Decoding Heel Pain: Unraveling Prognostic Factors with Achieve Podiatry

Welcome to the Achieve Podiatry blog,

where we delve into the fascinating world of foot health and bring you valuable insights. In today's post, we'll be shedding light on a common and often debilitating issue: heel pain. As experts in podiatry care, we understand the importance of identifying prognostic factors that contribute to heel pain. Join us as we explore the key factors that impact heel pain prognosis, providing you with the knowledge to better understand and manage this condition. Let's dive in and uncover the secrets behind effective heel pain management with Achieve Podiatry.

Predicting the outcome of plantar heel pain in adults: a systematic review of prognostic factors
Halime Gulle1, Dylan Morrissey1, Xiang Li Tan2, Matthew Cotchett3, Stuart Charles Miller1,

Aleksandra Birn Jeffrey4 and Trevor Prior


Plantar heel pain (PHP) is a common foot condition that affects 4 to 10% of the general population. It typically is reported as pain in the medial and plantar aspect of the heel, worse with WB activities and typically painful after periods of rest (long and short periods).

Multiple treatment options are available for PHP, including stretching, taping, patient education, shock wave therapy, foot orthoses, and injections. However, some cases of PHP remain resistant to treatment, with up to 50% of patients experiencing persistent pain even after 10 years

Prognostic factors are variables at baseline that are associated with pain, function, and disability outcome.


The aim of this research paper is:

Determine which baseline patient characteristics are associated with outcomes in observational cohorts or after specific interventions. Understanding prognostic factors for PHP will improve clinical care


Eligibility criteria

Studies investigating baseline characteristics with follow-up of patient-reported outcomes relating to indicators of recovery (e.g. pain and/or function) after at least one week were included. Studies were also required to clearly define recovery and provide an effect size for the prognostic estimate. Prospective cohort studies, single arm clinical trials reporting prognostic factors and studies developing clinical prediction rules were included.



Search results and critical appraisal of methods

5 studies investigating 811 participants with PHP in total (range = 74 to 278).


Summary of findings

Studies in this review reported two directions (favourable vs unfavourable) of a statistically significant relationship.


What was associated with positive and negative outcomes?


REMEMBER – some of these associations were low and some moderate. These are good to discuss with patients, talking about possible factors associated with better outcomes.

Let's list them as easy to read dot points.


Limited evidence suggests that being female predicts an unfavorable long-term outcome in PHP, with only 49 women cured per year for every 100 men cured.

Having bilateral heel pain is associated with an unfavorable long-term outcome in PHP, controlling for various factors such as sex, age, BMI, smoking, physical work, time to ultrasound, fascia thickness, and heel spur.

There is weak evidence indicating that the number of painful sites in the lower back and lower extremity region predicts short-term success in anti-pronation taping intervention.

Moderate evidence suggests that a decrease in pain intensity by over 1.5 points (on a 10-point scale) in response to anti-pronation taping predicts medium-term success in foot orthoses intervention, considering factors such as ankle plantar flexion range, ankle plantar-flexor strength, and hip internal-external rotation range.

Very limited evidence suggests that a shorter history of symptoms and lower average pain intensity predict a favorable outcome in the medium term following an ESWT intervention, while controlling for the presence of a heel spur.

Average pain intensity is a predictor of short-term favorable outcome for ESWT, in conjunction with the absence of edema and a heel spur.

No significant associations were found between PHP prognosis and bilateral heel pain, first step pain, or the onset of pain.

Very limited evidence suggests that increased ankle plantar flexion range (>54°), reduced hip internal rotation range (<39°), and increased hip external rotation range (>45°) are positive predictors of foot orthoses intervention success in the medium term.

Hansen et al. (2018) revealed that having bilateral heel pain and being female predict a negative prognosis in PHP.

Individuals with bilateral symptoms are likely to experience more severe effects.

According to Wu et al. (2019), a decrease in average pain intensity by over 1.5 points with anti-pronation taping predicts a favourable outcome for foot orthoses intervention.

Results reported by Wu et al. (2019) suggest that increased ankle plantar flexion and hip internal and external rotation angles are associated with a positive outcome from the use of foot orthoses.

A shorter symptom duration with lower pain frequency predicts a favourable outcome following ESWT

higher pain severity at baseline and longer pain duration have also shown an association with a poor prognosis in other musculoskeletal pain condition