Review| Volume 42, P55-64, February 2017

Gait deviations associated with plantar heel pain: A systematic review


      • A variety of foot-specific gait variables have been studied in plantar heel pain.
      • There was strong evidence stance phase duration is unchanged.
      • Reduced rearfoot loading early in stance resulted in variable compensations later.
      • Component measures of pronation provided conflicting evidence.
      • Further research will help determine clinical relevance of gait analysis/treatment.



      Plantar heel pain is a common foot disorder associated with significant pain and gait-related disability. The aim of this systematic review was to identify gait deviations associated with plantar heel pain.


      A systematic review of articles with quantitative gait variables in individuals with plantar heel pain was conducted using the CINAHL, MEDLINE, Scopus, and Embase databases. Methodological quality was assessed using the modified Downs and Black criteria and used along with the number of studies per gait variable to determine level of evidence.


      Nineteen articles were included. There was strong evidence that stance phase duration is unchanged. There was moderate to strong evidence of decreased rearfoot center of pressure duration, impulse, and peak vertical ground reaction force at loading response. In compensation there was increased contact time of the midfoot and forefoot, increased midfoot and forefoot impulse, delayed time to the mid-stance vertical ground reaction force valley, and decreased peak force at terminal stance. The only quantitative measure of pronation/supination included limited evidence of increased medial forefoot and rearfoot inversion-eversion total mobility, and medial forefoot plantar flexion.


      Studies included in this review identified specific foot and ankle gait deviations in individuals with plantar heel pain compared to asymptomatic cases or limbs. The variables identified in this review may be used to assist in identifying movement-related gait dysfunction for treatment decisions or as outcome measures of recovery. Additional research is needed to increase confidence and clinical relevance of gait variables used to assess and treat individuals with PHP.


