Foot Musculoskeletal Disorders, Pain, and Foot-Related Functional Limitation in Older Persons

Fadi Badlissi, MD, MSc; Julie E. Dunn, PhD; Carol L. Link, PhD; Julie J. Keysor, PhD, PT; John B. McKinlay, PhD; David T. Felson, MD, MPH


J Am Geriatr Soc. 2005;53(6):1029-1033. 

In This Article


Seven hundred eighty-four subjects with a mean age ± standard error of 74.5 ± 6.0 were evaluated; 56.8% were female, and 44.5% were African American, 41.7% white non-Hispanic, and 13.8% Puerto Rican. One-third were obese (BMI≥30). The most common foot musculoskeletal disorder was hallux valgus (37.1%) ( Table 1 ); 52.5% had lesser digits deformities, which included hammer (34.5%), mallet (33.4%), overlapping (15.6%), and claw (8.7%) toes; 41.6% of the sample reported foot pain.

Hallux valgus and toe deformities were not associated with foot pain. Only plantar fasciitis and pes cavus were associated with foot pain. The adjusted ORs for foot pain in those with plantar fasciitis and pes cavus were 14.4 (95% CI=4.2-50.6) and 4.0 (95% CI=1.4-11.3), respectively ( Table 1 ). Pes planus had a modest association with pain that did not reach statistical significance (adjusted OR=1.6, 95% CI=0.9-2.9).

The sample FHFS scale mean score was 84.6 ± 0.97. Plantar fasciitis explained 11.3% of the variance in the FHFS scale; arch deformities (pes cavus and pes planus) explained an additional 1.8%; other foot deformities (hallux valgus, bunionette, and lesser digits deformities) 0.7%, with covariates (age; sex; race/ethnicity; BMI; ingrown toenail; claudication; diabetes mellitus; foot or hip fracture; hip, knee, and low back pain; assistive devices; and the role-emotional scale) explaining an additional 23.2%; foot pain added 7.9%. The model explained 44% of the variance in the FHFS scale. Adding foot pain to the model attenuated the effects of plantar fasciitis and pes cavus, but they continued to be associated significantly with functional limitation ( Table 2 ).

The sample walk test score was 3.10 ± 0.06 (range 0-4, 4=fastest). Plantar fasciitis explained 3.2% of the variance in the walk test scores, arch deformities added 0.02%, other foot deformities added 0.2%, covariates added 20.5%, and foot pain added 0.02%. The model explained 24% of the variance in the walk test scores. Unadjusted for foot pain, plantar fasciitis had a significant association with the walk test scores (-0.56; P =.04); adding foot pain to the model attenuated this effect ( Table 3 ).


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