Relationship Between Central Sensitization and Clinical Features in Plantar Fasciitis

Official title

IInvestigation of the Relationship Between Central Sensitization and Clinical, Functional, and Ultrasonographic Parameters In Plantar Fasciitis

Overview

Plantar fasciitis is a common cause of heel pain and is traditionally considered a mechanical musculoskeletal disorder. Recent evidence suggests that central sensitization may also contribute to pain in individuals with plantar fasciitis. This study aims to investigate the relationships between neurophysiological variables (pressure pain threshold, central sensitization, and pain intensity), psychological factors (pain catastrophizing, kinesiophobia, anxiety, and depression), ultrasonographic findings (plantar fascia thickness), and functional outcomes (foot function and quality of life) in patients with plantar fasciitis.

Detailed description

Heel pain caused by plantar fasciitis is one of the common reasons for visits to Physical Medicine and Rehabilitation outpatient clinics. Plantar fasciitis is characterized by throbbing medial plantar heel pain that occurs especially with the first step in the morning or after long periods of rest and is a musculoskeletal disorder. The diagnosis of plantar fasciitis is usually determined clinically. In ultrasound, findings such as thickening of the plantar fascia and hypoechogenicity in the fascia are advantageous in diagnosis. Although the mechanical aspect of pain has often been emphasized in the treatment of plantar fasciitis, recent studies have gained momentum in suggesting that central sensitization is also among the pain mechanisms of plantar fasciitis. In addition, as with many chronic musculoskeletal pains, the role of psychological factors such as kinesiophobia, catastrophizing pain, depressive symptoms, and anxiety has been investigated in plantar fasciitis. However, data on the relationship between factors such as pressure pain sensitivity, central sensitization, catastrophizing pain, and kinesiophobia in plantar fasciitis are limited. The aim of this study is to contribute to the increasing literature in this field by investigating the relationship between psychological (catastrophizing pain, kinesiophobia, anxiety, and depression), ultrasonographic findings (plantar fascia thickness), and functional status (foot functional index, quality of life) variables with neurophysiological (pressure pain threshold, central sensitization, pain) variables in plantar fasciitis.

Interventions

• Other Pressure Pain Threshold Assessment
  Pressure pain threshold measurements will be performed using a pressure algometer to assess pain sensitivity.
• Other Ultrasonographic Assessment
  Ultrasonographic evaluation will be performed to measure plantar fascia thickness and assess plantar fascia morphology.

Primary outcome measures

• Forearm Pressure Pain Threshold (PPT) [Time frame: Baseline]

Secondary outcome measures (10)

• Numeric Pain Rating Scale, NPRS [Time frame: Baseline]
• Short Form-12 (SF-12) [Time frame: Baseline]
• Foot Function Index [Time frame: Baseline]
• Pain Catastrophizing Scale [Time frame: Baseline]
• Tampa Scale for Kinesiophobia [Time frame: Baseline]
• Central Sensitization Inventory [Time frame: Baseline]
• Thickness of the plantar fascia in ultrasonographic imaging [Time frame: Baseline]
• Hospital Anxiety and Depression Scale [Time frame: CROSS-SECTIONAL]
• Weight-Bearing Lunge Test [Time frame: Baseline]
• FOOT POSTURE INDEX [Time frame: Baseline]

Eligibility criteria

Plantar Fasciitis Group

• Inclusion criteria

• Be between the ages of 18-65
• Have unilateral heel pain that has been ongoing for at least 3 months, particularly worsening with the first few steps in the morning and increasing with weight-bearing activities throughout the day
• Have tenderness on palpation of the medial calcaneal tubercle
• Have read and signed the volunteer consent form (VCF)
• Exclusion criteria

• Being under 18 years old or over 65 years old
• Having a history of physical therapy, injection, radiation, or surgery targeting the plantar fascia within the last 6 months
• Calcaneus fracture, tumor, or cyst related to the plantar fascia
• Foot deformity (club foot, pes cavus, calcaneovalgus, etc.)
• Lumbosacral radiculopathy, tarsal tunnel syndrome, peripheral neuropathy
• Rheumatic diseases such as rheumatoid arthritis, ankylosing spondylitis, gout
• Foot and ankle osteoarthritis
• Presence of osteomyelitis or skin infection in the foot
• Systemic diseases such as kidney and liver failure, diabetes, peripheral arterial vascular disease

Healthy Control

• Inclusion criteria

• Being completely healthy
• Being between the ages of 18 - 65
• Having read and signed the volunteer consent form (BGOF)
• Exclusion criteria

• Being under 18 or over 65 years old
• Having any acute or chronic illness
• Being illiterate and not giving consent to participate in the study

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Observational model

Case-control

Study locations

Turkey (Türkiye) · 1 center

• Sultan Abdulhamid Han Training and Research Hospital — Istanbul

Publications

• Jayaseelan DJ, Fernandez-de-Las-Penas C, Blattenberger T, Bonneau D. Altered Central Pain Processing in Patients With Chronic Plantar Heel Pain: A Critically Appraised Topic. J Sport Rehabil. 2021 Feb 16;30(5):812-817. doi: 10.1123/jsr.2020-0371. PMID 33596547
• Nijs J, Malfliet A, Nishigami T. Nociplastic pain and central sensitization in patients with chronic pain conditions: a terminology update for clinicians. Braz J Phys Ther. 2023 May-Jun;27(3):100518. doi: 10.1016/j.bjpt.2023.100518. Epub 2023 Jun 14. No abstract available. PMID 37348359
• Plaza-Manzano G, Rios-Leon M, Martin-Casas P, Arendt-Nielsen L, Fernandez-de-Las-Penas C, Ortega-Santiago R. Widespread Pressure Pain Hypersensitivity in Musculoskeletal and Nerve Trunk Areas as a Sign of Altered Nociceptive Processing in Unilateral Plantar Heel Pain. J Pain. 2019 Jan;20(1):60-67. doi: 10.1016/j.jpain.2018.08.001. Epub 2018 Aug 16. PMID 30121357
• Cotchett M, Lennecke A, Medica VG, Whittaker GA, Bonanno DR. The association between pain catastrophising and kinesiophobia with pain and function in people with plantar heel pain. Foot (Edinb). 2017 Aug;32:8-14. doi: 10.1016/j.foot.2017.03.003. Epub 2017 Mar 20. PMID 28605621
• Bennell KL, Talbot RC, Wajswelner H, Techovanich W, Kelly DH, Hall AJ. Intra-rater and inter-rater reliability of a weight-bearing lunge measure of ankle dorsiflexion. Aust J Physiother. 1998;44(3):175-180. doi: 10.1016/s0004-9514(14)60377-9. PMID 11676731
• Redmond AC, Crosbie J, Ouvrier RA. Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clin Biomech (Bristol). 2006 Jan;21(1):89-98. doi: 10.1016/j.clinbiomech.2005.08.002. Epub 2005 Sep 21. PMID 16182419
• Sabir N, Demirlenk S, Yagci B, Karabulut N, Cubukcu S. Clinical utility of sonography in diagnosing plantar fasciitis. J Ultrasound Med. 2005 Aug;24(8):1041-8. doi: 10.7863/jum.2005.24.8.1041. PMID 16040817

Identifiers

NCT: NCT07640620 · E-54230385-929-301089224

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