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        • Barton C.J.
        • Lack S.
        • Malliaras P.
        • Morrissey D.
        Gluteal muscle activity and patellofemoral pain syndrome: a systematic review.
        Br. J. Sports Med. 2013; 47: 207-214
        • Bedi H.S.
        • Love B.R.
        Differences in impulse distribution in patients with plantar fasciitis.
        Foot Ankle Int. 1998; 19: 153-156
        • Butterworth P.A.
        • Landorf K.B.
        • Smith S.E.
        • Menz H.B.
        The association between body mass index and musculoskeletal foot disorders: a systematic review.
        Obes. Rev. 2012; 13: 630-642
        • Chang R.
        • Rodrigues P.A.
        • Van Emmerik R.E.A.
        • Hamill J.
        Multi-segment foot kinematics and ground reaction forces during gait of individuals with plantar fasciitis.
        J. Biomech. 2014; 47: 2571-2577
        • Chen Y.N.
        • Chang C.W.
        • Li C.T.
        • Chang C.H.
        • Lin C.F.
        Finite element analysis of plantar fascia during walking: a quasi-static simulation.
        Foot Ankle Int. 2015; 36: 90-97
        • Cole C.
        • Seto C.
        • Gazewood J.
        Plantar fasciitis: evidence-based review of diagnosis and therapy.
        Am. Fam. Physician. 2005; 72: 2237-2242
        • Crawford F.
        • Thomson C.
        Interventions for treating plantar heel pain.
        Cochrane Database Syst. Rev. 2003; : Cd000416
        • Downs S.H.
        • Black N.
        The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
        J. Epidemiol. Community Health. 1998; 52: 377-384
        • Duval K.
        • Lam T.
        • Sanderson D.
        The mechanical relationship between the rearfoot, pelvis and low-back.
        Gait Posture. 2010; 32: 637-640
        • Fessel G.
        • Jacob H.A.
        • Wyss C.
        • Mittlmeier T.
        • Muller-Gerbl M.
        • Buttner A.
        Changes in length of the plantar aponeurosis during the stance phase of gait–an in vivo dynamic fluoroscopic study.
        Ann. Anat. 2014; 196: 471-478
        • Golightly Y.M.
        • Hannan M.T.
        • Dufour A.B.
        • Hillstrom H.J.
        • Jordan J.M.
        Foot disorders associated with overpronated and oversupinated foot function: the Johnston County Osteoarthritis Project.
        Foot Ankle Int. 2014;
        • Gomes L.G.
        • Scremim R.
        • de Souza M.A.
        • Gamba H.R.
        Biofeedback baropodometry training evaluation: a study with children with equinus foot deformity.
        Conf. Proc. IEEE Eng. Med. Biol. Soc. 2013; 2013: 5914-5917
        • Harty J.
        • Soffe K.
        • O'Toole G.
        • Stephens M.M.
        The role of hamstring tightness in plantar fasciitis.
        Foot Ankle Int. 2005; 26: 1089-1092
        • Hsu W.H.
        • Lai L.J.
        • Chang H.Y.
        • Hsu R.W.
        Effect of shockwave therapy on plantar fasciopathy. A biomechanical prospective.
        Bone Joint J. 2013; 95-b: 1088-1093
        • Huang Y.C.
        • Wei S.H.
        • Wang H.K.
        • Lieu F.K.
        Ultrasonographic guided botulinum toxin type A treatment for plantar fasciitis: an outcome-based investigation for treating pain and gait changes.
        J. Rehabil. Med. 2010; 42: 136-140
        • Hunt M.A.
        • Takacs J.
        • Hart K.
        • Massong E.
        • Fuchko K.
        • Biegler J.
        Comparison of mirror, raw video, and real-time visual biofeedback for training toe-out gait in individuals with knee osteoarthritis.
        Arch. Phys. Med. Rehabil. 2014; 95: 1912-1917
        • Irving D.B.
        • Cook J.L.
        • Young M.A.
        • Menz H.B.
        Impact of chronic plantar heel pain on health-related quality of life.
        J. Am. Podiatr. Med. Assoc. 2008; 98: 283-289
        • Ji S.G.
        • Kim M.K.
        The effects of mirror therapy on the gait of subacute stroke patients: a randomized controlled trial.
        Clin. Rehabil. 2015; 29: 348-354
        • Kanatli U.
        • Yetkin H.
        • Simsek A.
        • Besli K.
        • Ozturk A.
        The relationship of the heel pad compressibility and plantar pressure distribution.
        Foot Ankle Int. 2001; 22: 662-665
        • Katoh Y.
        • Chao E.Y.
        • Laughman R.K.
        • Schneider E.
        • Morrey B.F.
        Biomechanical analysis of foot function during gait and clinical applications.
        Clin. Orthop. Relat. Res. 1983; 177: 23-33
        • Katoh Y.
        • Chao E.Y.
        • Morrey B.F.
        • Laughman R.K.
        Objective technique for evaluating painful heel syndrome and its treatment.
        Foot Ankle. 1983; 3: 227-237
        • Kelly A.
        • Wainwright A.
        • Winson I.
        Plantar pressures are normal in plantar fasciitis.
        Foot Dis. 1995; 2: 129-132
        • Khallaf M.E.
        • Gabr A.M.
        • Fayed E.E.
