27 ± 5.2$* | 24 ± 3.9 | 23 ± 3.1 |
Morning Pain Severity, VAS (mean ± SD) | 43 ± 20 | 54 ± 14 | NA |
Morning Pain Duration, mins. (mean ± SD) | 24 ± 18 | 25 ± 19 | NA |
FAOS (mean ± SD) | 55 ± 28$* | 80 ± 17 | 99 ± 1 |
Occupation, (n, (%)) | |||
Blue-collar | 0 (0%) | 0 (0%) | 2 (17%) |
White collar | 10 (83%) | 9 (75%) | 6 (50%) |
Unemployment & students | 2 (17%) | 3 (25%) | 4 (33%) |
Exercising regularly, (yes:no) | (9:3) | (9:3) | (7:5) |
Statistical analysis
Results
Sample characterisation
MEASUREMENTS | DOMAIN | PURPOSE | RESULTS | OUTCOMES |
---|---|---|---|---|
Patient Reported Outcome Measures (n = 36) | ||||
Pain Catastrophizing Scale (PCS) | Psychosocial factors | V R F | LoA = 0.2 ± 8.5; d = 0.01; p = 0.83 Excellent (ICC = 0.97) Patients reported psychosocial questions duplication | Online use valid Reliable measure Redesign order |
Global Physical Activity Questionnaire (GPAQ) | Activity level | V R F | LoA = −5.3 ± 22.2 d = − 0.22; p = 0.51 Good (ICC = 0.81) Designed logic between relevant question to avoid time wasting and make GPAQ appropriate for online use | Online use valid Reliable measure Time burden Reduction needed |
Fear-Avoidance Belief Questionnaire subscale (FABQ) | Psychosocial factors | V R V R F | PA: LoA = 1.6 ± 15.9; d = −0.06; p = 0.55 PA Excellent (ICC = 0.92) W: LoA = − 0.5 ± 8.5; d = 0.25; p = 0.77 W: Poor (ICC = 0.39) Patients reported psychosocial questions duplication | Online use valid Reliable measure Online use valid Poor reliability Redesign order |
Health-related Quality of Life (EQ. 5D-5L) | Quality of Life | V R V R F | VAS: LoA = − 0.3 ± 13.6; d = − 0.26; p = 0.07 VAS: Excellent (ICC = 0.94) State: LoA = − 1.1 ± 8.5; 0.16; p = 0.55 State: Moderate (ICC = 0.64) Easy to report & understandable | Online use valid Reliable measure Online use valid Moderate reliability Easy to use |
Foot and Ankle Outcome Score (FAOS) | Physical factors | V R F F | LoA = 1.3 ± 10–2.5 ± 18.2; d = 0.11–0.16 p = 0.49–.08 Excellent to moderate (ICC = 0.99–0.73) Patient answers inconsistent for last subscale. Patients reported many questions in physical factors | Online use valid Reliable measure Redesign look Reduce repetition |
Key miscellaneous questions | Morning pain duration (mins) Morning pain severity (VAS) | V R V R F | LoA = 2.2 ± 18.7; d = 0.10; p: 0.34 Excellent (ICC = 0.94) LoA = − 2.1 ± 19.0; d = − 0.10; p: 0.33 Excellent (ICC = 0.94) Both measures easy to report & understandable | Overall: Online use valid, reliable measures that are feasible. |
Pain map | Foot pain map | V R F | Pain-spreading region with 66% agreement. %98 matched; the medial aspect of RF clumsy system | Valid Use Reliable measure Navigate Pain |
Clinic Examination (N = 18) | ||||
Foot mobility | Navicular drift Navicular drops MLA angle | V F V F V F | PHP = 6 ± 3; OP = 8 ± 1; H = 7 ± 3 mm; difficult to control medial movement PHP = 10 ± 4; OP = 9 ± 4; H = 12 ± 9 mm; Difficult to determine the change PHP = 160° ± 7; OP = 156° ± 11; H = 155° ± 5 difficult to position and maintain set-up | Overall: a new measurement procedure is required. |
Range of motion | Hip IR Ankle active DF 1MTPJ DF | V F V F V F | PHP = †43° ± 4; OP = 45° ± 9; H = 57° ± 12 Difficult to estimate centre of rotation PHP = 27° ± 6; OP = 25° ± 3; H = 27° ± 3 Difficult to estimate true vertical and horizontal positions PHP = 36° ± 4; OP = 38° ± 10; H = 37° ± 7 The test was affected by instrumentation, | Overall: valid measure but binary outcomes needed and amended procedure. |
Strength (oxford scale) | H. ER Ankle PF Inversion Intrinsic muscle | V F V F V F V F | PHP = 4.7 ± 4; OP = 4.8 ± 4; H = 5 Difficulty to detect difference between grades PHP = 4.9 ± 2; OP = 4.9 ± 2; H = 5 assesses muscles when contracting concentrically PHP = †3.5 ± 5; OP = 5; H = 5 No difficulty is detected PHP = 4,8 ± 4; OP = 5; H = 4.8 ± 6 Difficulty to control participation of other muscle groups | Overall: valid measure but binary outcome needed and more practical test. |
Modified knee to wall | ADROM before NP DFROM in full | V V F | PHP = 20° ± 8; OP = 21° ± 9; H = 21° ± 7 PHP = †14° ± 6; OP = 18° ± 8; H = 28° ± 10 Navicular drop not clear | Overall: sensible values but test needs modified |
Ultrasound Assessment (N = 18) | ||||
Thickness measures | PF origin Mid PF Heel pad | V V V F | PHP = †‡3.7 ± 0.4; OP = 2.6 ± 0.8; H = 2.9 ± 0.4 mm. PHP = †‡3.7 ± 0.4; OP = 2.6 ± 0.7; H = 2.8 ± 0.4 mm. PHP = 8.4 ± 0.2; OP = 7.8 ± 0.2; H = 9.3 ± 1.9 mm. Difficult to control pressure | Overall: sensible values but practice needed. |
Biomechanical Assessment (N = 9) | ||||
Graded loading challenge (GLC) | First vGRF peak (N/BW) | V R F | NW = 7626 ± 1565; LS = 8866 ± 1822; NWW = 9445 ± 1564; LSW = 10,825 ± 1320 Excellent (ICC = 0.92–0.95) Easy to measure & high-quality data | Overall: valid and reliable measure which is feasible to collect. |
Second vGRF Peak (N/BW) | V R F | NW = 7826 ± 1656; LS = 8598 ± 1859; WW = 9569 ± 1541; LSW = 10,919 ± 1805 Good to excellent (ICC = 0.81–0.92) Easy to measure & high-quality data | Overall: valid and reliable measure which is feasible to collect. | |
Rate of force development (N. s− 1) | V R F | NW = 4741 ± 1307; LS = 5949 ± 1671; WW =5235 ± 1518; LSW =7356 ± 1799 Excellent (ICC = 0.91–0.96) Easy to measure & high-quality data | Overall: valid and reliable measure which is feasible to collect. | |
1.MTPJ DF on Toe off phase of gait cycle | V R F | NW = 14° ± 6; LS = 15° ± 7; WW =15° ± 8; LSW =14° ± 6 Moderate (ICC = 0.60–0.71) Time consuming | Sensible values Moderate reliability Discard measure. | |
MLA during midstance | V R F | NW = 139° ± 15; LS = 139° ± 15; WW = 140° ± 13; LSW = 143° ± 14 Poor to Good (ICC = 0.53–0.78) Time consuming | Sensible values. Modest reliability Discard measure. |