        Effect of task specific exercises, gait training, and visual biofeedback on equinovarus gait among individuals with stroke: randomized controlled study.
        Neurol. Res. Int. 2014; 2014: 693048
        • Lane G.D.
        • London B.
        Heel spur syndrome: a retrospective report on the percutaneous plantar transverse incisional approach.
        J. Foot Ankle Surg. 2004; 43 (United States): 389-394
        • Liddle D.
        • Rome K.
        • Howe T.
        Vertical ground reaction forces in patients with unilateral plantar heel pain - a pilot study.
        Gait Posture. 2000; 11: 62-66
        • Martin R.L.
        • Davenport T.E.
        • Reischl S.F.
        • et al.
        Heel pain-plantar fasciitis: revision 2014.
        J. Orthop. Sports Phys. Ther. 2014; 44: A1-33
        • Orchard J.
        Plantar fasciitis.
        BMJ. 2012; 345e6603
        • Orlin M.N.
        • McPoil T.G.
        Plantar pressure assessment.
        Phys. Ther. 2000; 80: 399-409
        • Pfeffer G.
        • Bacchetti P.
        • Deland J.
        • et al.
        Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis.
        Foot Ankle Int. 1999; 20: 214-221
        • Pourcho A.M.
        • Hall M.M.
        Percutaneous Ultrasonic Fasciotomy for Refractory Plantar Fasciopathy After Failure of a Partial Endoscopic Release Procedure.
        PM R, 2015
        • Segal N.A.
        • Glass N.A.
        • Teran-Yengle P.
        • Singh B.
        • Wallace R.B.
        • Yack H.J.
        Intensive gait training for older adults with symptomatic knee osteoarthritis.
        Am. J. Phys. Med. Rehabil. 2015; 94: 848-858
        • Sullivan J.
        • Burns J.
        • Adams R.
        • Pappas E.
        • Crosbie J.
        Plantar heel pain and foot loading during normal walking.
        Gait Posture. 2015;
        • Tate J.J.
        • Milner C.E.
        Real-time kinematic, temporospatial, and kinetic biofeedback during gait retraining in patients: a systematic review.
        Phys. Ther. 2010; 90: 1123-1134
        • Taunton J.E.
        • Ryan M.B.
        • Clement D.B.
        • McKenzie D.C.
        • Lloyd-Smith D.R.
        Plantar fasciitis: a retrospective analysis of 267 cases.
        Phys. Ther. Sport. 2002; 3: 57-65
        • Teran-Yengle P.
        • Birkhofer R.
        • Weber M.A.
        • Patton K.
        • Thatcher E.
        • Yack H.J.
        Efficacy of gait training with real-time biofeedback in correcting knee hyperextension patterns in young women.
        J. Orthop. Sports Phys. Ther. 2011; 41: 948-952
        • Thomas J.L.
        • Christensen J.C.
        • Kravitz S.R.
        • et al.
        The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010.
        J. Foot Ankle Surg. 2010; 49: S1-19
        • van Tulder M.
        • Furlan A.
        • Bombardier C.
        • Bouter L.
        Updated method guidelines for systematic reviews in the cochrane collaboration back review group.
        Spine. 2003; 28: 1290-1299
        • Wearing S.C.
        • Smeathers J.E.
        • Sullivan P.M.
        • Yates B.
        • Urry S.R.
        • Dubois P.
        Plantar fasciitis: are pain and fascial thickness associated with arch shape and loading?.
        Phys. Ther. 2007; 87: 1002-1008
        • Wearing S.C.
        • Smeathers J.E.
        • Urry S.R.
        A comparison of two analytical techniques for detecting differences in regional vertical impulses due to plantar fasciitis.
        Foot Ankle Int. 2002; 23: 148-154
        • Wearing S.C.
        • Smeathers J.E.
        • Urry S.R.
        The effect of plantar fasciitis on vertical foot-ground reaction force.
        Clin. Orthop. Relat. Res. 2003; 409: 175-185
        • Wearing S.C.
        • Smeathers J.E.
        • Urry S.R.
        • Sullivan P.M.
        • Yates B.
        • Dubois P.
        Plantar enthesopathy: thickening of the enthesis is correlated with energy dissipation of the plantar fat pad during walking.
        Am. J. Sports Med. 2010; 38: 2522-2527
        • Wearing S.C.
        • Smeathers J.E.
        • Yates B.
        • Sullivan P.M.
        • Urry S.R.
        • Dubois P.
        Sagittal movement of the medial longitudinal arch is unchanged in plantar fasciitis.
        Med. Sci. Sports Exerc. 2004; 36: 1761-1767
        • Wearing S.C.
        • Smeathers J.E.
        • Yates B.
        • Urry S.R.
        • Dubois P.
        Bulk compressive properties of the heel fat pad during walking: a pilot investigation in plantar heel pain.
        Clin. Biomech. (Bristol, Avon). 2009; 24: 397-402
        • Werner R.A.
        • Gell N.
        • Hartigan A.
        • Wiggerman N.
        • Keyserling W.M.
        Risk factors for plantar fasciitis among assembly plant workers.
        in: PM R. 2(2). 2010: 110-116 (quiz 111 p following 167)
        • Yi T.I.
        • Lee G.E.
        • Seo I.S.
        • Huh W.S.
        • Yoon T.H.
        • Kim B.R.
        Clinical characteristics of the causes of plantar heel pain.
        Ann. Rehab. Med. 2011; 35: 507-513